Sinusitis
                                                                       By:  Elizabeth Reed

                  Sinusitis is an infection or inflammation that occurs in one or more of the four sets of paranasal sinuses. Sinuses are hollow, air filled cavities inside the head around the nasal cavity area (Sinusitis, 1999). The sinuses all have openings into the nasal canal to allow for continuous air and mucous exchange and secretion. A common theory surrounding the need and purpose of sinuses is that they  help to lighten the entire weight of the skull. Sinuses also function to help humidify air and capture inhaled or inspired dust particles (Lev, 1998).

   The four sets of paranasal sinuses include:
                                                    Ethmoid Sinuses (green)
                                                    Frontal Sinuses (checkered)
                                                    Maxillary Sinuses (red)
                                                    Sphenoid Sinuses (yellow)
 

                           

                The ethmoid sinuses are located between the nose and eyes. The frontal sinuses are found in the forehead and eyebrow area. The maxillary sinuses are in the area of the cheekbones. And lastly, the sphenoid sinuses, which sit farthest back in the skull, are deep behind the nasal cavity (Sinusitis, 1999).

The two major classifications of sinusitis are chronic and acute cases.

    Acute sinusitis is the abnormal secretion and production of mucous. This is similar to cystic fibrosis. On x-rays, acute sinusitis is suggested by air fluid levels in the sinuses. Patients with immunodeficiency diseases, such as HIV or AIDS, are more likely to acquire acute sinusitis (Lev, 1998).

    Chronic sinusitis is a disease usually diagnosed after a patient has had a sinus infection lasts longer than three weeks to three months. There are variable sources of chronic sinusitis that include allergies, asthma, nasal polyps, and damp weather. On x-rays, chronic sinusitis is seen as nasal sinus wall thickenings and bony sclerosis. The general population is more at risk to developing chronic sinusitis (Sinusitis, 1999).


                                                        Etiology

                    The paranasal sinuses all drain into the nasal cavity. All of the sinuses are lined with mucousal membranes. This is the area most commonly infected because of drainage problems.  Sometimes a blockage can form from excessive build up of mucousal secretions. If a sudden  blockage occurs, the sinuses can no longer drain in a normal fashion. This leads to an increase fluid in a sedentary space, which is a perfect breeding place for bacterial growth or viral infection. Once infection is set in place, the inflammation process of sinusitis begins. Air can also become trapped inside a sinus and cause increased pressure inside the paranasal sinuses leading to sinusitis (Sinusitis, 1999).

            Drainage problems and air pressure are not the only causes of sinusitis. Any injury or infection that causes swelling of the face and nose can end up affecting the sinuses. Processes that are involved with changing anything in the sinuses can lead to serious problems and infections such as sinusitis.

              The four most common causes come from (1) Viral Infection
                                                                                   (2) Bacterial Infection
                                                    (3) Fungal Infection
                                                                                   (4) Allergic Responses

        Viral infections of the sinuses would be from things such as colds or tooth infections. Streptococcus pneumoniae and Haemophilus Influenzae have also been found to lead to sinusitis (Sinusitis, 1999).

        Bacterial infections are caused by bacterial growth in the upper respiratory tract. Bacteria get caught in obstructed and blocked sinuses and cause infection in mucousal linings (Sinusitis, 1999).

        Fungal infections usually cause acute sinusitis. Fungi, such as Aspergillus, are found in immunodeficent people and a failure to respond to antibiotics can lead to spread of infection to the sinuses (Lev, 1998).

        Allergic reactions are broken down into two categories. The first is labeled Allergic Rhinitis. This tends to be from hay fever. The hay fever causes an infection in the nasal passageway that leads to sinus infections and eventually sinusitis. The second allergic response is called Vasomotor Rhinitis. Cold air, humidity, alcohol, perfumes, environmental conditions, and dust can lead to vasomotor rhinitis and can be followed by sinusitis.


                                            Signs & Symptoms

       Some of the symptoms of sinusitis are general to all four sinuses. Some however, are sinus specific in origin. Facial pain is a sign of infection. If the pain is centered over the forehead, the frontal sinuses are involved. Cheek tenderness or toothaches are signs of inflammation in the maxillary sinuses. Ethmoid sinus infections is accompanied by eyelid swelling, clogged tear ducts, and loss of smell. Tenderness of the nose can also be related to the ethmoid sinuses. Sphenoid sinusitis symptoms include earaches and neck pain (Sinusitis & Sinus Pain Relief, 2000).

