Sinusitis is an inflammation of the tissue around and between the sinuses. The sinuses consist of empty cavities which are located in the area of the nose, behind the cheekbones, between the eyes and in the forehead. When these cavities are healthy, they are filled with air.

The role of sinuses is to create mucus. Healthy sinuses create thin mucus that slowly drains throughout the nose channels in order to keep them moist and to filter out the harmful particles of polluted air, dust or allergens that could get into your nose and even reach the blood and they also keep nose away from bacteria.

Healthy sinuses, normally, are filled with air. But they can get blocked and liquid filled. This is a situation that could lead to bacterial sinusitis, as the sinuses become a very attractive place for bacterial development.

Anyone can suffer from sinusitis. Those who suffer from nasal allergies, polyps, asthma and abnormal nose structures are prone to get affected by sinusitis. Smoking is another factor that can increase one’s chances to develop sinusitis.

Also, sinusitis can occur as a result of an infection, due to a virus, bacteria or fungus. Such infections can create the perfect environment for sinusitis to occur, as the sinuses become inflamed and the nasal channels get blocked. Therefore, the drainage flow of mucus is considerably affected.

Moreover, it is very important to know that sinusitis is not contagious. Though, the viruses that cause the sinusitis bouts could be easily transmitted. Therefore, it is important to always wash your hands and try to protect those around you.

Where are the Sinuses located?

The sinuses are quite complex as they are spread from the nose’s level towards the forehead. The names of each type of sinuses are given after the bones in whose structure they locate. The sinuses are:

• Paranasal sinuses, which are found in near the nose and eyes;
• The ethmoidal sinuses are situated between the eyes;
• The maxillary sinuses are situated under the eyes;
• The sphenoidal sinuses are situated behind the eyes;
• The frontal sinuses are situated over the eyes.

Generally, the sinus that gets most often infected is in the maxillary cavity, which is also the most considerable sinus in terms of dimensions.

As the sinuses are a complex system of cavities, there are different causes of inflammation. Therefore, we will discuss about the different types of sinusitis.

Sinusitis bacterial / Acute sinusitis

The bacterial sinusitis, or the acute bacterial sinusitis, describe the type of inflammation of sinuses which occurs all of a sudden during a normal cold. The symptoms could be a stuffy or runny nose and facial pain. The bacterial sinusitis usually lasts about 10 days. It is known that the symptoms start to become weaker, but after a few days of improvement, their intensification suddenly grows and symptoms could get more severe than the initial ones.

The causes of acute sinusitis usually are normal colds, allergies or viruses. It can also be started by a bacterial or fungus infection that make blocks the sinuses and let them swell.

The treatment of acute sinusitis consists of:

• Nasal sprays and decongestants. These should not be used for more than three consecutive days, unless the doctors tell you otherwise. The over dose of nasal sprays and decongestants might affect your capacity of smelling.
• Drink as much fluids as possible.
• Also rest as much as possible.
• Take over the counter pain killers. Ibuprofen is one of the best choices as it has anti-inflammatory properties.
• Cleanse the nose channels with saline solution. As this is not a medicine and it consists of sterile water and saline only, you should repeat the procedure for longer than the days when the symptoms are persistant

Acute sinusitis could also be treated with antibiotics, but just in case that the cause for the sinusitis episode is a bacterial infection. Otherwise, antibiotics have no effect on the condition.

Subacute Sinusitis

The subacute sinusitis is happening when the symptoms tend to last between a month and three months. Mostly, it appears due to seasonal allergies and bacterial infections.

Recurrent Acute Sinusitis

The recurrent acute sinusitis is the type of sinusitis that reoccurs often. Usually, the recurrent acute sinusitis appears at least four times per year and the symptoms persist generally fourteen days per bout.

Sinusitis Chronic

The chronic sinusitis is way different in comparison to the acute sinusitis. The difference is that the chronic sinusitis is generally active for more than three months, unlike the acute sinusitis which is gone in a couple of days.

