There are four pairs of sinuses in the head that assist the control of temperature and humidity of the air reaching the lungs. They are connected to the inside of the nose through smaller openings called ostia.
Normally the nose and sinuses produce a pint and a half of mucus secretions per day. These secretions pass normally through the nose picking up dust particles, bacteria and other pollutants along the way. This mucus is swept into the back of the throat by millions of tiny hair-like structures called cilia, which line the nasal cavity. The mucus moves into the throat and is swallowed. Most people do not notice this mucus flow because it is a normal bodily function.
Types of sinusitis
Sinus infection occurs in two types:
Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold. Typically a green-yellow nasal discharge occurs a week or more after the onset of the cold and this is associated with severe pain around the cheeks, eyes and/or forehead. This may be associated with swelling and a high fever along with toothache.
Chronic sinusitis is sinusitis that continues for many weeks. Chronic sinusitis may be caused by an acute sinus infection which fails to resolve or as a result of an underlying allergy affecting the lining membranes of the nose and sinuses. Common symptoms include nasal obstruction, headache, nasal discharge, low grade fever, reduced sense of smell, facial pain and halitosis.
What causes sinusitis?
It is worth noting that pain in the face may well be due to other causes such as tension headache, migraine, neuralgia and jaw dysfunction. The pain from sinusitis usually occurs as a result of blockage of the sinus opening. These blockages may be caused by infections, irritants, allergies or a structural abnormality.
Sinus surgery
Surgery is normally only considered if medical treatment fails. When surgery is needed the ENT specialist can choose from a number of different options depending on the severity of the sinus disease. Most sinus operations are performed without an external incision. Most surgeons will ask for a scan of the sinuses to assist with the planning of the operation.
Diagnosis and treatment of sinusitis
Acute sinusitis is usually treated with antibiotics and medication to reduce the swelling of the nasal lining e.g. decongestants. Chronic sinusitis may need long term treatment.
Medical treatment options include antibiotics, decongestants and other treatments to reduce the swelling of the lining such as nasal steroid sprays. Antihistamines will have a place in patients who have an underlying allergy. In the vast majority of cases sinusitis can be managed effectively with medical treatment.
Occasionally symptoms will persist despite ongoing use of medicines in which case surgery may be necessary. The diagnosis of sinusitis by a specialist will involve the use of a nasal endoscope which the doctor can use to examine the nasal lining and the sinus openings.
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