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Sinusitis (Acute, Chronic), Congested Sinuses and Sinus Infection

There are four pairs of paranasal sinuses, which are hollow air-filled cavities, in the skull. It is believed that the sinuses play a role in making the skull lighter in weight, and allows for resonance that enhances the voice. It is a continuous with the nasal cavity, and lined with a similar epithelium that produces mucus. Most of this mucus drains into the nasal cavity and throat and ensures that there is no congestion. However, being exposed to the same environmental factors as the nasal cavity, it is also prone to the same irritants and microbes.

What is sinusitis?

Sinusitis is the inflammation of the paranasal symptoms leading to a congestion of the cavity with copious mucus secretion. Almost all cases of sinusitis are due to an infection, either viral or bacterial, and less frequently due to fungi. The most common causes of non-infectious sinusitis is allergies, and allergic sinusitis is similar to allergic rhinitis (hay fever) with the latter being isolated to the nasal cavity. It is common for rhinitis, whether allergic or infectious, to precede and involve the sinuses. Overall sinusitis is a common condition affecting millions of people across the globe and in most instances it is chronic in nature. It is one of the most common disorders seen by otolaryngologists and surgery for sinus wash-outs/drainage are a common procedure.

Acute and Chronic Causes

Acute sinusitis, like acute rhinitis, is often due to a viral infection. It typically lasts about 2 weeks and is still considered as acute if it resolves within 30 days. Subacute sinusitis tends to last longer and persist for 30 to 90 days. Chronic sinusitis is either persistent or recurrent. It lasts longer than 90 days and recurrent cases are acute cases that tend to recur within 10 days. Chronic sinusitis is more often associated with recurrent bacterial infections, persistent fungal infections or allergic factors. This is further complicated by anatomical defects like a deviated septum which does not allow for adequate drainage of one or more sinuses.

Other factors that may cause or trigger sinusitis includes :

  • Cigarette smoking
  • Chronic acid reflux (gastroesophageal reflux disease)
  • Environmental pollution
  • Hormonal fluctuations – pregnancy, oral contraceptives.
  • Cocaine use.
  • Dental disorders.

Signs and Symptoms

There are four pairs of paranasal sinuses and the symptoms of sinusitis may depend on which of these sinuses are affected. A quick guide to the location of these sinuses is as follows :

  • Frontal sinuses lie in the forehead above the eyes.
  • Ethmoid sinuses lie on either side of the bridge of the nose next to the inner corner of the eyes.
  • Sphenoid sinuses lies behind the nose and eyes.
  • Maxillary sinuses lie in the cheek below the eyes.

The clinical features of sinusitis includes :

  • Runny nose, often with pus.
  • Nasal congestion.
  • Nasal tone to the voice.
  • Impaired sense of smell.
  • Facial pain.

Sometimes there may be a cough and bad breath. The more specific symptoms depending on the sinuses affected are as follows :

  • Toothache and frontal headache (maxillary sinusitis)
  • Eye pain and frontal headache (frontal sinusitis)
  • Eye pain, swelling around eye and excessive tearing (ethmoidal sinusitis)
  • Headache (front, top or back of head) and sometimes no runny nose or nasal congestion (sphenoidal sinusitis)

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