Sinus infections

Sinusitis:

Sinusitis is an inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. Newer classifications of sinusitis refer to it as rhinosinusitis, taking into account the thought that inflammation of the sinuses cannot occur without some inflammation of the nose as well (rhinitis).

There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses. The ethmoid sinuses can also be further broken down into anterior and posterior, the division of which is defined as the basal lamella of the middle turbinate. In addition to the acuity of disease, discussed below, sinusitis can be classified by the sinus cavity which it affects:

Maxillary sinusitis - can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache) Frontal sinusitis - can cause pain or pressure in the frontal sinus cavity (located behind/above eyes), headache Ethmoid sinusitis - can cause pain or pressure pain between/behind eyes, headache Sphenoid sinusitis - can cause pain or pressure behind the eyes, but often refers to the vertex of the head(J01.3/J32.3) Recent theories of sinusitis indicate that it often occurs as part of a spectrum of diseases that affect the respiratory tract (i.e. - the "one airway" theory) and is often linked to asthma. All forms of sinusitis may either result in, or be a part of, a generalized inflammation of the airway so other airway symptoms such as cough may be associated with it.

Acute sinusitis:

Acute sinusitis is usually precipitated by an earlier upper respiratory tract infection, generally of viral origin. Virally damaged surface tissues are then colonized by bacteria, most commonly Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. Other bacterial pathogens include other streptococci species, anaerobic bacteria and, less commonly, gram negative bacteria. Another possible cause of sinusitis can be dental problems that affect the maxillary sinus. Acute episodes of sinusitis can also result from fungal invasion. These infections are most often seen in patients with diabetes or other immune deficiencies (such as AIDS or transplant patients on anti-rejection medications) and can be life threatening. In type I diabetes, ketoacidosis causes sinusitis by Mucormycosis.

Chronic sinusitis:

Chronic sinusitis is a complicated spectrum of diseases that share chronic inflammation of the sinuses in common. The causes are multifactorial and may include allergy, environmental factors such as dust or pollution, bacterial infection, or fungus (either allergic, infective, or reactive). Non allergic factors such as Vasomotor rhinitis can also cause chronic sinus problems.

Symptoms include: Nasal congestion; facial pain; headache; fever; general malaise; thick green or yellow discharge; feeling of facial 'fullness' worsening on bending over; aching teeth.

Very rarely, chronic sinusitis can lead to Anosmia, the inability to smell or detect odors.[citation needed]

In a small number of cases, chronic maxillary sinusitis can also be brought on by the spreading of bacteria from a dental infection.

Attempts have been made to provide a more consistent nomenclature for subtypes of chronic sinusitis. A task force for the American Academy of Otolaryngology - Head and Neck Surgery / Foundation along with the Sinus and Allergy Health Partnership broke Chronic Sinusitis into two main divisions, Chronic Sinusitis without polyps and Chronic Sinusitis with polyps (also often referred to as Chronic Hyperplastic Sinusitis). Recent studies which have sought to further determine and characterize a common pathologic progression of disease have resulted in an expansion of proposed subtypes. Many patients have demonstrated the presence of eosinophils in the mucous lining of the nose and paranasal sinuses. As such the name Eosinophilic Mucin RhinoSinusitis (EMRS) has come into being. Cases of EMRS may be related to an allergic response, but allergy is often not documentable, resulting in further subcategorization of allergic and non-allergic EMRS.

A more recent, and still debated, development in chronic sinusitis is the role that fungus may play. Fungus can be found in the nasal cavities and sinuses of most patients with sinusitis, but can also be found in healthy people as well. It remains unclear if fungus is a definite factor in the development of chronic sinusitis and if it is, what the difference may be between those who develop the disease and those who do not.

Acute sinusitis:

There are over the counter medicines that can relieve some of the symptoms associated with sinusitis, such as headaches, pressure, fatigue and pain. Usually these are a combination of some kind of antihistamine along with decongestant or pain reliever. Seeing a doctor will usually result in a prescription for antibiotics and a recommendation for rest.

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Therapeutic measures range from the medicinal to the traditional and may include nasal irrigation or jala neti using a warm saline solution, hot drinks including tea and chicken soup, inhaling steam, over-the-counter decongestants and nasal sprays, and getting plenty of rest. Analgesics (such as aspirin, paracetamol (acetaminophen) or ibuprofen) can be used, but caution must be employed to make sure the patient does not suffer from aspirin-exacerbated respiratory disease (AERD) as this could lead to anaphylaxis.

If sinusitis doesn't improve within 48 hours, or is causing significant pain, a doctor may prescribe antibiotics (Amoxicillin usually being the most common) with amoxicillin/clavulanate (Augmentin/Co-Amoxiclav) being indicated for patients who fail amoxicillin alone. Fluoroquinolones may be used in patients who are allergic to penicillins.[citation needed]

A recent British study has found that for most cases of acute sinusitis, antibiotics and nasal corticosteroids work no better than a placebo.

Surgical approach:

A number of surgical approaches may be used, either by endoscopy or conventional incision through nose, mouth or external skin. Once incissional entry is gained into the paranasal sinus, surgery can be extended to another sinus or other adjacent anatomical structures; e.g. internal maxillary artery, pterygopalatine fossa and sphenopalatine ganglion.

ALLERGIES CAN BE LINKED TO SINUS INFECTIONS, THEREFORE ONE MUST BE PROACTIVE IN CONTROLLING ALLERGIES, AND THEIR CAUSES. Doctor Robertson: member of the 4life medical advisory board.

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