Sinusitis

WHAT IS SINUSITIS?

WHAT ARE THE MEDICAL AND SURGICAL TREATMENTS?

The sinuses are air-filled spaces inside the skull and facial bones around the nose. There are five pairs of sinuses. These are:

• The cheek sinuses (maxillary sinuses),
• The forehead sinuses (frontal sinuses),
• The sinuses between the eyes (anterior and posterior ethmoid sinuses)
• The sinuses at the back of the nose (sphenoid sinuses)

In babies and children, the sinuses largely take on their adult appearance, developing as they fill with air, by the age of 12–14. However, they reach their final shape at around 22–24 years of age.

Their functions are:

• To warm the air we breathe,
• To clean it by filtering out small particles,
• To humidify it,
• To secrete mucus,
• To trap bacteria and prevent them from multiplying,
• To make the head and face lighter,
• To give the voice a bright, melodic quality.

Sinusitis: Inflammation of the cell layer lining the sinuses. The openings of the sinuses swell and become blocked. The roughly half a liter of secretions normally produced by the sinuses cannot drain out and becomes infected within a few days. This almost always occurs together with inflammation of the lining inside the nose (rhinosinusitis).

Causes of Sinusitis

• Viral or bacterial upper respiratory tract infections (URTIs): the most common cause of sinusitis.
• Swelling due to allergies,
• Deviation of the cartilage and bone inside the nose (deviated septum),
• Polyps,
• Enlarged turbinates (turbinate hypertrophy),
• Enlarged adenoids, especially in children,
• Tumors of the nose and nasopharynx,
• Pressure changes during swimming or air travel.

Symptoms of Sinusitis

Symptoms vary from person to person. The main complaints are nasal congestion, a change in voice, a feeling of fullness in the face, and nasal discharge and postnasal drip (thick and yellow-green).

• Headache and facial pain (worse when bending forward, spreading to the teeth, palate and nose),
• A persistent cough at night or toward morning,
• A feeling of pressure around the eyes,
• Bad breath, impaired sense of smell, nausea and/or vomiting,
• A cold (common cold/flu) lasting more than 10–14 days, sometimes with a mild fever,
• Postnasal drip, sometimes with a burning sensation in the throat,
• Behavioral changes,
• A headache that does not go away for a long time
• Weakness and fatigue,
• Sleeping with the mouth open at night, snoring

Classification of Sinusitis

• Acute sinusitis
• Chronic sinusitis
• Subacute sinusitis
• Recurrent acute sinusitis
• Acute exacerbation of chronic sinusitis

Acute Sinusitis

It usually develops following an upper respiratory tract infection such as a cold or flu. Fever, purulent yellow-green nasal discharge, postnasal drip, nasal congestion, headache, an irritating cough at night and pain over the sinuses are common symptoms. The diagnosis is made by physical examination. Imaging may be used if needed.

Treatment of Acute Sinusitis

A patient diagnosed with sinusitis is treated with appropriate antibiotics, nasal sprays, painkillers and decongestants. Antiallergic medications are added for patients thought to have allergies. It is important to clean the inside of the nose by rinsing or spraying it with water and to keep it open.

What Is Chronic Sinusitis?

It is a chronic disease lasting at least 12 weeks and characterized by nasal congestion, a reduced sense of smell, nasal discharge and postnasal drip, and facial pressure and pain. The diagnosis is made with sinus endoscopy and a sinus CT scan. Before a CT scan, the patient should have received proper medical treatment. Apart from infection, structural abnormalities in the nose, foreign bodies, tumors and polyps, as well as allergies, may play a role.

Treatment and Surgery for Chronic Sinusitis

The factors causing chronic sinusitis must be identified carefully. Correcting them is essential to treatment. First, correct and adequate medical treatment is tried. If this does not help, or if there are structural abnormalities (deviated septum, enlarged turbinates, nasal polyps, enlarged adenoids, tumors, etc.), these must also be corrected surgically.

Endoscopic Sinus Surgery

Chronic sinusitis surgery is now almost always performed endoscopically. General anesthesia is preferred. The surgery should be performed in a way that preserves the normal structure and functions of the nose. An endoscope and a microdebrider (a device that breaks up and suctions out polyps and masses) are used.

A CT scan should be taken before surgery. The operation takes about 1–1.5 hours. Nasal packing may need to be placed for one day. Significant pain after surgery is rare.