The word sinus means “shallow space” in Latin. Sinuses with a total of 4 pairs are named according to the bones they are between. The sinus located close to the cheekbones on both sides of the nose is called the maxillary sinus. The frontal sinuses are located in the frontal bone, which forms the front of the head. Sinuses on both sides of the nose close to the eyes are called ethmoid sinuses. The sinus located behind the eyes and inside the skull is the sphenoid sinus.
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What is sinusitis?
Sinuses are cavities located inside the facial bones and skull. They are lined with respiratory tract cells. The functions of these structures include heating the inhaled air, humidifying, holding foreign particles, secreting mucus and keeping bacteria from multiplying.
Inflammation of the cell layer covering the sinuses is called sinusitis. In sinusitis, the mouth of the sinuses is edematous and clogged. This can be caused by both bacteria and viruses.
Sinusitis is a health problem that is basically examined in 4 subgroups.
- Acute Rhinosinusitis
It defines the sinusitis discomfort of sudden onset and returning to normal within 4 weeks at the latest.
- Subacute Rhinosinusitis
It is the state of acute rhinosinusitis that lasts for a maximum of 12 weeks, but at the end of this period the problem has disappeared.
- Recurrent Acute Rhinosinusitis
It refers to the occurrence of four or more acute sinusitis attacks within 1 year in which the symptoms persist for at least 1 week.
- Chronic Rhinosinusitis
What causes sinusitis?
There can be many reasons for the formation of sinusitis. In general, the causes of sinusitis occur with the combination of personal factors and environmental factors. The most common cause of acute sinusitis is viruses, and this condition usually tends to be self-limiting. Approximately 90% of individuals with a cold have signs and symptoms of sinusitis.
People with an allergic constitution are classified as atopic. Sinusitis attacks may occur frequently in atopic individuals. Environmental factors such as air pollution, animal hair, cigarette smoke and dust are at the forefront in the development of sinusitis in these people. Allergies also cause the development of chronic sinusitis.
Adenoid, nasal curvature, cystic fibrosis, immune system insufficiency, strong blowing are among the causes of chronic sinusitis. In addition, swimmers who are constantly under water can develop sinusitis. Polyps and tumors in the nose, foreign body, anatomical abnormalities in the nose and dental infections are among the other factors that cause sinusitis.
Sinusitis, which means sinus inflammation, is a condition that can be encountered in everyone. There may be a predisposition to the development of sinusitis in case of certain disorders and various conditions.
The wall structure in the middle of the nose is called the septum. If the septum is tilted to the right or to the left, it is called septum deviation. In individuals with septum deviation, a closed environment is formed due to the obstruction of air passage from one side of the nose, and the reproduction of microorganisms can be facilitated here.
In addition to deviation of the septum, in some other cases, people may develop a sinus infection.
- nasal polyps
- Allergy history
- Mold exposure
- weakened immune system
- Tobacco use
- Recent upper respiratory tract infection
- Cystic fibrosis
- Frequent travel by plane
What is acute sinusitis?
Acute sinusitis refers to short-term sinus inflammation with nasal congestion, cheekbone, eye area and a feeling of fullness on the forehead. Acute sinusitis generally occurs after viral respiratory tract infections. Apart from viruses, bacteria and fungi are microorganisms that can cause acute sinusitis.
Among the most common viral acute sinusitis agents are rhinovirus, adenovirus, influenza virus and parainfluenza virus. Bacteria such as streptococcus pneumoniae, haemophilus influenzae and moraxella catarrhalis can be counted as examples of microorganisms that cause acute bacterial sinusitis. It is rare for fungi to cause acute sinusitis, and fungi can be detected as the causative agent of acute sinusitis, especially in people with immune system problems.
Allergic conditions other than infectious agents; Acute sinusitis may also develop in people due to genetic diseases such as nasal polyps, adenoid infections and cystic fibrosis, where the internal secretions are quite thick.