Chronic sinusitis is also different from the recurrent sinusitis, as the symptoms of chronic sinusitis persist for very long periods of time.

There exist more factors which could contribute to the ignition of chronic sinusitis. We can enumerate them:

• Blocked nasal channels. The channels that are found in the nose and through which the air is being breadthen in could get blocked due to asthma, allergies or due to other specific conditions, such as cystic fibrosis, for example.
• Infections. Any bacterial, viral or fungal infection can actually start an overgoing bout of chronic sinusitis.
• The structure of your nose. In case your nose is already affected by irregularities in its shape, it can make you prone to chronic sinusitis. By irregular shapes of the nose, we consider, for example, a deviated septum, which can tremendously affect your ability to breathe in and out.
• Polyps. Despite the fact that polyps are one of the most troublesome components of the respiratory system, they are also another specific ingredient of the chronic sinusitis.
• The immune system. Unfortunately, a weak immune system makes you prone to develop different types of conditions. One of the conditions a weak immune system might get you is chronic sinusitis.

The symptoms of chronic sinusitis usually are:

• Constant pressure in the upper part of the face; it is mostly in the nose, eyes and forehead area.
• You can feel mucus coming down on the throat.
• Abundant leaks of yellow or green excretion from the nose.
• Pain in the teeth, ear and assiduous headaches.
• Cough.
• Fatigue.
• Loss of taste and smell.
• A very bad smelling breath (Halitosis).

Sad to say, the symptoms of the chronic sinusitis could be all of the above mentioned or just some of them, in the most fortunate cases. The symptoms of chronic sinusitis could greatly affect your day-to-day life. As chronic sinusitis lasts a very long period of time, the symptoms could also set in motion a depression. Moreover, as the inflammation highly affects your respiratory airways, and therefore you might also find it difficult to sleep normally at night.

How is Chronic Sinusitis diagnosed?

The chronic sinusitis can be diagnosed by the specialists only when the symptoms have been active for more than three months.

Sometimes, the process of diagnosing involves an endoscopy. This means that the ENT (ear, nose and throat) doctor will look in your nose using a very flexible and small-scale device which allows him to get a sight of the depths of your nose and a sight of your sinuses.

In some cases of diagnosing chronic sinusitis CT SCAN or MRI are used to find out irregularities of the nose that could be the cause of your symptoms. The irregularities of the nose that are most often found out using the CT scan or the MRI are the deviation of the nasal septum or the polyps.

Moreover, in order to fully perform the diagnose, the doctors might also need to perform a biopsy. This means that they will take samples of tissue or bone and they will examine them under the microscope.

It is very important to consult a specialist if you have symptoms such as headaches, facial pain or tooth pain. Moreover, it is very important to consult the specialist if you have tried therapies for the symptoms afore mentioned and they had no effect. Though the afore mentioned pains could be symptoms of other different conditions, they could also be symptoms of chronic sinusitis. The diagnosing process might be a little bit difficult for a healthcare provider, therefore consulting an ENT doctor will help you improve your health.

Treatment of Chronic Sinusitis

Normally, chronic sinusitis is not a result of a bacterial infection. But sometimes it can be. In such situations, the doctor will prescribe an antibiotic, such as amoxicillin.

Otherwise, the most common procedures known for sinusitis treatment and its management are:

Avoid the potential triggers, such as allergies;

Use the intranasal corticosteroid sprays and leukotriene antagonists, in order to reduce the levels of inflammation.

Treat the conditions that could stimulate the occurrence of chronic sinusitis, such as allergies, asthma or immune deficiency conditions, with topical antihistamine, for example

Correct the irregularities of deviated nasal septum or polyps through surgical intervention.

Perform a balloon sinus ostial dilation, which consists of introducing a balloon into the affected sinus. As it inflates, it creates more space in the sinus.

Chronic sinusitis can be managed and fully cured. In order to do so, it is very probably that you will need to try out multiple treatments.

Moreover, it is important to know that chronic sinusitis in not necessarily a life-threatening condition, but it can be truly harmful sometimes. The infection that causes the chronic sinusitis can spread towards the bones, brain or even spine.

