Are your sinuses bothering you?

This is the season of headaches and the most common among them are sinus and migraine. An early diagnosis of both types can help cure them better.

Sinusitis is an infection of the small, air filled cavities within our facial skeleton called sinuses. When there is a blockage of the sinuses, or when the cilia fail to move the mucus, then an infection can occur.

The cilia do not move the bacteria out of your body so they can multiply and make you sick. Moreover anything that causes a swelling in the nose - an infection, an allergic reaction, or another type of immune reaction - also can affect the sinuses.

In sinusitis, the sinus tissue is infected and inflamed. Bacteria  and sometimes even fungi are present. The tissues in the sinonasal passages are swollen and inflamed. Mucopurulent discharge is often visible.

The same disease pathology can spread to the throat , airways and lungs causing seemingly unrelated symptoms such as chronic throat irritation, throat pain and cough.

Sinusitis versus common cold

Because your nose can get stuffy when you have a common cold, you may not know the difference between the two. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold. There are 2 main types of sinusitis : acute and chronic

Acute Sinusitis

Essentially in acute sinusitis, you get over the attack fully. Might take a month but then you are clear. If we take an X ray at the start of the blockage, fever and pain, we generally see fluid in the sinus cavity, membranes and sinus openings  are swollen. With appropriate treatment it fully clears.

Chronic Sinusitis

In Chronic Sinusitis, the symptoms have been present for weeks to months  or is the same infection that the patient  had months ago but never fully recovered from.

The underlying factors leading to such chronic infection from an acute event may be antibiotic resistance, failure of the cilia, or any problem that causes blockage and prevents the sinuses from draining properly . The most common cause of sinusitis is a cold, or influenza (flu).

The viruses that cause these conditions spread to the sinuses and, sometimes, a secondary bacterial infection can lead to further swelling and inflammation and acute sinusitis. Inappropriate treatment  of the acute episode or the presence of predisposing factors can lead to a chronic debilitating condition.

Symptoms

Common symptoms of sinusitis include:

*pain and tenderness of the affected sinus which may be headache, eye pain, toothache, facial pain
a blocked or runny nose

*fever- which is a feature of the acute variety

*tiredness, feeling of being unwell.

*postnasal drip (felt in the throat)

*bad breath (halitosis),

*pressure in your ears, ringing in ears and even impaired hearing can result due to eustachian tube blockade

*impaired  taste and smell

Diagnosis

There are many mimickers of the so called "sinusitis"  including nasal polyps, nasal cancers, foreign bodies, allergy,atrophic rhinitis and it is of utmost importance not only to clinch the correct diagnosis but also to discern all predisposing factors.

Diagnosis entails a thorough ENT and head and neck evaluation including endoscopy and blood tests. Imaging studies such as xrays and CT scans may be done both to diagnose as well as plan the most appropriate treatment.

Treatment

Acute cases often respond well to appropriate antibiotics. Chronic cases are challenging to treat and it is crucial to address the underlying predisposing conditions such as allergy, deviated septum etc.

Dr Prateek Nayak
The author is an ENT Consultant, Columbia Asia medical Center-Hebbal Ph: 080-41791000