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Sinusitis Types, Symptoms and Treatment

The sinusitis refers to the inflammation of the mucous membrane that covers the inside of the sinuses. The sinuses are bony cavities (in 4 pairs) located in the facial bones (see diagram). Each sinus communicates with the nasal cavity through small openings through which the mucus produced in the sinuses normally flows.

Inflammation of the sinus lining, also known as rhinosinusitis, is usually caused by a viral or bacterial infection. When a virus or bacteria spreads in the sinuses, the mucosa gets irritated and swells, which can clog the sinuses? The mucus is then no longer drained normally towards the nose and, in this closed environment, the microbes multiply freely.

The pain and sensation of pressure in the face, well known to people with sinusitis, come from the accumulation of mucus inside the sinus.

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Sinusitis is a common condition, but the prevalence is difficult to estimate. According to some studies, it would affect 10% to 15% of the population, adults and children.

Note. Each sine has a different name depending on its position (see diagram). Thus, according to the infected sinus, we speak of frontal sinusitis, maxillary, left sphenoidal (if only one side is touched), etc.

Types of sinusitis

Acute sinusitis. It does not last more than 4 weeks and does not reappear more than 3 times a year. In most cases, she follows a viral infection of the upper respiratory tract, most commonly a cold. In Canada, 0.5% to 2% of people with colds develop sinusitis.

Other causes or possible factors:

  • a bacterial or fungal infection (by fungi);
  • allergies;
  • dental abscess that spreads to the sinuses;
  • the pollution atmospheric;
  • of nasal polyps ;
  • A deviation of the nasal wall.

Chronic sinusitis. Sinusitis becomes chronic when it persists beyond 12 weeks (we speak of subacute sinusitis between 4 and 12 weeks). If acute sinusitis does not respond to usual treatments or if it is not treated, it may progress to chronic sinusitis. In general, chronicity occurs after several outbreaks of acute sinusitis (recurrent sinusitis), but sometimes acute sinusitis evolves immediately to chronicity.

Most often, chronic sinusitis is due to allergies. These may include allergies to pets, house dust mites, pollen, fungi or other substances that cause inflammation of the nose and sinuses. Thus, 50% to 80% of people with chronic sinusitis are allergic or have allergic rhinitis.

Other factors may be involved:

  • active or passive smoking;
  • a weak immune system;
  • cystic fibrosis;
  • an anatomical anomaly  : an abnormal shape of the small channels allowing the sinuses to communicate with the nasal fossae or a deviation of the nasal septum;
  • nasal polyps;
  • swimming (irritation due to chlorine );
  • the use of cocaine nasally;
  • trauma facial causing the obstruction of one or several sinus;
  • exposure to irritating chemicals (such as formaldehyde)
  • Untreated gastro-oesophageal reflux (especially in children).

Possible complications

In very rare cases, the sinus infection can spread to the eyes or the brain, which can cause the following problems:

  • meningitis;
  • abscess in the brain
  • a thrombophlebitis of eye veins;
  • An osteomyelitis of the frontal bones (especially in children).

In addition, untreated or chronic sinusitis may exacerbate respiratory problems in people with asthma, especially in children.

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Symptoms of sinusitis

Typically, sinusitis occurs after a cold, which appears to be cured or healing and complicated by sinus infection.

Typical symptoms

  • facial pain (above the eyebrows, nose, cheeks, around and behind the eyes).
  • Painful pressure sensations in the sinus area or on one side of the face.
  • congestion nasal.
  • Of secretions nasal yellowish or greenish thick pus in case of bacterial infection. If the secretions are clear, it is rather a viral infection (for which antibiotics are of no use).
  • A slight fever and general discomfort.
  • A decrease or loss of smell.

Other possible symptoms

  • A bad breath.
  • Of headaches.
  • Pain in the teeth and upper jaw.
  • A fatty cough, because the secretions tend to end up in the throat.

Remarks

  • The pains are accentuated when one bends the head down.
  • In case of chronic sinusitis, the symptoms are the same as those of acute sinusitis, but they last longer and there is no fever.

People at risk for Sinusitis

  • The children. Children contract an average of 6 to 8 colds per year, of which 0.5% to 5% progress to sinusitis (which mainly affects the ethmoid sinuses, because the other sinuses form later in childhood).
  • People who have had sinusitis are more likely to have others.
  • People who suffer from respiratory allergies (hay fever ).
  • People with asthma
  • People who have a congenital abnormality that causes obstruction of the nose or sinuses.
  • People who have nasal polyps or dental abscesses.
  • People whose immune system is weakened due to another disease.
  • People with cystic fibrosis.

Risk factors

  • Contracting an infection of the upper respiratory tract (main factor).
  • Live in an environment where the air is humid or polluted.
  • Smoking cigarettes or being exposed to smoke or other chemical pollutants.

Prevention of sinusitis

Why prevent?
  • The sinusitis, which usually lasts longer than a cold, can be very painful and cause serious complications.
  • People who know they are at risk (including those who have had sinusitis before) can reduce their risk of re – offending.
  • Preventive measures help prevent progression to chronic sinusitis.

 

Measures to prevent sinusitis
Some measures reduce the risk of contracting the disease once, or again, or having chronic sinusitis. Essentially, it’s about:

  • Prevent colds by the usual means: wash your hands well, avoid close contact with people with colds.
  • Prevent allergies with the least possible exposure to allergens (pets, pollen, mites, etc.) and pollutants that usually affect us.
  • Have a balanced lifestyle with respect to stress, physical activity, diet, etc. See the sheet reinforcing your immune system .
  • Avoid smoking or exposure to tobacco smoke, which irritates the sinuses.
  • Avoid using decongestants in the form of nasal sprays (Dristan, Otrivin) for more than 3 days, as they may result in habituation and nasal congestion of “rebound” (which reappears at the time of discontinuation). In addition, in some people they irritate the fragile lining of the nose. Decongestants taken orally cause fewer problems to the nasal mucosa, but may have troublesome side effects (eg, worsening of arterial hypertension). Moreover, their effectiveness is disputed.

