What is Sinusitis?
Before we can answer that Question,
we should talk a little bit about Anatomy:
Sinuses are hollow spaces in the bones around the nose
that connect to the nose through small, narrow channels.
Humans possess four paired paranasal sinuses.
Your cheekbones hold your maxillary sinuses (the largest).
The low-center of your forehead is where your frontal sinuses are located.
Between your eyes are your ethmoid sinuses.
In bones behind your nose are your sphenoid sinuses.
They’re lined with soft, pink tissue called mucosa.
Sinusitis means your sinuses are inflamed.
What Causes sinusitis?
98 percent of sinusitis occur due to viral infection,
it can also be caused by bacterial infection.
while small population can have it due to fungal disease.
There are some pre disposing factors that make it more likely that you get sinusitis
including: Allergic rhinitis which makes it easier for infection to occur,
exposure to smoke or cigratte smoking,
anatomical abnormailities which make it difficult for sinuses to drain.
The central event in sinusitis is blockage of the sinus openings,
or ostia as a result of inflammation.
Unable to circulate air and eliminate the secretions that are produced,
obstructed sinuses become an ideal environment for bacterial infection.
Types of Sinusitis?
Types of sinusitis include:
Acute Sinsusitis, which lasts up to 4 weeks
Subacute Sinsusitis, which lasts 4 to 12 weeks
Chronic Sinsusitis, which lasts more than 12 weeks
and can continue for months or even years.
Recurrent Sinsusitis, with several attacks within a year.
What are the signs and Symptoms of sinusitis?
First thing that most people notice is going to be pain .
The pain may be localized to the sinus involved
or it can also cause generalized pain which may present as headache.
If you tap on the sinus involved with finger, it can produce tenderness.
Also since the mucosa is inflammed it will produce lots of mucus,
which is going to drain into the nasal cavity through sinus openings or ostia.
Once in the nasal cavity there is only 2 things it can do,
1st thing is to come out of your nose so people will notice Nasal discharge.
The 2nd thing it can do is go to back of your throat
as the back of your nose is related to back of your throat
and there it causes irritation and cause you to cough.
Inflammation of mucosa can also alter the smell and taste of things.
Patients can also have fever because of the infection and inflammation.
How can we diagnose sinusitis?
By and large the diagnosis of sinusitis is made by symptoms alone.
Common symptoms include: Nasal or post nasal drip,
sinus pain orpressure,
Nasal congestion, decreased ability to smell, cough, headache and fever.
鼻塞 嗅觉减退 咳嗽 头疼和发烧
But sometimes the symptoms aren’t clear cut,
in that case there are some other tests that can be done to diagnose:
sometimes a medical practitioner will take a look inside your nose
to get a better look at nasal or post nasal drip
this is called ‘Rhinoscopy’.
X rays can be done to visualize sinuses.
The gold standard to diagnose is CT scan.
Other tests are only done if needed in special circumstances.
How can we treat sinusitis?
For Acute Viral sinusitis, The most common type of sinusitis,
there is not a lot we can do to actually treat the disease itself
but we can treat symptoms.
One of the first drugs to treat symptoms is going to be Nasal decongestants.
These medications shrink swollen nasal passages,
facilitating the flow of drainage from the sinuses.
We also give mucolytics medications which help clear mucus.
We also ask the patient to remain Well Hydrated,
as being well hydrated helps in drainage of mucus as mucus formed is not so sticky
that it gets stuck in if your body is well hydrated.
Finally, we also give pain killers to help relieve the pain.
For Acute Bacterial sinusitis, we give all of the above
plus Antibiotics for 10-14 days.
For chronic Sinusitis: again all of the above
but the antibiotics have to be given for a lot longer period,
most people recommend 4-6 weeks of antibiotics.
If the sinusitis is too severe and the person is at risk of complications.
We go for surgery.
surgery may be done to remove small amounts of bone
or other material blocking the sinus openings
or to remove growths blocking sinuses Also called as polyps.
Normally, a thin, lighted tool called an endoscope is inserted through the nose
so the doctor can see and remove whatever is blocking the sinuses.
What is Sinusitis?