Sinusitis Surgery

Normally, sinusitis is treated with medication. Unfortunately, there are cases in which the normal treatment has not been effective. In such situations, it might be necessary to perform a sinus surgery. In most of the sinus surgeries, the procedure was used in order to treat chronic sinusitis, as the symptoms were recurrent and persistent.

The sinus surgery represents a process of creating a larger room between the sinuses and the nasal channels. The sinusitis surgery actually consists in removing parts of the nasal structure that are obstructing the normal flow of drainage, such sinus tissue, bone or even polyps. After a sinus surgery, the air should get in more easily, while the drainage could get out normally.

Nowadays, there are three types of sinus surgery:

• Functional endoscopic sinus surgery (FESS). This type of sinus surgery is the most popular one among patients who suffer of chronic sinusitis. The surgeon uses an endoscope to see inside the nose and the sinuses. The surgeon has live images from your nostrils throughout the whole procedure. When he identifies an element that needs to be removed, in order to unblock the drainage from the sinuses, the surgeon will leave the endoscope steadily. In the meantime, he will use small scaled tools in order to remove the sinus tissue, bone or polyp that blocks the drainage flow. He can could also correct a deviated septum, in order to help you regain full breathing capacity. This procedure usually lasts about two hours and it requires at least one night of hospitalisation afterwards. Beside the fact that you will be able to normally breathe again, this procedure also has the advantage that it does not leave any marks.
• Image-guided sinus surgery. This procedure is also an endoscopic sinus surgery, but it is used mainly when the area of the procedure is very close to the eyes or to the brain. Therefore, it is imperative that the surgeon’s accuracy is at the highest possible level in each of the moves he makes. The whole intervention will be computer assisted. This means that a sinus CT scan will be performed at the very beginning of the procedure. The CT scan’s result will be uploaded into a computer to which the tools are also connected. Therefore, the CT scan will work as a map on which the surgeon will see exactly where the instruments are located within your sinuses. This type of procedure offers a high level of accuracy in the process of removing tissue or bone and it also helps in preserving the nearby structures. The image-guided sinus surgery takes about two hours and it requires general anaesthesia.
• Balloon sinuplasty. This type of procedure is the only one that does not consist in to removing tissue or bone, in order to unblock the sinuses. Therefore, the surgeon will carefully guide a wire with a flexible endoscope throughout the nostrils to the affected blocked sinus. When the surgeon has certitude about the location, he will also insert a catheter with a small balloon linked to it. After the balloon has been guided to the needed location, it will softly get inflated. As it inflates, it should smoothly dilate the opening to the sinus, resulting in normal drainage. In most cases of chronic sinusitis, the balloon sinuplasty improves the patient’s symptoms. Unfortunately, in more severe cases, the surgeons might decide to perform this procedure along with endoscopic or image-guided sinus surgery. The balloon sinuplasty is also performed under general anaesthesia and it usually lasts about an hour.

Sinusitis Frontalis

Sinusitis frontalis occurs when the sinuses that are situated behind the eyes and in the forehead get inflamed.

The causes of sinusitis frontalis could be any of the following:

• Bacterial infection;
• Viral infection;
• An allergy;
• Deviation of the nasal septum;
• Polyps.

Sinusitis with Polyps

Sinusitis with polyps represents an inflammation of the sinuses that usually lasts more than 12 weeks.

Polyps generally swell and get larger, occupying between 75% to even 90% of the nasal cavity and they become a major cause for chronic sinusitis.

Usually, in order to treat the chronic sinusitis, surgery might be needed, in order to remove the polyps. As the polyps reduce, the symptoms of sinusitis improve.

Sinusitis from Allergies

The sinusitis caused by allergies could be both acute or chronic. Normally, the allergic sinusitis occurs within the childhood and is a reaction of exposure to allergens, such as pollen, dust, smoke or pelage.

