Sinusitis: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On Jun 17, 2023

Sinusitis is an inflammatory process that affects one or more paranasal sinuses. These are small air-filled cavities located behind the cheeks and forehead

The mucus produced by the sinuses usually drains into the nose through small channels.

When the mucous membrane of the sinuses becomes inflamed (and therefore swells) it blocks the channels causing sinusitis

In most cases the inflammation is caused by a viral infection (as happens with a common cold) and passes within 2-3 weeks, without the need for treatment or resorting to simple self-medication.

Incidence and typology

Sinusitis can be acute: lasting less than 6-8 weeks or occurring less than 4 times a year with a duration of at least 10 days and resolves with adequate medical treatment.
Chronic sinusitis: lasting more than 6-8 weeks or occurs more than 4 times a year with a duration of at least 10 days and does not resolve completely with adequate medical treatment.

Rhinosinusitis is the most frequent sequela of a cold or vasomotor rhinopathy and, taking into account that at least 90% of the population has cold episodes, one can imagine the impact of this pathology.

5% of the Italian population is affected by chronic sinusitis.

It is present in 25-30% of rhinitis patients (allergic, vasomotor rhinopathy) and in 40-45% of asthmatic patients.

Prevalence is higher in women and tends to increase with age (> 45 years).

Symptoms of sinusitis

The symptoms of sinusitis vary according to its evolution, in acute or chronic forms.

Disorders that may be associated with sinusitis include:

heachache
stuffy nose
cold or runny nose for more than 7-10 days
decreased taste (dysgeusia) and smell (anosmia)
cough with phlegm
fever
sore throat
swelling around the eyes
bad breath (halitosis)
toothache

Often together with the attack of sinusitis, the sensation of plugged ears is recorded: this happens because when the nose has difficulty breathing, not only the paranasal sinuses are affected but also the Eustachian tube (duct that connects the nose with the middle ear).

Sinusitis in the acute form

Acute sinusitis can also lead to a yellowish-green discharge containing pus.

This yellow mucus flows from the site of inflammation down to the nose or throat (retropharyngeal drain).

The most common symptom of acute forms of sinusitis is the onset of unilateral facial pain, which usually affects the cheeks, just below the eyes, and the jaw.

The feeling of pressure on the face can also extend to the eye sockets and the sense of heaviness is exacerbated when the head is moved or when pressure is applied to the paranasal sinuses affected by inflammation.

In the acute form, the manifestations tend to resolve within two to three weeks (complete recovery in less than 30 days).

If they last longer, even for two months or more, it means that sinusitis has become chronic.

The symptoms of the latter are more attenuated and protracted over time, with peaks on certain occasions, such as following a cold or a cold.

Usually, affected patients experience intermittent pain in the face, along with a feeling of heaviness in the eye and on the side of the nose.

Although it does not generate particularly annoying symptoms, the inflammation extends and, in the most serious cases, can compromise the structure of the bones.

The complications of chronic sinusitis are linked to the exacerbation of the chronic process and can be divided into extracranial and intracranial.

The extracranial are bony (eg frontal sinus osteomyelitis) and orbital (periorbial cellulitis, subperiosteal or orbital abscess).

Intracranial are meningitis, brain abscesses and thrombophlebitis of the dural venous sinuses.

Causes of rhinogenic and odontogenic sinusitis

Depending on the origin of the inflammation of the paranasal sinuses, it is possible to distinguish between rhinogenic and odontogenic sinusitis.

Rhinogenic sinusitis is caused by the decrease or complete blockage of ventilation, i.e. the entry of air into the nasal cavity during breathing.

This causes an increase in the production of mucus (causing a narrowing or obstruction of the ostia of the paranasal sinuses) and prevents the normal drainage of secretions towards the nasal cavity.

The stagnation of mucus in the paranasal sinuses can induce the development and proliferation of pathogenic microorganisms, which, from the nose to the throat, can reach the paranasal sinuses.

In these cases, infection is added to the inflammation.

Rhinogenic sinusitis can have a viral (most common form), bacterial or fungal genesis

In general, sinusitis occurs following an acute (i.e. a cold) or chronic (allergic or hypertrophic) rhinitis.

Rhinogenic sinusitis can also be caused by:

the anatomical alterations of the nasal structures,
allergies
trauma (especially the fracture of the bones that surround the paranasal sinuses).

Odontogenic sinusitis, on the other hand, is the consequence of infectious dental pathologies.

Sometimes, in fact, it can happen that a periapical abscess of a maxillary tooth spreads to the overlying sinus.

Infections of the upper arch of the teeth can also be transmitted to the paranasal sinuses as a result of:

unsuitable placement of dental implants
dental care performed incorrectly (e.g. tooth extractions, inadequately treated oro-antral fistulas and endodontic therapies).

The alteration of the ventilatory function is at the basis of the generation of sinusitis as an alteration of the air exchange and of the gaseous exchanges at the level of the paranasal sinuses following the inflammatory edema produces effects of accumulation and superinfection of the mucus contained therein.