 

Measures to prevent complications
  • Consulting a doctor for an accurate diagnosis and taking the necessary steps to treat sinusitis usually helps to prevent complications (meningitis, osteomyelitis , etc.).
  • Monitor the following signs, which indicate a complication:
    – abnormal vision (sometimes, double vision);
    – swelling around the eyes;
    – a change in the state of consciousness.
  • Do not urge your doctor to receive antibiotics if it is not necessary. Most sinusitis is of viral or allergic origin and cannot be treated with antibiotics (which only fight bacteria).

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Medical treatment of sinusitis

In general, the home care described below will help relieve early symptoms of acute sinusitis and restore normal sinus drainage.

If it is a more serious case or chronic sinusitis, it may be necessary to use a drug, or even to have surgery. In some cases, it may be necessary to treat the underlying cause of sinusitis, such as the presence of nasal polyps or allergic rhinitis.

Pharmaceuticals

Most of the time, the treatment of sinusitis is only intended to soothe the symptoms while waiting for spontaneous healing. Indeed, in 75% of cases, sinusitis is cured without treatment in less than 1 month.

Analgesics (painkiller). Acetaminophen (Tylenol) and no steroidal anti-inflammatory drugs (Advil, Motrin, and Aspirin) help relieve headaches and pain.

Antihistamines. They are only used to relieve symptoms of allergies. Otherwise, avoid them because they dry out and thicken the nasal secretions.

Decongestants. Avoid using decongestants in the form of nasal sprays (Dristan, Otrivin) for more than 3 days, as they may cause rebound congestion. As a decongestant, saline or nasal spray can be used simply (see box below). This helps to alleviate the symptoms by removing secretions.

Corticosteroids. The doctor sometimes prescribes corticosteroids nasal spray to reduce inflammation. These medications may be useful for treating acute sinusitis and chronic sinusitis, for people who also have respiratory allergies or nasal polyps. In some cases, oral corticosteroids, such as prednisone , may be prescribed.

Antibiotics. When sinusitis is caused by a bacterial infection, antibiotics can be used. Taking antibiotics slightly shortens the duration of sinusitis and relieves symptoms. The treatment usually lasts 7 to 10 days. The antibiotics used are usually amoxicillin, erythromycin derivatives, doxicycline or trimetroprim-sulfa, which are usually effective and inexpensive. In case of chronic sinusitis, sometimes prolonged treatment is suggested (up to 21 days). In severe cases of bacterial sinusitis, antibiotics will be administered intravenously to the hospital.

Note. In the majority of cases of sinusitis, antibiotics are of no use because the factors involved are not bacteria, but viruses, allergies, nasal polyps, etc. In addition, two thirds of bacterial sinusitis heals spontaneously and quickly without antibiotics.

Immunotherapy. In case of chronic or recurrent sinusitis due to allergies, it is sometimes possible to follow a treatment by immunotherapy (or desensitization). It is a long-term treatment, which requires regular injections, and which allows to gradually accustom the body to substances that trigger allergies (pollen, mites …). Ultimately, it eliminates (or significantly reduces) the allergic reaction.

Surgery

When chronic sinusitis does not respond to standard treatments, surgery is sometimes used to restore openings to the nasal cavity and drain the sinuses. Surgery can also correct structural abnormalities of the nose or remove nasal polyps.

Home care

Contribute to the evacuation of nasal secretions with the basic means: blow your nose, drink plenty of water, and use a humidifier, inhale steam or saline solution.

Inhalation of steam. By moistening the nasal environment, the vapor liquefies the nasal secretions, which clears the sinuses and relieves pressure. To enjoy the benefits of steam, there is no need to use a device or go to a sauna. Simply breathe the steam from a bowl ofvery hot water by covering your head with a towel to keep the heat and moisture concentrated. You can also inhale hot, moist air from a shower or a hot bath. You can also enjoy the benefits of essential oils of eucalyptus and mint by adding them to the water.

Note. Attendance at public saunas could be responsible for chronic sinusitis as they result in particular from an allergy to mold. Indeed, the hygiene is not always impeccable 2.

Inhalation of salt water. This natural way allows clearing the sinuses by rinsing them with salt water. There are saline solutions already prepared in the pharmacy (Salinex, Hydrasense). You can also prepare them yourself. Just dissolve 1/2 tsp. teaspoon salt in 240 mL (8 oz) of boiled and cooled water. Here’s how to proceed:

  • Drop a few drops of saline into each nostril. For ease of application, lie on your back and tilt your head back.
  • Clean the inside of the nostrils with a swab.
  • Put a few drops of saline again in each nostril.
  • Blow your nose, or aspirate mucus with a nasal bulb in the case of a young child.

Other tips

  • If rest during the acute phase.
  • Drink more so you do not get dehydrated (about 8 glasses of water or other drinks a day). Increased water consumption also helps clear up secretions and evacuate them more easily.
  • Avoid exposure to severe temperature changes and cold, dry air.
  • Maintain a good humidity level, from 40% to 50% in the house, especially in the bedrooms. Be careful not to exceed 50% because the risk of mold (and allergies) increases.
  • Avoid leaning your head down, as this can increase pain.
  • Do not swim under water, make diving or travel by plane during the acute phase.
  • In case of chronic sinusitis, the preventive measures will prevent the aggravation of the symptoms.

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