Sinusitis

Overview of sinusitis

The four pairs of sinuses in the human body are critical for regulating the temperature and moisture content of inhaled air reaching the lungs.Infections in any of the sinuses due to the viral or bacterial pathogen, allergic agents or structural abnormalities can lead to “sinusitis”.According to factsheets documented by Center for Disease Control and Prevention (CDC), nearly 29.4 million adults are  diagnosed with the disease annually throughout the world.

In the United States alone, 16% of the adult population is suffering from sinus diseases, which is incurring healthcare and hospitalization costs of 5.8 billion dollars annually. Thus the global health burden of sinus problems is very high and needs to be addressed immediately.

Definition of sinusitis

In general, sinusitis is defined as the inflammation of the sinuses.

There are four paranasal sinuses present in the head namely- maxillary, ethmoid, frontal and sphenoid sinuses.

Proper functioning of the sinus depends on a few critical factors such as mucous composition and flow, proper drainage and ventilation.

Under healthy immune conditions, the mucosal layer of the sinus is protected by the Immunoglobulin A (IgA) protein.

But in immunosuppressed individuals, inflammation of nasal mucosa and sinuses occurs due to environmental triggers such as virus, bacteria or other allergens. This condition leads to sinusitis or rhinosinusitis.

Pathophysiology of sinusitis

Proper functioning of the sinuses depends on few critical factors like patent ostia, ciliary functions, and the mucous quality. In many cases, blockage of the natural ostia leads to the deficient supply of oxygen, which in turn leads to degradation of mucous quality and ciliary dysfunctions. Therefore, unnecessary accumulation of excess mucous occurs, that leads to sinus problems.

Causes of sinusitis

Sinusitis results from various environmental or anatomical factors which are listed below-

Age: Natural deterioration of body’s immunity occurs at old age, which predisposes a person to upper respiratory tract infections, due to damaged cartilages and dryness of the nasal passages. Very small children also face sinus problems due to the presence of very small nasal and sinus passages.

Pollutants: Serious damage to cilia can occur due to continuous exposure to industrial and vehicular pollutants (mainly carbon particulates) or cigarette smoking. This may affect the sinus.

Atmospheric pressure: Variations in atmospheric pressure occurs in different situations such as traveling at high altitudes, mountain climbing, deep-sea diving. All these cases can equally contribute to blockage of the sinus.

Swimming: Irritation and inflammation of nose and sinus linings (due to chlorine present in water) is a very common occurrence in swimmers and may result in sinusitis.

Asthma and allergies: People suffering from asthma or Samter Triad tend to have nasal polyps and inflammation of sinus mucosa.

Structural defect: Some people have defective or deviated nasal septum, nasal polyps which may cause obstruction of the nasal passage and lead to sinusitis. Facial injuries or trauma can impede mucous flow and cause similar diseases.

Dental disorders: A few dental diseases such as abscess, periodontal infections require surgical intervention. During few of these processes like tooth extraction, unintended sinus perforations may occur that may lead to sinus problems. Sinusitis arising from pain in the upper set of molars and premolars or the wisdom teeth is called odontogenic sinusitis and should be diagnosed on an emergency basis.

Medical conditions: Diabetes can cause inflammation of the nasal passage or excess mucous retention. AIDS patients are at greater risks for few types of fungal sinusitis such as mucormycosis, zygomycosis, or fulminant invasive sinusitis. A particular type autoimmune disease called Wegener granulomatosis can cause tumors in the air passages that can pave way for sinus problems. People suffering from a disease called Kartagener syndrome tend to have cystic fibrosis conditions which disrupt ciliary functions. All these conditions can equally contribute to sinusitis.

Hospitalization: In many cases of hospitalization, patients have to bear with intranasal tubes, mechanical ventilators, antibiotics and steroid treatments which increase risks of sinus related diseases.

Symptoms of sinusitis

Sinusitis is usually manifested through the following symptoms

• Production of thick and sticky phlegm from the nose
• Frequent mucosal drainage down the back of the throat
• Greenish yellow discoloration of sputum with the progress of the disease
• Presence of blood in mucosal discharge (occasional)
• Difficulty breathing due to obstruction of the nasal passage
• Pain and tenderness around the eyes, cheeks, nose, head, and throat
• Coughing with mucosal discharge (may worsen at night)
• Reduced taste and smell sensation
• Foul breath
• A sore throat along with pain
• Pain in upper jaw and teeth
• Nausea and vomiting
• Extreme fatigue and irritability
• Disturbed sleep

Types of sinusitis

Based on the severity and duration of the disease, sinusitis may be classified into two types-

• Acute: Acute sinus problem is characterized by nasal inflammation and mucosal discharge which lasts for few weeks or less. It typically occurs after some cold and flu infections that cause inflammation of the paranasal sinuses.
• It is marked by infections of the upper respiratory tract due to viral pathogens and usually follows after a bacterial infection of the air passage. Mucosal drainage and aeration of the maxillary, anterior ethmoid, and frontal sinuses are severely impacted in this condition. This results in ciliary dysfunctions and mucosal damage.
• The viral pathogen normally responsible for acute sinusitis is the rhinovirus.
• Chronic: Chronic sinusitis is attributed to a chain of mechanisms such as- mucociliary dysfunctions, mucostasis (damage to mucosal tissues), hypoxia (deficient supply of oxygen) and release of microbial substances. The ostiomeatal complex blockage is very prominent. Normally a combination of aerobic and anaerobic pathogens is responsible for chronic sinusitis conditions. Staphylococcus is the most common causative agent in this case.

Diagnostic tests for sinusitis

The following diagnostic tests are normally recommended for proper treatment of sinusitis-

• Ultrasound (to examine maxillary and frontal sinuses)
• CT scan (to examine ethmoid sinuses)
• Sinus puncture
• X-ray (to diagnose chronic sinusitis)

Treatment & Prevention

Sinusitis can be effectively treated by home remedies, which may prevent the need to resort to medications, especially antibiotics.

Home remedies for sinusitis include using damp hot towel to heat and humidify the sinuses.

Saline nasal washes are great for treating sinusitis. Refrain from blowing your nose too forcefully as it strains the sinuses even more.

Avoid smoking and alcohol at all costs. Stay away from things that might trigger allergic reactions such as pollen, cigarette smoke, cold dry air, dust mites, pollens etc.

Maintain a safe distance from people infected with cold or flu. Chronic sinusitis can be kept under control by using an air humidifier. Drink plenty fluids and inhale steam to faster recovery.  Surgical intervention may be required in the rare case the sinus inflammation is not reducing by help of home remedies and medication.In a recent survey conducted by World Health Organisation, nearly 20% of doctor and clinic visits in the past few years were due to sinusitis. Adequate immunizations are essential to completely eliminate possibilities of sinusitis in children and adults.

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