Sinusitis

Rhino-Sinusitis

What is sinusitis?

The sinuses are a connected system of hollow cavities in the skull surrounding the nose.The paranasal sinuses open into the nasal cavity and are lined with cells that make mucus to keep the nose from drying out during breathing and to trap unwanted materials so that they do not reach the lungs.Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses.
There are several types of sinusitis. 

Health experts usually identify them as follows:

• Acute, which lasts up to 4 weeks
• Subacute, which lasts 4 to 12 weeks
• Chronic, which lasts more than 12 weeks and can continue for months or even years
• Recurrent, with several attacks within a year.

Symptoms

• Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat
• Nasal obstruction or congestion, causing difficulty breathing through your nose
• Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead
• Aching in your upper jaw and teeth
• Reduced sense of smell and taste
• Cough, which may be worse at night.

Other signs and symptoms can include: 

• Ear pain
• Headache
• Sore throat
• Bad breath (halitosis)
• Fatigue
• Fever

When to see a doctor:
Symptoms that don't improve within a few days or symptoms that get worse
A persistent fever
A history of recurrent or chronic sinusitis

Diagnosis

Physical exam.

To look for the cause of your symptoms, your doctor will feel for tenderness in your nose or throat. Your doctor may use a tool to hold your nose open and apply medication that constricts blood vessels in your nasal passages. Your doctor will then shine a light into your nasal passages to look for inflammation or fluid. This visual inspection will also help rule out physical conditions that trigger sinusitis, such as nasal polyps or other abnormalities.

Nasal endoscopy. 

A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses

Imaging studies. 

Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical obstruction that's difficult to detect using an endoscope.

Nasal and sinus cultures. 

Laboratory tests are generally unnecessary for diagnosing acute sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial cause.

Allergy testing. 

If your doctor suspects that the condition may be brought on by allergies, an allergy skin test may be recommended. A skin test is safe and quick, and can help pinpoint the allergen that's responsible for your nasal flare-ups.

Treatment

Acute sinusitis

• Antibiotics to control a bacterial infection, if present
• Pain relievers to reduce any pain
• Decongestants (medicines that shrink the swollen membranes in the nose and make it easier to breathe.

Chronic sinusitis

• Nasal steroid sprays are helpful for many people..
• Saline (saltwater) washes or saline nasal sprays can be helpful in chronic rhinosinusitis because they remove thick secretions and allow the sinuses to drain.
• Oral steroids, such as prednisone, may be prescribed for severe chronic rhinosinusitis. However, oral steroids are powerful medicines with significant side effects, and these medicines typically are prescribed when other medicines have failed.
• Surgery 

When medicine fails, surgery may be the only alternative for treating chronic rhinosinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. 

Nasal surgery usually is performed to accomplish the following:

• Enlarge the natural openings of the sinuses
• Remove nasal polyps
• Correct significant structural problems inside the nose and the sinuses if they contribute to sinus obstructionAlthough most people have fewer symptoms and a better quality of life after surgery, problems can reoccur, sometimes even after a short period of time.