Sinusitis (inflammation of the sinuses)

Sinusitis refers to inflammation of the sinuses. Normally, the nasal mucosa is also involved. Triggers for sinusitis are bacteria, fungi or allergies. The disease is favoured in its development by constrictions in the nose.

Sinuses are cavities that are located in the facial bones on both sides of the nose and open into the nose. The frontal sinus lies directly above the nose in the middle. The ethmoid sinuses (also called ethmoid labyrinth) are small cavities located between the nose and the inner corner of the eye. The maxillary sinus is located directly next to the nose in the facial bone. Analogous to the nose, the sinuses are all covered by a mucous membrane.

Along with allergic and viral diseases of the upper respiratory tract, sinusitis is considered one of the most common diseases of the respiratory tract. It can occur both temporarily (acute sinusitis) and over a period of two to three months (chronic sinusitis).

In the absence of sinusitis, the sinuses are usually well ventilated. They contain the same mucous membrane as the nose, which is responsible for the production of secretion that cleans the cavity. This secretion is carried away from the sinuses into the nasopharynx. If this path is not freely accessible, the secretion builds up in the cavity. The congestion creates favourable conditions for the growth of bacteria and other pathogens, which trigger an inflammation of the mucous membrane. Thus, sinusitis develops.

The main triggers of sinusitis are viral or bacterial infections of the nose. Even with a simple cold, the sinuses are also affected in over 80 percent of cases (rhinosinusitis). In most cases, the bacterial inflammation of the sinuses develops from a viral rhinosinusitis. The trigger for maxillary sinusitis (one of the sinuses) is sometimes dental root inflammation, since the roots of the upper molars have a close topographical position to the maxillary sinus.

Chronic sinusitis is often caused by changes in the nose that prevent adequate ventilation. These include curvatures of the nasal septum or nasal polyps. Other reasons for sinusitis can be swelling of the mucous membrane due to an allergic reaction, cystic fibrosis or diseases of the immune system.

Acute:

Acute sinusitis is characterized by the fact that it is usually preceded by a cold a few days earlier. The following symptoms can be used to recognize that an inflammation of the sinuses is present:

• Headache or feeling of pressure in the head. In severe cases, there may also be a throbbing pain above the forehead, in the cheek area, behind the eyes or occasionally in the back of the head.
• If the upper body is bent forward (e.g. when bending over), or if the foot is stepped on firmly, the pain is intensified. The pain is also intensified if light pressure is applied to the affected area.
• The cold can often be purulent.
• In a severe course of the disease, fever, fatigue and visual disturbances occur. In some cases, swelling is clearly visible from the outside.

Chronic:

In the case of chronic sinusitis, the symptoms often show a much weaker manifestation. It can even happen that the pain is completely absent. Characteristic of chronic sinusitis, however, are olfactory disturbances. Sufferers of such olfactory disorders can smell much less and in some cases nothing at all. Nasal breathing is impeded and a mucous or purulent secretion may be discharged.

At the beginning of the diagnosis is the exact questioning of the complaints. Then an ENT doctor examines the nose from the inside (rhinoscopy) with the help of a thin, usually rigid tube (endoscope), at the end of which there is a light source and a camera. The endoscope can be used to examine the excretory ducts of the paranasal sinuses.

If the rhinitis is purulent, a smear test, in which the bacteria causing the infection are examined, can provide clarification. The most common bacteria causing sinusitis are Streptococcus pneumoniae and Haemophilus influenzae. An x-ray can be used to determine if there is already a buildup of fluid in the sinuses. Some sinuses can also be examined by ultrasound. If the disease has spread to several sinuses or if there is chronic sinusitis, a computer tomography can provide clarification.

If the cause of sinusitis is an allergic reaction, it is necessary to find out which allergen is triggering the reaction. Special skin tests, such as the prick test or a provocation test, can be used for this purpose.

Acute inflammation:

To treat sinusitis, medications are used to cause swelling of the nasal mucosa. The purpose behind this is to clear the excretory ducts and thus ensure the ventilation of the sinuses. If the infection is caused by bacteria, antibiotics may also be used.

Mucolytic medications are used when the intention is to liquefy the secretion so that it can drain better. Nasal sprays and inhalations with 0.9 percent salt water have the same goal. The formerly frequently used jaw rinses are hardly used anymore.

With these factors one can prevent even an acute sinusitis:

• One should make sure to take enough liquid to liquefy the mucus. It is advisable to drink about three to four litres of liquid a day, which should consist of tea and diluted fruit juices.
• Red light irradiation curbs the inflammation.
• In bed, care should be taken to elevate the head so that mucus can drain away.
• During the winter months, a good indoor climate is important. The humidity should not be too low. This can be achieved, for example, by regular ventilation or humidifiers.
• Cigarette smoke irritates the mucous membranes. For this reason, it should be avoided.

Chronic inflammation:

If it is a chronic inflammation of the sinus, the exact cause should be clarified by a doctor. If the origin lies in an allergy or inflammation of the roots of the teeth, this should be treated. Causes such as a crooked nasal septum, narrowed sinus excretory ducts or polyps can be corrected. Nasal rinses and inhalations with salt water can provide relief for chronic sinusitis.

As a rule, acute sinusitis subsides after a certain time. If sinusitis occurs more than four times a year or lasts longer than two months, it is considered a chronic sinusitis, in which the environment of the mucous membrane is subject to change. This can be explained by the fact that the outflow of secretion is blocked all the time. This favors the spread of germs that are not normally found in the sinuses.

In the rarest cases, complications occur. However, if timely treatment is not given, the inflammation can, in the worst case, spread to the adjacent bones towards the eye, the meninges (meningitis) or the brain (encephalitis). If this is the case, it is an emergency with life-threatening consequences. If such complications occur, further treatment takes place in hospital.

In order to avoid sinusitis, care should be taken to ensure that the connections between the sinuses and the nose are unobstructed. This ensures that the secretion can flow out unhindered. The renunciation of smoking and a healthy lifestyle support the mucous membrane in its function.

Sprays containing a pure salt-water solution can be used safely over a longer period of time. They have the effect of moistening and caring for the nasal mucosa. Nasal douches with salt-water solutions moisten the mucous membranes and can remove dust particles and dirt from the nasal mucosa.

To keep the risk of sinusitis as low as possible during a cold, make sure you drink enough and regularly moisten the nasal mucosa. If the symptoms are severe, mucous membrane decongestant nasal sprays can help. These have the effect that the secretion can flow off more easily. However, care should be taken not to use these medications for longer than five to seven days, as the mucous membrane can adapt to these agents and swell even more in response. In addition, herbal preparations can be taken which also help to liquefy the mucus and prevent the sinuses from becoming infected.

If the cause is an allergy, salt water treatments can also provide relief. Anti-allergic nasal sprays and tablets target the allergy directly. These can also be used over a longer period of time. Since an allergy lasts for the duration of a cold, the use of mucous membrane decongestant nasal sprays is not recommended due to the risk of habituation.