|
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?
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.
|
 |
|
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.
|
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-Scope™
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.
|
| |
|
| |
|
| |
|
