Sinusitis is an inflammation of the mucosa of one or more sinuses, causing symptoms such as headache or facial pressure with variable localization, nasal obstruction (stuffy nose), reduction or absence of smell, among others, as we will see below in more detail.
The sinuses are air cavities located in the craniofacial skeleton next to the nasal cavities and lined by a mucous membrane identical to that of the rest of the respiratory system. The nasal cavities have the function of filtering, moistening, and warming the air that is inhaled into the lungs (see upper pictures).
According to which sinuses are affected by the inflammatory process, sinusitis is thus designated by:
– Frontal sinusitis – if it affects the frontal sinuses;
– Maxillary sinusitis – if it affects one or both maxillary sinuses;
– Ethmoid sinusitis – if it affects the anterior and/or the posterior ethmoid sinuses;
– Sphenoid sinusitis – if it affects the sphenoid sinus;
– Pansinusitis – when all sinuses are involved
Most frequently affected are the anterior sinuses, namely the frontal, maxillary and anterior ethmoid sinuses.
Classification of sinusitis
We can identify different types of sinusitis or classify them according to the temporal clinical presentation and in relation to the intensity of the inflammation.
1 – Concerning the temporal clinical presentation, we can classify sinusitis in
The term acute sinusitis is applicable when the symptoms last less than 4 weeks.
Recurrent acute sinusitis is referred to whenever 4 or more episodes per year with 7 to 10 days duration occur.
The designation acute rhinosinusitis vs acute sinusitis is currently the most accepted one within the Otorhinolaryngology academies as the sinus mucosa is in continuity with the nasal mucosa and both are involved in the acute inflammatory process (sinusitis and rhinitis).
Chronic sinusitis is an inflammatory or infectious disorder of the sinuses which lasts longer than 12 weeks, i.e. when it is persistent over time.
In chronic sinusitis, unlike in acute sinusitis/rhinosinusitis, the inflammatory process may be confined only to the sinuses without involvement of the nasal mucosa.
The clinical manifestations are very variable and may occur only in acute episodes. In these occurrences the symptoms are similar to those of acute rhinosinusitis and are called acute chronic sinusitis.
The most common symptoms in chronic sinusitis are nasal obstruction and anterior / posterior purulent rhinorrhea. Diffuse “headache” type headaches, smell disturbances (hyposmia, anosmia, cacosmia), epistaxis (“blood or nose bleed”) as well as systemic symptoms (fatigue, cough, feeling of facial pressure) are possible but not constant symptoms.
2 – We can classify sinusitis regarding the intensity into:
Mild sinusitis, moderate sinusitis or severe sinusitis, depending on the sinuses involved, extrasinusal involvement and aggravating factors such as atopy and immunosuppression.
Find out below what are the symptoms of acute sinusitis.
Signs and symptoms of sinusitis
The signs and symptoms of sinusitis are in the acute stage usually the following:
– Facial pain or pressure, aggravated by tilting of the head, with varying location depending on the sinus or sinuses most affected (major symptom);
– Nasal obstruction with anterior or posterior purulent nasal discharge (major symptom);
– Hyposmia or anosmia, i.e., the reduction or absence of smell (major symptom);
– Fever (major symptom);
– Headache (headache), halitosis (bad breath), odontalgia, otalgia / ear fullness, cough, fatigue or tiredness (minor symptom).
Causes of sinusitis
The causes of sinusitis are related to the etiologic agents and to a variety of favoring factors.
According to the etiological agent involved, acute sinusitis/rhinusitis may also be called:
– Viral or viral sinusitis – Viral or viral sinusitis is caused by viruses such as Rhinovirus, Influenza virus, Parainfluenza virus, among others.
– Bacterial sinusitis-Bacterial sinusitis is caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Pseudomonas, and others).
– Fungal sinusitis- Fungal sinusitis is caused by fungi such as Aspergillus, Actinomyces, and others.
The most frequent are viral and bacterial sinusitis.
Besides the etiologic agent, several factors favoring acute sinusitis/rhinosinusitis are identified:
– Immunological alterations;
– Existing allergies to dust mites, pollens, fungi, food, among others, often responsible for complaints of seasonal or perennial allergic rhinitis (nasal obstruction, mucous rhinorrhea, nasal and ocular pruritus, sternutation crises);
– Anatomical alterations of the nasal fossae and perinasal sinuses;
– Systemic diseases (endocrine, metabolic);
– Exposure to pollutants (chemical, toxic, etc);
– Infectious dental pathology;
– Gastroesophageal reflux;
Other determinants in the pathophysiological process of acute sinusitis/rinosinusitis are the good permeability of the sinus drainage ostia, the existence of a good ciliary function of the nasosinusal mucosa and the quality of nasal secretion.
Acute sinusitis / rhinosinusitis in children
In children anatomy and immunological immaturity play an important role, ethmoid sinusitis is the most frequent, due to the early developmental stage of these sinuses.
The vast majority of cases of childhood sinusitis or acute childhood sinusitis starts with a viral infection of the upper airways which later evolves into a bacterial infection. The bacteria most frequently involved are Staphylococcus aureus, Streptococcus pneumoniae , Moraxella catarrhalis and Haemophilus influenzae.
Adenoid vegetations may also contribute to the onset of acute rhinosinusitis in the child by being a bacterial reservoir.
Is sinusitis contagious?
Chronic sinusitis is not normally contagious, i.e. it is not transmitted from person to person, however, in its acute stages and particularly when the etiologic agent is a virus, contagion may occur.
