Sinusitis (Sinus Infection)

Overview
Sinus infection, or sinusitis, is a condition marked by inflammation of the nasal cavity and sinuses. Sinus infections are categorized according to the length of time that the symptoms persist.
The types of sinus infection include:
  • Acute Sinusitis – This type of sinus infection usually affects patients for no more than 4 weeks. The causes of this type of infection include:
    • Viral infections that, for the most part, go away within 10 days or a viral infection of the upper respiratory system lasting more than 10 days
    • Bacterial infections whereby patients suffer from cold-like symptoms
Alternatively, symptoms may ease off before coming back even worse than before.
  • Subacute Sinusitis – A form of sinusitis that is present for 4–12 weeks
  • Chronic Sinusitis – This type of sinus infection has symptoms that can affect patients for more than 12 weeks, during which time symptoms of acute sinusitis can also occur

Symptoms of sinusitis include nasal congestion, runny nose with mucus that drips down the back of thethroat, and facial pain and pressure. Pressure within the nasal cavity may be accompanied by swollen nasal passages, nasal polyps or pus-filled mucus — each of which can cause the patient to lose their sense of smell while the infection persists.

  1. A sinus X-ray may find irregularities such as opaqueness in the nasal cavity when comparing the area around the maxillary sinus to the area surrounding the eye socket. The X-ray could be either fully opaque or partially opaque when viewed at the air-fluid level. Alternatively, the scan could show a thickness in the sinus membrane. The first two types of X-ray scans are of more use in making assessments, as a thickness in the sinus membrane can be found in those not suffering from sinusitis, or in patients who suffer from allergies.
 
  1. MRI scan or CT scan of the sinus. This could detect irregularities in the nasal cavity and/or an abnormality in the area of the ostiomeatal complex, at the opening of the nasal cavity. It is possible to find these irregularities in up to 33% of patients with no sinusitis symptoms. Therefore, this type of assessment is not recommended for all types of sinus infections, but should instead be used when evaluating causes of acute sinusitis in patients who have underlying eye or brain issues, or for those patients suspected of having a tumor in their nose and/or sinus. These scans could also be used to identify the cause of facial pain and pressure, or for patients who have taken a course of medicine but for whom the infection still persists. Such scans may also be carried out on patients who have been found to have a sinus infection, along with a medical history of being involved in an accident, or having had an operation on the facial region. Furthermore, those at risk of developing complications from their sinusitis, such as patients who suffer from conditions resulting from a compromised immune system, including diabetics or people with low white blood cell levels, for example, may also benefit from the aforementioned examinations.
Generally speaking, assessment methods might vary but the diagnostic process usually begins by checking the patient’s medical history followed by a nasal examination. X-rays are generally only necessary when evaluating patients whose symptoms do not correspond to the usual patterns — or for patients for whom the causes are difficult to determine. Bacterial samples may also be sent for analysis to assist patients who do not respond to anti-microbial therapy or are suspected of being resistant to medication.

 

  1. In patients suffering from viral sinusitis, treatments are usually prescribed based on symptoms. This includes, for example, prescribing pain relief medicine, flushing the nasal cavity with a saline solution, or using a nasal steroid spray.

  2. For patients suffering from acute sinus infections caused by bacteria, whereby the patient’s symptoms are not serious, the pain is manageable, and body temperature is below 38.3°C, it is recommended that anti-microbial medications be used to treat the infection if symptoms do not go away or if the infection worsens within 7 days. However, the patient’s age, general health, and congenital conditions must be taken into consideration before prescribing anti-microbial medications.

  3. The first type of anti-microbial medication that may be prescribed is a 10- to 14-day course of amoxicillin (for patients who are allergic to penicillin, trimethoprim, sulfamethoxazole, or macrolides may be used instead, depending on the diagnosis). If anti-microbial treatment does not lead to any improvement in symptoms after 7 days of use, it may mean that the infection may not be bacterial at all or may be a drug resistant strain of bacterial infection. In such cases, samples of the bacteria should be sent for lab analysis so that a suitable treatment may be prescribed.                                                                                                                                 
    While waiting for the results of the analysis, a different type of anti-microbial treatment may be prescribed. If a patient has taken a course of anti-microbial drugs within the previous 6 weeks, or the patient displays serious symptoms, changing the type or dose of medicine should be considered. Nasal steroid sprays can also be used in the treatment of acute sinus infections to ease the patient’s symptoms.

  4. For chronic sinusitis sufferers, bacteria may not be the root cause of the infection. According to studies of the bacteria found in the nasal cavities of both chronic sinus infection sufferers and people not infected, the same types of bacteria were present in both groups. Prescribing anti-microbial medicine to the group of sufferers has yet to be proven effective. Hence, such medicine should only be prescribed to patients with acute exacerbation sinusitis after their bacteria samples have been analyzed, so as to find a suitable course of treatment. This is because studies have shown that the bacteria present in this group of patients was found to have undergone changes during the period of time it took to analyze a sample of said bacteria.

Nasally administered corticosteroids play a part in reducing the size of nasal polyps and their associated symptoms, such as a blocked or runny nose and sneezing; however, they are not particularly effective in restoring a patient’s sense of smell.
  1. Complications related to the eyes – The following symptoms should be monitored carefully: blurred vision, swelling and pain around the eyes.
  2. Complications related to the brain – The following symptoms should be monitored carefully: headaches, nausea, blurred vision, muscle weakness, and high fever.

Risk factors that may lead to sinus infection include: fever, allergies, nasal cavity swelling, and gastro-esophageal reflux disease (GERD). Other situations that can lead to a swollen nasal cavity are prolonged exposure to the cold, irritation from cool, dry weather, and even acute temperature changes.

Getting sufficient amounts of rest, eating healthy, avoiding fatty foods, drinking no more than 2 cups of caffeinated beverages per day, and consuming at least 1.5 liters of water per day, can all help in the prevention of sinusitis.
 

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