Other general signs include the following:

                * Headache                                     * Loss of smell
                * Nasal Discharges                         * Fatigue
                * Nasal Congestion                          * Pain
                * Post Nasal Drip                            * Pressure
                * Runny Nose                                   * Fever
                * Cough                                            * Sore Throat
                * Facial Pain                                     * Loss of Sleep
                * Difficulty Breathing Through the Nose

             A doctor can look into the nose and will see reddening and swelling of the mucous membranes if sinusitis is present. The discharge from the nose may be green or yellow in color. And severe cases of sinusitis left untreated can progress and cause severe brain infections (Sinusitis, 1999).


                                                          Diagnosis
      The best way to diagnose sinusitis is through physical examination and good medical history including all symptoms. X-rays and CT (computed tomography) can also be performed. CT is the modality of choice because it shows the extent and severity of infection. If the maxillary sinuses are involved, a examination of the teeth may be performed to check for abscesses (Sinusitis, 1999).
            Radiographs of sinuses can show air fluid levels in the sinuses. They can also demonstrate nasal polyps, opacifications, cysts, and mucoceles. Sinusitis can also be seen on CT by demonstrating mucousal hyperplasia, bone lesions, fluid retention, and bullous concha.  CT helps in imaging thickened mucousal membranes in the paranasal sinuses (Pal, 2000).

                                                           Treatment

             In some cases, sinusitis can resolve and clear up spontaneously. If not, then a physician can and may prescribe decongestants, antibiotics, pain relievers, nasal steroid sprays, or oral steroids.
            Some of the commonly prescribed medications include Amoxicillan, Phenylephrine, Psuedoephedrine, Claritin, and Flonase.
            There are some home remedies for relief of sinusitis also. These include inhalation of steam, saline nasal sprays, hot water baths, hot water compresses, heating pads, and humidifiers (Merck, 1997).

                                                             Prognosis

            Sinusitis is not a life threatening disease if properly treated under a physicians care. There is treatment available. If antibiotics and medications do not work. A specialists can be consulted on nasal and sinus surgery. These surgeries can improve drainage flow and remove infected mucousal materials. Removal of the adenoids in children can help clear up sinus problems. Opening of the nasal airway through removal of nasal polyps and correction of a deviated nasal septum can also be accomplished through surgery. This can also help eliminate or decrease sinus problems (Sinus Infections, 1999).

For more information please check out the following web sites:

http://www.sinucare.com

http://www.entmanual.com

http://www.webmd.com


 

                                                                             References

        Lev, M.H., Groblewski, J.C., Shortsleeve, C.M., and Curtin, H.D.  (1998, January).  Imaging of the sinonasal cavities: inflammatory disease.  Applied Radiology , 185, 1-6.  Retrieved on March 16, 2001  from the World Wide Web: [online] Available:
http://www.appliedradiology.com/article/article.asp

      Merck Manual of Medical Information (book).  Home Ed.  (1997).  1112-1113.  New York:  Merck & Co.,Inc.

          Pal, Shalmali.  (2000, February).  Lose dose CT touted for oft-needed sinus imaging.  AuntMinnie: Radiology Starts Here. 1-2.  Retrieved on March 16, 2001 from the World Wide Web: [online] Available:
http://www.auntminnie.com

       Sinus Infections (sinusitis).  (1999).  1-2.  Retrieved on March 14, 2001 from the World Wide Web: [online] Available:
http://www.entmanual.com

       Sinusitis and Sinus Pain Relief- SinuCare.  (2000).  1-2.  Retrieved on March 14, 2001 from the World Wide Web: [online] Available:
http://www.sinucare.com/sinuspain.html

        WebMD.  Sinusitis.  (1999) 1-4.  Retrieved on March 16, 2001 from the World Wide Web: [online] Available:
http://www.mywebmd.com/content/article1680.51929


                                                              Graphics

      Labeled sinus diagram. Retrieved on March 14, 2001 from the World Wide Web: [online] Available:
http://www.sinucare.com/sinuspain.html

      Colored sinus graphics. Retrieved on April 14, 2001 from the World Wide Web: [online] Available:
http://www.sinuscarecenter.com