Chronic sinusitis diagnosis

The presence of a deviated nasal septum or some sinus anatomical variants are among the predisposing factors. In these cases, particular types of stenosing septal deviations or the presence of variants such as for example the “concha bullosa” can predispose following an inflammatory insult to greater difficulty in breathing and blockage of the paranasal sinuses.
Facial trauma involving the breakage of one or more of the bony elements that make up the paranasal sinuses;
Respiratory tract infections.

The most common respiratory tract infections that can cause sinusitis are colds, flu.

These infections, supported by Rhinovirus, Coronavirus, Mixovirus and Adenovirus are responsible for an inflammatory process that affects the mucous layer of the paranasal sinuses.

They represent the ideal conditions for the growth of bacterial agents, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphiloccoco aureus.

Dental infections, which have spread to the maxillary bones of the skull and which have induced an inflammatory process in the maxillary sinuses.

Chronic sinusitis differentiates into a polypoid and a non-polypoid form, in which bacterial or fungal superinfection can occur.

The polypoid form is frequently associated with asthmatic bronchitis and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs-aspirin).

It is essential to consult an otolaryngologist when the symptoms defined as typical of chronic sinusitis last for more than 4 weeks or there are ongoing complications.

The diagnosis is obtained in the first instance by a fiberoptic rhinoscopic examination and confirmed by a CAT scan of the facial mass, which is usually performed at the end of a therapy or immediately in case of complications.

Therapies

A therapy is distinguished by the chronic form proper and its exacerbation.

In the exacerbation of a chronic form, the drug of choice is the antibiotic for oral use and the use of corticosteroids always for oral use and nasal decongestants with topical washes.

The use of probiotic-based nasal sprays has been proposed but the effects of which are to be configured in certain clinical conditions.

In the chronic symptomatic forms, on the other hand, the use of topical coricosteroids together with nasal washings (preferably hypertonic saline solutions) for a certain period of time is the most used therapy.

When the symptoms are not controlled by medical therapy or are recurrent or predispose to inflammation of the lower respiratory tract (asthmatic bronchitis – rhino-bronchial syndrome) the indication for endoscopic surgery is given.

This surgery is based on the principle of freeing the paranasal sinuses blocked by edema or polyps by restoring the common drainage and ventilation routes and consequently improving nasal breathing and, many times but not always, the sense of smell and consequently the taste.

Therapies for light and chronic forms of sinusitis

The latest therapy trend for chronic relapsing polypoid forms associated with asthma is the use of a “biological” drug (immunotherapy-monoclonal antibody) which, according to the first results, reduces the tendency to relapse and improves, especially after the intervention, the patient’s symptoms.

If the sinusitis symptoms are mild and last less than a week, self-medication measures may be enough to mitigate them, freeing the nasal cavities from mucus, reducing pain and fever, if present.

To remove the mucus and clear the nose, it is necessary to wash the nose with saline several times a day.

Another way to relieve nasal obstruction is the use of decongestants and mucolytics.

Note, however, that to avoid addiction or addiction, or the so-called “return congestion”, i.e. the congestion caused by their use, it is preferable not to use them for more than a week.

To ease the pain and lower the fever, if present, you can take over-the-counter pain-relieving and anti-inflammatory drugs such as, for example, paracetamol and ibuprofen.

However, it is always advisable to ask to consult the doctor who knows the general state of health of his patients.

Applying warm compresses to the face can help relieve pain and help drain mucus from the sinuses.

Treatments for severe symptoms

In the case of severe symptoms, in the absence of improvement after 7-10 days or in the presence of worsening symptoms (chronic sinusitis), it is necessary to consult the doctor in charge.

If necessary, he may prescribe treatment with antibiotics or corticosteroid sprays, nasal drops or aerosols.

Antibiotics are useful if sinusitis is caused by a bacterial infection and should only be taken with a doctor’s prescription, carefully following the indications regarding the doses and duration of treatment.

If the medical treatments have not been sufficient to cure the sinusitis which, therefore, has become chronic, it may be necessary to undergo a specialist visit by an otolaryngologist to evaluate the opportunity for surgery.

Sinusitis cannot be classified as a serious disorder, however it can become so when the pathology is neglected or even treated inappropriately and thus lead to serious complications.

Useful tips

For this reason it is essential not to underestimate the symptoms and to act promptly.

In addition, there are some useful measures to relieve the discomfort associated with sinusitis and promote healing, such as:

try to blow one nostril at a time: this prevents excess pressure in the ears which can facilitate the passage of bacteria into the sinuses
drink plenty of water during the day, to maintain proper hydration and help make nasal secretions less dense
avoid dry and crowded environments
humidify the environment adequately, so as to favor nasal drainage.
abstain from cigarette smoke, as it irritates the respiratory mucosa and blocks its defense mechanisms, especially the mucociliary transport;
do not expose yourself to drafts: the cold can worsen the pain associated with sinusitis, as well as direct contact with a heat source. Intense heat acts by increasing the state of inflammation
massage the painful areas
exercise
apply warm, damp cloths to the sinuses
drink hot drinks
resort to thermal treatments (steam inhalations)
to thin the mucus, perform suffumigation with boiling water and bicarbonate or irrigation of the nasal cavities with a saline solution. Nasal washing can also be performed with other methods, such as the micronized shower and saline-based sprays that can be purchased in pharmacies.