Sinus Disease

Chronic Sinusitis

Nasal sinuses are hollow, air containing cavities in the skull behind the forehead and cheeks of the face. There are four pairs of sinuses and these are referred to as the paranasal sinuses. Sinusitis occurs when one or more sinusesbecome infected causing inflammation of the membranes that line the sinus cavity. Sinusitis is a common problem affecting millions of people around the world.

Sinuses

There are four paired sinuses called Paranasal Sinuses. The paranasal sinuses consist of the following:

• Ethmoidal Sinuses: These are paired sinuses located in between the eyes and nasal cavity. Each sinus consists of 4 – 18 air containing cavities – the ethmoidal air cells. These sinuses are present at birth and continue to grow until adolescence. The anterior air cells open into the middle meatus and the posterior group open into the superior meatus.
• Maxillary Sinus: It is the largest of all sinuses with a volume of about 15 ml. These are paired cavities located inside the face around the area of the cheeks. This sinus is also present at birth and continues to grow afterwards. The sinus opens into the middle meatus.
• Frontal Sinus: This is the last of the sinuses to develop. These are paired cavities located inside the face around the area of the forehead. The sinuses open into the middle meatus.
• Sphenoid Sinus: These are also paired cavities located deep in the face behind the nose. Each sinus has a volume of about 7.5 ml. They open into a small recess behind the superior meatus.

Sinusitis means your sinuses are infected or inflamed. Health experts usually divide sinusitis cases into:

• Acute cases, which last for 4 weeks or less
• Subacute cases, which last 4 to 12 weeks
• Chronic cases, which last more than 12 weeks and can continue for months or even years
• Recurrent cases, which involve several acute attacks within a year

Causes of Chronic Sinusitis

• In chronic sinusitis, the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed.
• Most experts now use the term “chronic rhinosinusitis” to describe this condition, and they also recommend that the condition be divided into rhinosinusitis with or without nasal polyps.
• Nasal polyps are grape-like growths of the sinus membranes that protrude into the sinuses or into the nasal passages. Polyps make it even more difficult for the sinuses to drain and for air to pass through the nose.
• The causes of chronic sinusitis are largely unknown. The condition often occurs in people with asthma, the majority of whom have allergies.
• It is possible that constant exposure to inhaled allergens that are present year-round, such as house dust mites, pets, mold (a kind of fungus), and cockroaches cause chronic inflammation of the nose and the sinuses.
• An allergic reaction to certain fungi may be responsible for at least some cases of chronic sinusitis; this condition is called “allergic fungal sinusitis.” However, at least half of all people with chronic rhinosinusitis do not have allergies.
• Most health experts believe that chronic rhinosinusitis is not an infectious disease (like acute sinusitis).
• If you suffer frequent episodes of acute sinusitis, however, you may be prone to develop chronic rhinosinusitis.
• Other causes of chronic rhinosinusitis may be an immune deficiency disorder (for example, primary immune deficiency disease or HIV infection) or an abnormality in the quality of mucus produced by the respiratory system (cystic fibrosis).
• Another group of people who may develop chronic sinusitis are those with significant anatomic (structure) variations inside the nose, such as a deviated septum, that lead to blockage of mucus.

Diagnosis

Because your nose can get stuffy when you have a condition like the common cold, you may confuse simplenasal congestion with sinusitis. A cold, however, usually lasts about7 to 14 days and goes away without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than a cold.

Your doctor can usually diagnose acute sinusitis by noting your symptoms and doing a physical examination, which includes examining your nasal tissues. If your symptoms arevague or persist, your doctor may order a computed tomography (CT)scan, a form of X-ray, to confirm that you have sinusitis.

Laboratory tests your doctor may use to diagnose chronic sinusitis include:

• Blood tests to rule out conditions associated with sinusitis, like an immune deficiency disorder
• A sweat test or a blood test to rule out cystic fibrosis
• Tests on the material that is inside your sinuses to detect bacterial or fungal infection
• Biopsy of the membranes (linings) of the nose or sinuses to determine the health of the cells lining these cavities

Conservative Treatment

After diagnosing sinusitis and identifying a possible cause, your doctor can suggest various treatments.

Chronic Sinusitis

• Doctor often find it difficult to treat chronic sinusitis successfully.
• The two main forms of treatment that are used, nasal steroid sprays and long courses of oral antibiotics, alone or in combination, have not been rigorously tested in chronic sinusitis. Scientists need to do more research to determine what the best treatment is.
• Many doctors also recommend using saline (saltwater) washes or sprays in the nose to help remove thick secretions and allow the sinuses to drain.
• If you have severe chronic sinusitis, your doctor may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.

Surgery

When medicine fails, surgery may be theonly alternative for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. During surgery, usually done through the nose, the surgeon:

• Enlarges the natural opening of the sinuses
• Removes any polyps

Corrects significant anatomic deformities that contribute to the obstruction