Diagnosis of acute sinusitis
The diagnosis of acute sinusitis/rhinosinusitis should be made by an otorhinolaryngologist (ENT) physician taking into consideration the following aspects:
– Clinical history (symptoms and temporal evolution);
– Objective examination: anterior rhinoscopy (hypermia and edematous nasal mucosa with purulent exudate coming from the middle or upper meatus), painful palpation of the sinus points, posterior rhinorrhea in the oropharynx);
– Imaging exams (x-ray or plain x-ray of the sinuses or preferably computed tomography (CT) of the sinuses;
Some pathologies should be considered in the differential diagnosis of acute sinusitis/rhinosinusitis, namely
– Common Constipation;
– Trigeminal neuralgia;
– Neuralgia of dental cause;
– Tension headaches, migraine headaches
– Temporal arthritis;
– Arthritis/arthritis of the temporomandibular joint;
– Rhinosinusal neoplasms.
Diagnosis of chronic sinusitis
It is the endoscopic and radiological findings, not always correlable with the patient’s symptoms, which allow a diagnosis of chronic sinusitis to be made. At anterior rhinoscopy, an edematous mucosa and sometimes polypoid degeneration is prominent. In the oropharynx or posterior rhinoscopy a thick purulent rhinorrhea is visualized.
Computed axial tomography (CT) is the preferred exam in the study of nasosinusal pathology, allowing an evaluation of the bone structure and helping in the planning of possible surgical interventions.
Magnetic resonance imaging (MRI) can be important for a better evaluation of soft tissues, particularly in the extension of the pathology to intracranial or orbital compartments. It is also relevant in distinguishing between fungal infection and other types of inflammatory processes, as well as in distinguishing between inflammation and neoplasia.
Complications of acute sinusitis/rhinusitis
Complications of acute sinusitis/rhinosinusitis require hospitalization, and an aggressive bacterial agent should be suspected, and in the case of the immunocompromised, mycotic infection. The following complications may occur:
1- Bone complications such as frontal osteomealitis.
2- Orbital complications, the most frequent, due to the proximity and relationship of the orbit with the paranasal sinuses. These are in order of severity:
– Meningitis (the most frequent);
– Pre-septal cellulitis (inflammation of the soft tissues anterior to the orbital septum);
– Subperiosteal abscess (that develops between the lamina papyracea and the periorbit);
– Periorbital cellulitis (diffuse infection of the retro-orbital soft tissues);
– Orbital abscess;
– Cavernous sinus thrombophlebitis (severe and life-threatening);
– Intracranial complications;
– Epidural abscess and subdural empyema;
– Brain abscess.
Is sinusitis curable?
Sinusitis is a disease that can be triggered by different etiological agents and that has several factors favoring it (see more information under causes). The prognosis depends on the underlying causes.
Learn how to treat sinusitis below.
The treatment for acute sinusitis is based on the pathophysiological process which triggers it. It should be done individually and according to the clinical presentation and setting.
In the first 3 to 5 days of the inflammatory/infectious process, since it is probably a viral sinusitis, the recommended treatment which may contribute to its resolution and thus relieve the symptoms consists of
– Non-steroidal anti-inflammatory drugs such as paracetamol;
– Treatments or home remedies such as nasal irrigations with saline solutions, (aerosols) to humidify the airways;
– Tea drinking and natural or homemade effusions, which is good to allow a good hydration and that will end up ensuring a better fluidification of nasal secretions and thus improve the symptoms;
– Pharmacy nasal vasoconstrictors (ex: inhalation of neosinephrine twice a day for a maximum of 5 days).
After 5 days of persistent symptoms or in severe initial cases, in which case a probable bacterial sinusitis is involved, treatment, after medical evaluation, should be started immediately, aiming to eradicate the bacteria, reduce the duration of symptoms, prevent complications and prevent the evolution to a chronic process.
The selection of the antibiotic should always be made by the doctor and should take into consideration the intensity of symptoms, the time of evolution and previous treatment with other antibiotic therapy.
This medical treatment can be coadjuvated with topical nasal corticoids (edema reduction, sinus drainage improvement), anti-inflammatory/analgesics, systemic corticoids, nasal vasoconstrictors, antihistamines (in rhinosinusitis with allergic exacerbation), mucolytics.
Hospital admission should be considered in the following cases:
– In the absence of response to instituted medical treatment or worsening of the clinical picture;
– In fungal sinusitis;
– In immunocompromised patients;
– In suspected complications.
In acute chronic sinusitis, the treatment is the same as in acute rhinosinusitis.
In case of acute sinusitis in pregnancy, the treatment should be the most appropriate for the presenting clinical situation, but always under medical supervision.
Outside of acute episodes, the treatment of chronic sinusitis should be appropriate to each clinical case and depending on the endoscopic evaluation and imaging tests, may include:
– Medical treatment (periodic nasal irrigation with saline solution or thermal waters (thermal spas), nasal topical corticosteroids, antihistamines if there is evidence of a history of allergies,…);
– Surgical treatment, in some cases, as we will see below.
Surgery in sinusitis
In sinusitis, surgery (or operation) should be considered whenever:
– Complications occur in acute rhinosinusitis;
– In chronic sinusitis, when the clinical picture justifies it, the surgical technique has to be adapted to the sinus or sinuses affected and to the existing nasal and paranasal anatomical changes (always very variable).
How to prevent sinusitis?
Regarding the prevention of sinusitis, only a few factors can be prevented, among these are:
– Avoid exposure to chemical and toxic pollutants;
– Promote within the home and workplace/workplace a healthy atmosphere;
– Have a balanced and healthy diet;
– Maintain good oral hygiene;
– Take measures to combat gastro-esophageal reflux;
– Perform annual influenza vaccination, particularly in patients at risk.
If you are looking for a sinus specialist, see the ear, nose and throat (ENT) clinic or doctor we recommend in your county for more information.