After the occurrence of acute sinusitis, various signs and symptoms occur in people:
- Nasal fullness and congestion
- thick runny nose
- Throat ache
- Cough that gets worse at night
- Postnasal drip
- Sensation of pressure in the sinuses of the face
- Bad breath
- Problems with the sense of smell and taste
Three of these symptoms are of diagnostic importance for acute sinusitis. Nasal congestion accompanying a thick nasal discharge and a feeling of pain, fullness or pressure in the face area constitute these 3 symptoms. Headache alone is not of diagnostic importance for acute sinusitis, whereas facial fullness may sometimes be sufficient for the diagnosis of acute sinusitis. Acute sinusitis cases due to viruses usually tend to regress within 3-5 days.
If symptoms persist for 10 days or more, or tend to subside for a while and then worsen, these people may indicate that the underlying cause of sinusitis is a bacterial infection. Unlike adults, fever may accompany other symptoms in acute bacterial sinusitis in children. Initially, the child’s runny nose is water-like, but it darkens over time. Approximately 80% of people who develop acute bacterial sinusitis have a history of upper respiratory tract infection.
What is chronic sinusitis?
Sinusitis is considered to have become chronic if it lasts longer than 12 weeks. Chronic sinusitis is caused by the combination of infectious diseases, structural factors and inflammatory conditions. Chronic sinusitis may occur in the person after environmental factors such as allergens such as dust and mold, cigarette smoke and loss of function in the cilia structures responsible for clearing mucus in the respiratory tract. Apart from these reasons, chronic sinusitis may also be encountered during the course of middle ear infections or in asthma patients.
Hay fever is one of the leading allergic causes that can cause chronic sinusitis. Pollen and various chemicals are among the environmental allergen factors and may cause chronic sinusitis by causing inflammation in the nasal mucosa. Asthma is another cause of chronic sinusitis because it causes a chronic inflammatory response in the airways. Apart from these situations, chronic sinusitis may also occur in people with reflux disease who have stomach acid returning to the esophagus for various reasons.
Many signs and symptoms may occur in people who develop chronic sinusitis:
- Trouble with taste and smell
- Yellow-green nasal and postnasal discharge
- Thick mucus causing nasal congestion
- The leakage of mucus from the nose into the nasal cavity, defined as postnasal drip
- Feeling of tension and discomfort in the eye, forehead and cheek area
- Jaw and toothaches
- extreme tiredness
- feeling of nausea
In people with symptoms of sinusitis, if this situation takes a long time and is not intervened, this disease may progress and lead to the development of important health problems. Difficulty in breathing continuously due to long-term sinusitis can cause the body to not get enough oxygen, causing the person to feel tired all the time. Apart from this situation, various very important health problems may manifest themselves in untreated sinusitis cases:
- Permanent loss of sense of smell due to the involvement of the olfactory nerve, which is responsible for the perception of smell in the brain,
- Vision problems due to skin infections or abscesses that may occur when the infection in the sinuses spreads to the eye area,
- The development of meningitis, which means inflammation of the meninges due to the proximity of the sinuses to the meninges,
- Infection of the skull bones.
How is sinusitis diagnosed?
Acute sinusitis is basically a disease that can be diagnosed based on clinical symptoms. The most important factor that determines whether antibiotic drugs will be included in the treatment planning is to distinguish whether the symptoms of the person with the symptoms and signs of acute sinusitis are caused by a viral or bacterial factor in the physical examination performed by the physician after their application to the health institutions.
Symptoms that occur with acute sinusitis are divided into 2 categories as major and minor. In order to make a clinical diagnosis, the presence of at least 2 major criteria or 2 minor criteria accompanying 1 major criterion is required.
Dark nasal discharge, postnasal drip, nasal congestion, facial fullness, loss of taste and smell, and fever are the major criteria in the clinical diagnosis of acute sinusitis. Minor criteria include headache, earache, bad breath, toothache, and fatigue.
Although many laboratory tests are not used in the diagnostic approach to acute sinusitis, sometimes when the physician thinks that the underlying cause of sinusitis is a bacterial infection, he may want to see the level of markers indicating inflammation in the patient’s bloodstream. High levels of CRP and ESR among these markers may indicate a bacterial infection. The gold standard diagnostic method in bacterial acute sinusitis is culture culture of samples taken from the patient’s respiratory tract endoscopically with the help of aspirate. The nasal endoscope also allows the detection of structural abnormalities and inflammations of the nasal and sinuses.
