Sinusitis: how to recognise and treat it

By Cristiano Antonino On Jan 21, 2022

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Sinusitis: what causes it? The paranasal sinuses are cavities located in the thickness of the skull bones, connected to the nose by small ducts (osti) which allow mucus to pass through

They can be divided into

frontal: located above the eye sockets, in the frontal bone;
maxillary: located below the eye sockets, in the upper part of the maxillary bone, up to the upper dental arch;
ethmoidal: located between the two eye sockets, in the ethmoid bone;
sphenoidal: located at the back of the eye sockets, within the sphenoid bone.

Types of sinusitis

Depending on the duration of symptoms, sinusitis can be

acute: 3 to 7 days;
subacute: up to 3 months, with no general improvement in symptoms;
chronic: more than 3 months.

Causes of sinusitis

Sinusitis occurs due to an increase in the body’s production of mucus as the ostia narrows.

This leads to a real blockage and stagnation of secretions, encouraging the proliferation of pathogens that can reach the paranasal sinuses from the nostrils.

The causes that can lead to this pathology are mainly inflammatory, and are generally due to

viruses, such as the cold virus, which in 0.5%/2% of cases can develop into a bacterial form;
mycetes, fungal infections generally attributable to odontogenic causes affecting the maxillary sinuses given their relationship with the teeth of the upper jaw;
allergies;
anatomical factors such as deviation of the nasal septum, concha bullosa (an abnormal expansion of the middle turbinate bone due to pneumatisation) which can contribute to poor ventilation and drainage of the sinuses, etc;
trauma;
adenoiditis: in paediatric patients, sinusitis is often due to neglected or inadequately treated inflammation of the adenoids.

Sinusitis: the symptoms

Sinusitis often results in the common symptom of headache (headache) and facial pain, usually located in the area affected by the inflammation, i.e. above, behind or below the eyes, in the jaw or on the forehead.

In addition to this, the classic symptoms that characterise it are:

cold with nasal discharge or a runny nose for a period of more than 15 days;
sensation in the throat of secretions coming from the nose;
nasal congestion (stuffy nose);
productive cough (with phlegm);
reduction or absence of taste and smell (anosmia/hyposmia, ageusia/hypogeusia);
feeling of localised swelling of the eyes
fever.

Diagnosis

The diagnosis of sinusitis is made by the specialist on the basis of the symptoms reported by the patient and clinical observation.

The presence of 2 or more of the symptoms indicated, combined with obstruction of the ostia and mucus identified during the endoscopic physical examination can help to delineate the clinical picture, with confirmation coming from computed tomography (CT) of the facial mass.

How to treat sinusitis

The treatment of sinusitis generally involves the use of corticosteroids and mucolytics taken orally or by aerosol, which can exert a decongestant action, combined with nasal washes with physiological or hypertonic solutions.

If there is pain, the doctor may also prescribe painkillers and antihistamines to reduce mucosal swelling and symptoms.

In the case of bacterial sinusitis, an antibiotic is also prescribed for a period of 8-10 days.

When to use endoscopic FESS surgery

Endoscopic FESS (Functional Endoscopic Sinus Surgery), which mechanically unblocks the sinuses, is indicated in cases of:

failure to respond to medical and pharmacological therapy
for recurrent, chronic or complicated forms;
for fungal sinusitis.

How to prevent sinusitis

There is no real prevention.

What can be done is to maintain a healthy immune system with a healthy diet; rich in fruit and vegetables and combined with the right daily intake of water, including hot drinks, together with good room humidification.

Sinusitis or Covid-19?

Rhinitis (cold) associated with headache, reduction or absence of taste and smell, cough, are symptoms that characterise both sinusitis and Sars-Cov-2.

One could say that Covid-19 would seem to be characterised more frequently, although this is not always the case, by a dry cough and more respiratory symptoms than sinusitis, but, if the timing in relation to anti-Cov-2 vaccination, the lifestyle, and the clinical history of the patient and his family do not help to formulate a differential diagnosis, only tests to detect the new Coronavirus can do so.

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Source:

GSD