Sinusitis: how to treat it

A sinusitis is the most common health problem. It results from an infection in the nose area that causes severe discomfort. Learn how to treat and prevent it.

Sinusitis is an inflammation of the mucous membranes of the sinuses, a set of air-filled bony cavities located around the nose, cheeks and eyes. It is also called rhinosinusitis because the inflammatory process affects both the sinus lining and the nasal mucosa.

This condition is one of the most common pathologies of the upper respiratory tract and is caused by infections caused by viruses, bacteria or fungi. It can also result from allergic reactions.

In terms of pathophysiology, environmental factors such as allergens, viruses or air pollutants stimulate the mucosal epithelium, inducing local inflammation of the sinus mucosa.

In narrow canals, this inflammation causes the mucosal surfaces to close together, inducing obstruction and accumulation of secretions in the draining sinuses, creating additional inflammation.

Sinusitis usually occurs at the same time as inflammation of the nasal passages – called rhinitis – and can be classified as follows:

  • Acute sinusitis (lasting less than 30 days)
  • Chronic sinusitis (lasting more than 90 days)
  • Subacute sinusitis (lasts between 30 and 90 days)
  • Recurrent sinusitis (four or more episodes of acute sinusitis per year)

Preventing and Treating Sinusitis

Symptoms

The most common symptoms of sinusitis are:

  • Mucus accumulation in the nose
  • Nasal congestion
  • Pain or pressure sensation in the face
  • Headache
  • Mucus running down the throat
  • Sore throat
  • Cough
  • Bad breath

The physician, specializing in otolaryngology, should be consulted when the person presents with:

  • Severe symptoms, such as severe headaches or facial pain
  • Symptoms that worsen after initial improvement
  • Symptoms that last more than 10 days and do not improve
  • Fever that lasts more than three or four days

Although the symptoms are identical in acute and chronic sinusitis, their intensity is very different.

 

Acute sinusitis

Acute sinusitis usually results from a viral infection of the upper respiratory tract, such as the common cold, and should be cured in less than 30 days.

The most common symptoms are:

  • Headache in the most affected area of the paranasal sinus.
  • Nasal obstruction marked by the presence of yellow or greenish secretions, with traces of blood, that make breathing difficult.
  • Fever, fatigue, coryza, cough, muscle aches and loss of appetite.

 

Chronic sinusitis

Chronic sinusitis must last more than 90 days.

There is no specific reason for the onset of sinusitis, but some factors that may be related to it include: chronic allergies, nasal polyps, and exposure to environmental irritants (such as air pollution or tobacco smoke).

The most common symptoms are:

  • Absence of pain and fever
  • Cough is usually the most predominant symptom.
  • The cough is usually nocturnal and increases in intensity when the person is lying down.
  • Coughing spells are particularly frequent in the morning, upon rising, and decrease in intensity, or even disappear, during the day.

 

Risk factors

As with virtually all health problems, there are also certain risk factors for sinusitis:

  • Deviation of the nasal septum
  • Nasal bone spur (bony growth in the nose)
  • Nasal polyps, usually benign
  • History of allergies
  • Recent contact with mold/soot
  • Weak immune system
  • Tobacco
  • Recent upper respiratory tract infection
  • Cystic fibrosis
  • Dental infection
  • Air conditioning
  • Air travel (due to high concentration of germs)

 

Treatment

Treatment of sinusitis is primarily aimed at improving sinus drainage and curing the infection.

Nasal nebulizers, such as phenylephrine or oxymetazoline, are most effective in rapidly deflating swollen membranes.

The main purpose of using antibiotics in the treatment of sinusitis is to eradicate bacteria from the site of infection, allowing the affected sinus to return to its normal state, decreasing the duration of symptoms, preventing complications, and preventing the process from becoming chronic. The most commonly used antibiotics include amoxicillin/clavulanate or doxycycline.

The Infectious Diseases Society of America suggests that the following characteristics help identify patients who should receive antibiotics:

  • Mild to moderate symptoms of sinusitis persisting for 10 days or more;
  • Severe symptoms (e.g., fever greater than 39°, severe pain) lasting more than 3 to 4 days;
  • Worsening sinusitis symptoms after initial improvement in typical viral upper respiratory tract disease (recurrent or biphasic disease).

When sinusitis is caused by allergy, an antihistamine is advised.

There are also some measures that can facilitate treatment, namely relief of inflammation of the membranes and drainage of mucus :

  • Steam inhalation (e.g., Turkish bath)
  • Apply warm, moist towels to affected sinuses.
  • Drink plenty of fluids, especially hot drinks.
  • Cleaning the nose with a saline solution (sea water)
  • Rest
  • No Smoking

In cases of chronic sinusitis, surgical treatment is possible. The most common method is endoscopic sinus surgery, a minimally invasive procedure.

However, there are other surgical methods, and it is up to the physician to recommend the one that is best for the individual.

 

Prevention

There is no 100% way to prevent sinusitis, but there are a number of behaviors that, if adopted in everyday life, can reduce the risk.

Some examples:

  • Do not smoke and avoid being in a smoking environment.
  • Wash your hands frequently, especially during cold seasons
  • Try not to touch your face with your hands
  • Avoid products you know you are allergic to

 

Complications

The main complication of sinusitis is the spread of the bacterial infection to the tissues surrounding the eye. This leads to changes in vision or swelling of the area.

More rarely, the infection can also spread to the eye itself, causing pain and vision problems.

Less commonly, it can spread to the tissues surrounding the brain (meningitis) and cause severe headaches and mental confusion. In such a situation, the person should seek medical attention as soon as possible.

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