RHINITIS AND SINUSITIS: SINUSITIS

Sinusitis is an inflammation and infection of the moist air cavities, called sinuses, located around the nose, behind the cheeks and in the forehead above the eyes. Sinusitis is considered acute when it lasts for fewer than 30 days and chronic when it persists for more than 30 days. The infection may be caused by bacteria, such as streptococcal bacteria or by viruses including rhinovirus, influenza and parainfluenza. The infection is sometimes due to fungal infections or allergic reactions. In rare instances, a dental infection is associated with sinusitis. An upper respiratory tract infection sometimes precedes sinusitis and is often associated with it.

Sinusitis occurs when the mucous membrane of the nose becomes swollen and obstructed. Secretions from the mucous membrane may then fill the affected sinus, and this accumulated fluid becomes a medium for bacteria or other infective agents. Children most commonly acquire infections that involve the sinuses around the nose and behind the cheeks, while teens and adults generally find that their sinuses in the forehead are more commonly involved.

Symptoms, Diagnosis and Treatment

Swelling and tenderness in the affected sinus or sinuses is usually the first sign of sinusitis. Headache is a common symptom, and there may be a discharge of yellow or green mucus from the nose. Pain behind and between the eyes accompanied by a severe headache may also occur. Fever, chills and malaise may indicate spread of the infection. In children, sinusitis causes a runny nose or nasal congestion. A fever and discharge of a thick, green or yellow mucus from the nose then develop. There may be swelling around the eyes, bad breath and tenderness or a heavy sensation in the cheeks or around the nose. When sinusitis is chronic, a child may snore during sleep or have a persistent cough that interrupts sleep. Pain around the upper teeth may be mistaken for a dental problem, but in the presence of other symptoms, is usually produced by infection in the sinuses in the cheeks.

Sinusitis may be diagnosed by an evaluation of physical symptoms. CT (computed tomography) scans or X rays of the sinuses may be performed to determine the extent and degree of the infection. Dental X rays may be necessary to exclude the possibility of a dental abscess. In children, if fluid has accumulated in the sinuses, the fluid may be gently suctioned out through the nose. In cases of chronic sinusitis, the doctor may suggest an examination to detect nasal polyps or enlarged adenoids.

Adults are treated for sinusitis by methods to improve nasal drainage and control infection. Steam inhalation and saline nasal washes may be used to promote drainage of the sinuses. Medications to constrict swollen membranes and open up the sinuses may be prescribed or recommended, either in topical form or to be taken orally. A course of oral antibiotic therapy of at least 10 to 12 days' duration is generally prescribed to control infection. In some cases of chronic sinusitis, antibiotic therapy may be prolonged over a period of four to six weeks. When sinusitis does not respond to antibiotics, functional endoscopic sinus surgery may be necessary. Children are treated for sinusitis with a two- to three-week course of oral antibiotics, usually amoxicillin, which may be changed to another antibiotic if symptoms do not improve within two days. Chronic sinusitis may require antibiotic therapy lasting as long as six weeks. Decongestants may also be prescribed in some cases. Acetaminophen may be recommended to reduce fever and relieve pain associated with sinusitis. A cool-mist vaporizer may be used to help open clogged nasal passages. Increased fluid intake is generally recommended. Older children may be more comfortable with an extra pillow to elevate the head when in bed. Decongestant nose drops and sprays are usually not advised as they can make symptoms worse if used too frequently or over long periods.