Generally, radiological imaging examinations are not required in acute sinusitis cases. Sometimes, a radiological examination called sinus radiography may be requested by the physician in people with a different course of the disease. The presence of air-fluid level in the sinuses on this X-ray indicates sinusitis, but does not provide any information to distinguish whether the source of the problem is bacterial or viral.
In cases of recurrent and severe acute sinusitis, sinus CT (computerized tomography), another radiological examination, can be used. With this examination, air liquid level and blockages can be detected. Detection of intra-sinus mucosal tissue thickened more than 5 mm in computed tomography images indicates inflammatory changes in this region. With this examination, problems related to bone structures can also be easily detected.
Chronic sinusitis is less common than acute sinusitis. The criteria used for the diagnosis of chronic sinusitis are similar to the criteria for acute sinusitis. In general, for the diagnosis of chronic sinusitis, at least 2 of the symptoms of thick discharge, pain in the face and tooth region, nasal congestion and decreased smell should be present for more than 12 weeks.
In addition to these symptoms, it is imperative to document inflammation within the sinuses by computed tomography or nasal endoscopy to confirm the diagnosis of chronic sinusitis. In cases of chronic sinusitis developing on an allergic basis, general allergy tests may be among the tests requested by physicians.
How is sinusitis treated?
Supportive treatment is generally applied to patients with acute sinusitis. The aim of supportive treatment is to control the symptoms that occur due to this condition. Ambient air humidifiers, nasal sprays and increasing fluid intake are among the applications included in the supportive treatment.
Increasing the amount of water consumed daily is one of the main applications that can be done for the natural treatment of sinusitis. Consumed liquids soften the thick mucus and facilitate its drainage.
Intranasal steroid applications in people with edema in the intranasal mucosal tissue can reduce the edema and relieve the problem of nasal congestion. In acute sinusitis cases with allergic causes, drugs classified as antihistamines can be applied.
If it is determined that the cause of acute sinusitis is a bacterial infection, antibiotic drugs can be added to the treatment plan.
There is no single generally agreed treatment plan for the treatment of chronic sinusitis. In the treatment of this disease, it may be necessary to avoid triggering factors, reduce inflammation, and if there is an underlying infectious disease, it may be necessary to treat it. In general, the treatment of chronic sinusitis varies depending on the underlying cause.
If the underlying cause of chronic sinusitis is understood to be allergic conditions, the basis of treatment is to identify the factors that trigger the allergic response and to determine how the patient can avoid these factors. These patients may also be prescribed antihistamine drugs.
In the medical treatment methods, intranasal steroid applications for a period of 8-12 weeks and antibiotic drugs used for a long time such as 3 weeks are included.
While nasal decongestant sprays provide relief from nasal congestion in short-term use, care should be taken as they can worsen the existing picture in long-term use.
Nasal polyps are benign formations in the nose that can cause chronic sinusitis. If there is no improvement in this problem after 12 weeks with topical intranasal steroid applications, short-term oral steroid drugs can be applied. The reason for the short-term use of these drugs is due to the side effects they can cause.
Surgical interventions can be considered as another treatment option in chronic sinusitis cases that do not respond to medical treatment. Expansion of the sinus cavities and increasing their drainage can be achieved with various surgical applications. These endoscopic surgeries help to remove blockages and re-vent the sinuses properly. Approximately 75% of patients with chronic sinusitis who do not respond to medical treatment benefit from surgical treatment.
It is an issue that should be considered that chronic sinusitis patients should continue their medical treatment in order to prevent these problems from reoccurring after treatment with surgical interventions.
What can be done to prevent the development of sinusitis?
Thanks to various practices and lifestyle changes, it may be possible to prevent sinusitis:
- Strengthening the immune system with a healthy and balanced nutrition program,
- Avoiding triggers such as air pollution and cigarette smoke,
- Avoiding contact with people showing signs of respiratory tract infection,
- Washing hands regularly and giving importance to hand hygiene,
- Using various humidifiers in order to prevent the ambient air to be dry,
- Get an annual flu vaccine
- In case of having allergic disorders, to be treated for these disorders,
- If there is a predisposition to the development of chronic sinus infection, to apply regularly for nasal opening applications.