The Nasal sinuses are hollow cavities found within the skull
and located behind the eyes, the nose and the cheek bones. The primary function
of these sinuses is to warm, moisten and filter the air passing through the
nasal cavity. The sinuses also play a role in our ability to vocalize certain
sounds. Sinusitis is an infection of the sinuses, and is most common in the
winter months.
Sinusitis may last for months or even years (if inadequately
treated), and sinusitis is often misdiagnosed as nasal allergies. This is
especially true for young children who are often thought to be suffering with
allergies during a sinus infection because their nasal drainage is observed to
be “mostly clear” or because they have only nasal congestion. Nasal drainage,
when present during sinusitis, can be either colored or clear. The accurate
diagnosis of true nasal allergy can only be made by documenting the presence of
allergic antibodies (IgE); either by skin testing or blood testing (RAST).
Sinusitis can produce symptoms in the nose, eyes, throat, middle ear and even
the lungs. Sinusitis may cause very noticeable symptoms such as facial pain,
headache, thick nasal drainage or “post-nasal drip” (which may result in a
productive cough). Conversely, sinusitis may cause only mild symptoms such as
throat clearing, nasal congestion (with or without drainage), a non-productive
“dry” cough, toothache (upper teeth), ear pain, balance problems, fatigue, or
even concentration difficulties. Sinusitis is also a very common trigger of
asthma symptoms in asthmatics. Only very rarely does a sinus infections cause a
fever.
There are
two types of sinusitis: acute and chronic.
Acute sinusitis is typically caused by a bacterial
infection. It often develops as a late complication following a viral
respiratory infection (“the common cold”). Sinusitis should be suspected
whenever nasal symptoms last for more than 2 weeks. Acute sinusitis usually
causes more prominent or noticeable symptoms than chronic sinusitis. Chronic
sinusitis is also usually caused by bacterial infections however; this
diagnosis requires that nasal symptoms be present for more than 6 weeks. When
laboratory cultures are performed on chronically infected sinuses, multiple
strains of bacteria are often found to co-exist. Each bacterial strain has its
own unique antibiotic sensitivity profile and a single course of antibiotics
will frequently fail to kill all the strains present in a chronically infected
sinus.
Although viral “colds” are the most common preceding cause
of acute sinusitis, people who suffer with nasal allergies (allergic rhinitis)
or environmental irritant sensitivity (non-allergic rhinitis) are also at risk
for developing frequent sinusitis. These nasal problems cause swelling of the
mucous membranes lining the sinuses. If the small opening of a normally hollow
sinus cavity becomes blocked, mucous accumulation can occur. The inability to
clear mucous from the sinuses allows for bacterial growth, which then leads to
further mucous membrane inflammation and prolonged sinus obstruction.
Most patients with recurring sinusitis have more than one
problem that predisposes them to infection. Addressing all potentially relevant
factors is the key to successfully breaking this pattern. Persons with sinus
problems should avoid environmental irritants such as tobacco smoke, and any
other triggers which have been noted in the past to worsen their nasal
symptoms. Environmental irritant sensitivity (Non-Allergic Rhinitis) causes
symptoms that are nearly identical to those of true allergy (Allergic
Rhinitis). Among persons suffering from allergic rhinitis, about 70% also
suffer from non-allergic rhinitis. Unfortunately, some of the medications
commonly used to treat Allergic Rhinitis (i.e. Claritin / Allegra / Zyrtec), have
no significant effect on controlling the symptoms of Non-Allergic Rhinitis.
Treatment of nasal inflammation with the appropriate medication(s) can often
control nasal obstruction, thereby reducing the risk for developing recurrent
infections. Making the correct diagnosis concerning the cause of the nasal
symptoms is the most important factor in choosing the medication(s), which will
most likely be effective for each individual.
In addition to causing nasal inflammation as an irritant
(non-allergic rhinitis), tobacco smoke exposure also adversely affects nasal
cilia. Cilia are microscopic hair-like projections from the surface of the
cells lining the respiratory system (mucous membranes).
Cilia beat in a coordinated fashion to move mucous and
bacteria down and out of the sinuses and up and out of the lungs toward the
back of the throat where they are normally swallowed. Smoke exposure causes the
cilia to beat in an uncoordinated manner decreasing the normal clearance of
mucous and bacterial. This is why children of smokers have a higher incidence
of ear infections and why smokers have more bronchitis and sinusitis episodes
than non-smokers. (See www.AlamoAsthma.com for “scientific studies” concerning
tobacco smoke)
Some people (both adults and children) who suffer from
recurrent sinusitis have poor immunity to a bacterial organism that causes the
majority of sinus infections: Streptococcus pneumonia. If there are low levels
of protective antibodies (IgG) to these organisms in the blood, a person may
get the same type of bacterial infection over and over again. Frequent nasal
and ear infections occur even among normal healthy children under the age of
two. Under normal circumstances, each new infection triggers the immune system
into creating a long lasting protective IgG antibody response and over time,
the frequency of these childhood infections normally decreases. It is noted
that persons with poor immunity to these organisms often never seem to
“out-grow” their frequent infection period. Children who have failed to develop
protective antibody levels following their infancy immunizations with the
pneumococcal (7 strain) vaccine are especially at risk for frequent infections.
These immune system problems are easily diagnosed by blood testing and if present,
are usually correctable by administering the appropriate booster
vaccination(s). After age 2, if needed, children (and adults) can be immunized
with a vaccine called “Pneumovax” containing 23 different varieties of
Streptococcus pneumonia.
Finally, structural problems inside the nose that narrow the
air passages such as polyps, a deviated nasal septum (the bone and cartilage
structure that separates the left and right sides of the nose), or enlarged
adenoids may also contribute to the risk for recurrent sinusitis. Surgery is
sometimes needed to correct these issues.
Even if symptoms seem to be coming
from the sinuses, the sinuses are not always infected. To make a correct
diagnosis, a physician will need to take a history and perform a physical examination.
The physician may also order testing to help determine the factors contributing
to recurrent infection. These tests may include: allergy testing, immune system
testing, or a CAT scan (which shows very precise images of the sinus cavities).
In addition, it may be necessary to collect samples of the nasal secretions for
evaluation or culture.
Treatment
Sinus infections
generally require treatment with a combination of therapies. Antibiotics may be
given for 2 or more weeks and frequently more than one course of antibiotics
may be required. Medications to reduce nasal blockage or control allergies may
also be prescribed. These medicines may include: decongestants, mucus-thinning
medicines, oral steroids, antihistamines, and/or topical nasal steroid sprays.
For persons with year-round allergies or irritant sensitivity long-term daily
anti-inflammatory treatment is often necessary to reduce the risk for recurrent
infections. At times, effective treatment of “true” nasal allergies (allergic
rhinitis) may require immunotherapy (also called "allergy shots").
Allergy shots are typically recommended only when available medications fail to
adequately control allergic symptoms. Allergy shots do not improve symptoms of
non-allergic rhinitis. In addition, the use of a saline sinus rinse solution,
especially during an active sinus infection or after an allergen / irritant
exposure, may also help to improve nasal symptoms. Occasionally, a sinusitis
may be due to a fungal infection. If your physician suspects this, treatment
with the anti-fungal medication Amphotericin B may be added to the saline sinus
rinse. - Bird
