Category: Nasal & Sinus  

Sinusitis

Introduction

Patients and doctors alike often interpret sinus pain as infection. Pain in the region of the cheekbones and around the orbits of the eye is indeed the classic area of sinus discomfort. However, pain of a sinus origin may be referred to the top or back of the head. So using pain is a poor marker for localizing the source of sinusitis. Sinus pain may be due to a combination of factors including allergy and sinusitis, mostly due to sinus “pressure points” causing pain or perhaps not due to sinus disease at all. Many patients have different types of sinus pain, one due to allergy and a second due to migraines, for example.

What and where are the sinuses?

Anatomy of Sinuses

The sinuses are hollow cavities in the facial bones that connect to the nasal cavity through narrow channels called ostia. The frontal, maxillary and anterior ethmoid sinuses drain through a common channel called the middle meatus. The posterior ethmoid and sphenoid sinuses drain into the sphenoethmoid recess.

What is the purpose of sinuses?

The reason is unknown but there are a number of theories as to why the sinuses developed:

  • Humidification and filtration of inhaled air
  • Lightens the weight of the skull
  • Affect vocal resonance/enhance voice
  • Absorb energy of an impact therefore helping to prevent brain injury (much like the body of a car does in a crash)

What are cilia?

The sinuses in their normal state are empty since mucous is constantly swept out by cilia. The cilia work in unison to sweep the mucous through the ostia. The mucous is swept into the nasal cavity where it then drains out of the nose (runny nose) or into the back of the throat (post nasal drip). When cilia do not function properly either due to an inborn problem (rare), infection or smoking, mucous is not properly cleared. This becomes self-perpetuating process where the infected mucous interferes with the normal sweeping process of the cilia and this in turn prevents proper clearance of the mucous.

Sinus Drainage SystemSinus Cilia

Definition of sinusitis:

Sinusitis is defined as inflammation within the sinus cavities. Acute sinusitis often occurs in the common cold and in the first ten days of symptoms there is reason to wait since things often improve on their own. In fact, a recent study suggests that treatment with a nasal steroid spray is as good as antibiotics in acute sinusitis. Beyond 10 days, it’s likely that things have evolved into a bacterial sinusitis. Anyone can get a bacterial sinusitis but it’s more likely if you have allergies, smoke cigarettes (or smoke anything for that matter), have some certain anatomic variances within your sinuses (such as a deviated nasal septum) or if you have an immune deficiency. Bacterial sinusitis can relapse and require more than one round of antibiotics.

Chronic sinusitis is potentially much more complicated than acute sinusitis depending upon the cause. Some patients with chronic sinusitis have localized areas of infection due to their sinus anatomy that might respond well to surgery alone. For others there is widespread swelling of the sinus membranes and though surgery may help some of these patients, they also need careful close monitoring and medications to keep the sinus swelling in check. Go to the chronic sinusitis page.

Rhinovirus

How long does a typical cold last? Symptoms can linger up to 2 weeks. If things are gradually improving each day, there is reason to wait rather than take antibiotics. Upper respiratory infections may be routine viral infections but may be the flu. Follow this link to see the difference between the flu and a the common cold.

Diagnosis

A thorough medical history, physical examination and diagnostic testing help to differentiate between the many causes of sinus pain. Testing for sinus disease usually consists of allergy skin testing to determine sensitivities to airborne allergens with an emphasis on mold. Evaluation of the upper airway requires a visual examination (endoscopy) with a small camera attached to a thin flexible endoscope. Our office uses the D-Scopeā„¢ VCCU (Video Capture and Compression Utility) a PC Based digital video system developed by Dr. Chandler. This enables us to review the images immediately with the patient, to share findings with other physicians as necessary and to compare findings over time. Lastly since many patients with sinus disease have asthma, a pulmonary function test is often done at the time of the first visit. By the time the patient has left the office after the initial consultation they often know their allergic sensitivities, the status of their sinus disease and their lower airway function (as applicable).

Treatment

Treating acute bacterial sinusitis can be as easy as taking antibiotics. Treating chronic sinusitis is another matter entirely since it is a fairly complex problem. Please see chronic sinusitis treatment.

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