The common symptoms of allergic sinusitis are:

• Itchy nose, throat or eyes;
• Nasal congestion;
• Limited smell and taste;
• Headache pain, tenderness, swelling and pressure around the forehead, cheeks, nose and between eyes;
• Insomnia.

Nobody is born with allergies but they can develop in time, depending on the surrounding environment. In order to improve the symptoms of the allergic sinusitis, it is very important to treat the sinusitis firstly.

Sinusitis vs Allergies

Often, allergies and sinusitis can come together, as allergies are known to ignite the inflammation of the sinuses.

The main difference between sinusitis and allergies is that the allergies occur as a reaction of the immune system to allergens, such as dust, pollen or animal hair. Sinusitis is an inflammation of the sinuses, due to blockage or infection of the nasal channels.

Symptoms that help you identify sinusitis as they do not occur in any allergy:

• Pain around cheeks and eyes;
• Thick yellow or green discharge;
• Inability to blow the nose;
• Pain in teeth;
• Fever;
• Bad smell of the breath.

Sinusitis drainage

The discomfort that you could feel during a sinusitis bout could be very annoying. Helpfully, there are some possibilities for you to drain the sinuses. When you are affected by sinusitis, you should:

• Drink as much liquids as possible, preferably water. Hydration will get the mucus thinner more likely to drain out of the sinus.
• Take long and hot showers.
• Breathe in steam, preferably from a pot with boiled water.
• Try a vaporizer or a humidifier.
• Keep a warm and wet towel on the face; it could unblock the nasal passages and relieve some of the discomfort.
• Use a nasal saline spray.
• During the night, try to sleep with the head a little bit higher than the level of the body, so the drainage of the sinuses could happen easier.

Sinusitis and Dizziness

Sinusitis vertigo could happen if the Eustachian tube gets filled with mucus. The Eustachian tube is part of the system that helps one keep the balance. As the sinuses are unable to drain normally during a sinusitis bout, the mucus can stop in many areas of the ears, nose and throat, including the Eustachian tube.

If the Eustachian tube gets filled with mucus, you might feel dizzy, or even fell that you do not have equilibrium any more.

Sinusitis Pain

Pain is one of the main characteristics of sinusitis. The pain that sinusitis come with could be felt all over the face, depending on which of the sinuses is inflamed. When suffering from sinusitis, you could feel the pain mostly above and under the eyes, but also behind the nose.

Due to the inflammation and swelling, the signature pain of sinusitis comes along with a dull pressure in the forehead, on either side of the nose, in the upper jaws, between the eyes or even in the teeth.

Prevention of Sinusitis

You can avoid the bouts of acute and chronic sinusitis, by:

• Keeping a healthy lifestyle; consuming healthy food and always keep hydrated;
• Avoiding smoking;
• Avoiding exposure to allergens to which you are sensible;
• Rinsing the nasal channels with saline solution;
• By keeping the nasal tissues moist (you can use a humidifier for that).

Sinusitis when pregnant

During pregnancy, it is important to avoid any health issues as possible. Also, it is very important to avoid the usage of various medicines, which could negatively affect the pregnancy depending on the toxicological profile of the drug and the trimester of pregnancy the woman is in.

As sinusitis can occur at any time, during pregnancy it could be a little bit more stressful and challenging to deal with. The key information is that most of over-the-counter medicines should be safe to consume. For example, the sinusitis headache symptoms could be relieved acetaminophen. Also, you can use some decongestants; antihistamines; expectorants or cough suppressants, but only at the recommendation of your doctor. Also, it is very important to note that aspirin and ibuprofen are not recommended during pregnancy.

Conclusion

Though any sinusitis bout could be very distressing and it could make you feel very uncomfortable, it is very important to know that treating it well, you might get rid of it sooner than you would expect it. If you suffer from a more complicated case of sinusitis, the ENT specialist will help you improve the symptoms. In worst case, you will need a surgical intervention. The good thing is that, normally, any sinus surgery doesn’t take longer than 2 hours, and there are no scars left after the procedure.

Anyway, if your symptoms last for more than 4 weeks, you should consult your doctor.