The increasing prevalence of acute sinusitis infection is noteworthy and therefore understanding the disease process will aid in prompt evaluation and treatment of this condition.
A sinus is a sac or cavity found in bone, organ, or tissue. In particular, paranasal sinuses are air cavities found in facial bones adjacent to the nasal cavity. There are four air-filled paired spaces found in the face namely frontal sinuses, maxillary sinuses, ethmoid sinuses, and sphenoid sinuses. These are located superior to the eyes, around the nasal cavity, between the nose and the eyes, and at the center of the skull base respectively and are present to warm and humidify air, to give resonance to voice, to reduce skull weight, to reduce auditory feedback, and to trap inhaled pathogens through production of mucus. Inflammation of sinuses is medically called sinusitis which is caused by viral, bacterial or fungal pathogens that block the sinuses with fluid, inhabit within, and cause infection.
There are several types of sinusitis infection. Acute sinusitis infection is of a sudden onset and is characterized by stuffy, runny nose and facial pain that persist for 1 to 2 weeks. Subacute sinusitis lasts for up to 8 weeks while chronic sinusitis lasts longer than 8 weeks. Recurrent sinusitis, on the other hand, appears several times a year and may have varying acute to chronic symptomatology.
Triggers for sinusitis infection include but may not be limited to allergic rhinitis, common colds, nasal septal deviation, or nasal polyps. All these cause blockage to sinus openings, thus resulting in fluid entrapment and subsequent development of infection. Repeated exposure to cigarette smoke may also pose increased risk at developing sinusitis.
Acute sinusitis infection is more commonly brought about by bacterial upper respiratory tract infection, whereas chronic sinusitis commonly develops from bacterial or fungal sinus invasion. The previous also has the highest incidence rate of all the types of sinusitis infection.
Clinical symptoms of acute sinusitis infection usually start after development of persisting cold for more than a week. Early symptoms include sore throat, pressure-like headache, and nasal congestion. Worsening cough follows with development of fever, facial tenderness, and loss of smell. Additionally, patients may have bad breath, fatigue, and postnasal drip. Chronic sinusitis usually produces same but milder symptoms and longer morbidity.
Severe symptoms that may present with acute sinusitis infection and will require immediate medical attention include development of rear eye pain, severe headache, bouts of confusion, vision alteration, neck stiffness, and shortness of breath. Therefore, prompt detection of these symptoms, careful observation, and detailed documentation can help doctors at ruling out triggers for sinusitis and provide detailed care plan and specific patient care.
Prompt detection is also important to prevent complications brought about by sinusitis like asthma flare-ups. Asthma is triggered when increased pressure in the sinuses activate sensitive components of the immune system that are likely connected with asthma exacerbation. Meningitis may also result if infection reaches lining of the brain and underlying cerebrospinal fluid. Reduced vision or blindness may also eventually develop if infection reaches eye socket and urgent medical treatment is not sought.
Physical examination may include transillumination or passing of light inside buccal membrane. Disparity in sinus coloration may mean presence of sinusitis, but this is not a golden standard for diagnosing sinusitis. A more reliable technique is checking for thick mucus coming out of sinus opening through the nostril. Palpation over the sinus area easily reveals tenderness depending on the cause of the symptoms.
Diagnostic tests that may help in evaluating sinusitis include nasal endoscopy, imaging studies, and sinus cultures. Introduction of endoscope through the nose to visualize sinuses is helpful to determine purulent discharge or mucosal erythema and is usually done by ENTs but in cases where nasal obstruction is present, imaging studies like MRI or CT scan can see pass through the physical obstruction and verify the inflammation. Although laboratory cultures may not be initial interventions for diagnosis, sinus cultures may be undertaken if symptoms fail to respond to management to pinpoint pathogenic cause. Recurring sinusitis, however, would need further tests in the form of nasal cytology, allergy test, blood testing, or ciliary function test to rule out primary cause of infection.
In terms of management, self-care treatment for acute sinusitis infection is principally aimed at reducing congestion. Gold label for treatment as with other upper respiratory tract infections is drinking plenty of water to liquefy mucus. This is best done in conjunction with nasal saline spray as tolerated and inhaling steam several times a day. A dampened warm washcloth can be applied to the face for added comfort. Utilization of Neti pot and humidifier can also be done.
The use of antibiotics may not be recommended for treating acute sinusitis infection as this tends to relieve on its own; however, antibiotic therapy may be prescribed for fever greater than 102.2 degrees Fahrenheit, cough greater than 2 weeks, or severe periorbital swelling. It must be administered for 10 to 14 days for acute cases and 3 to 4 weeks for chronic cases.
Alternatively, corticosteroid sprays and allergy shots can help at decreasing swelling and preventing disease recurrence. Pain medications can alleviate headache.
Surgical intervention may be done in cases in which symptoms persist beyond 3 months or wherein patients develop recurring sinusitis in a year. This is usually for fungal sinusitis cases and is performed by an ENT surgeon.
Preventive measures for patients include avoiding extreme temperatures, sudden temperature changes, bending forward with head down, and flying. Stress reduction, frequent hand washing, and healthy diet are also universal precautions to ward off infections. Also, an influenza vaccine is also recommended especially for those at higher risk including those regularly exposed to pollutants, cigarette smoke, and stress.
Although acute sinusitis infection is self-limiting, prompt management needs to be made to ensure no serious underlying condition is present. Prognosis is generally good except for high risk individuals as mentioned above who require more intensive management, and just like any other medical conditions, prevention has always been better than curing acute sinusitis infection.