Understanding Sinusitis

A recent article by Dr. Paul Lim Vey Hong explains very clearly what and how you get a sinus infection and the types of surgery available to chronic sinus infection sufferers.

Excerpts from his article as follows:

Sinuses are normally air-filled spaces connected to the nose and lined
by a thin lining called mucosa that is continuous with the lining of
the nose. The openings of the sinuses into the nose are tiny holes
called ostia (ostium=singu-lar) and the diameter of each ostium is
usually only a few millimetres wide.

The mucosa of the sinuses and nose contains mucous glands and numerous
microscopic finger-like or hair-like projections called cilia. These
cilia beat in a specific direction and transport the mucous produced
from the mucosa of the sinuses into the nose through their respective
ostia.

Everyday, the mucosa of our nose and sinuses produce approximately one
litre of mucous which is moved to the back of the nose by these beating
cilia and then swallowed subconsciously. Any condition that adversely
affects the mucosa, cilia or ostia will cause problems for the sinuses.

Being closely connected to each other, conditions affecting the nose
can easily affect the sinuses.

Inflammatory conditions

When inflammation occurs in the nose and sinuses, the cilia stop
beating and fail to transport the mucous, which then builds up in the
sinuses. At the same time, the mucosa lining swells up and blocks up
the ostia of the sinuses. The infection then changes the mucous from a
colourless fluid to greenish pus in the affected sinuses.

Sinusitis refers to this condition when the mucosa of the sinuses is
inflamed. Sinusitis and inflammation of the nose, known as rhinitis,
occurs as a result of allergy, infection, irritation from chemicals and
dust, or a combination of any of these. In some cases, the swelling of
the mucosa becomes severe and bulges outwards to form polyps, which are
like balloons filled with fluid. Such polyps can “grow” up to sizes of
several inches and obstruct the sinuses and nose.

The presence of polyps usually implies severe inflammation and allergy.
Individuals who suffer from asthma and allergic rhinitis are at higher
risk of developing polyps in their noses.

Sinusitis is typified by symptoms of blockage or stuffiness of the
nose, discharge from the nose, phlegm in the throat, loss of sense of
smell, headaches or/and pain of the affected sinuses. Infection of the
sinuses could be due to viruses, bacteria and fungus. “Colds” and flu
are due to virus infection of the upper airways.

Once infected, the mucosa of the nose and sinuses rapidly succumb to
secondary infection by bacteria. This is the reason for the change in
colour of the discharge of the nose and sinuses from the initial clear
colour to green when bacteria infection sets in. Most of the time, the
immune system fights off the infection and we recover after several
days when the cold or flu symptoms recede. Our noses clears up and the
discharge becomes increasingly less and clearer.

Sometimes the symptoms persist and we require a course of antibiotic
treatment to recover. When the duration of sinusitis lasts for days or
up to a couple of weeks, it is called acute sinusitis. When the
duration of an infection persists longer than a couple of weeks, it is
called chronic sinusitis.


Diagnosing sinusitis

The diagnosis of sinusitis can be made by simple clinical examination,
endoscopy of the nose, X-rays, computerised tomographic (CT) scans and
magnetic resonance imaging (MRI). Simple clinical examination involves
looking into the nose and if pus can be seen from the ostia of the
sinuses, then the diagnosis of sinusitis can be made. The method,
however is not very sensitive and sinus infections, polyps and tumours
can be missed.


CT scans of the sinuses give clear images of the sinuses and also show
the anatomy of the nose and sinuses in great detail. CT scans will pick
up minute changes in the sinuses and therefore its interpretation is
important with regard to the management of the patient.

The images consist of series of slices of the nose and sinuses from the
front to the back, like slicing a loaf of bread. Specialists rely on CT
scans as their maps of the nose and sinuses during surgery.

The limitation of CT scan is that the images captures are snap shots of
the state of health of the nose and sinuses at that point in time.
Therefore if a CT scan is done during or just after a cold, it will
show swelling and abnormalities in the nose and sinuses, even though
the nose and sinuses are normally healthy.

MRI is the newest imaging technology available. MRI is highly accurate
and reliable for information on the soft tissues of the nose and
sinuses. However, it is less favoured by specialists treating the
sinuses as MRI does not show the fine bone details and landmarks of the
sinuses. These bone details and landmarks are crucial during surgery to
guide the surgeon through the complex anatomy of the sinuses and skull
base, which has a high degree of variation from one patient to another.

Treatment

Infection and allergy are the main causes of sinusitis. Once sinusitis
is diagnosed, the treatment usually involves antibiotics to clear the
bacterial infection and topical decongestants to reduce the
inflammation and swelling. Where allergy is suspected to co-exist,
steroids and anti-histamines are used to further reduce swelling due to
the allergic reaction.

In the vast majority of cases of acute sinusitis, this treatment will
resolve the sinusitis. It must be stressed at this point that all
prescribed courses of antibiotics should be completed, with the
exception of allergic reactions to the antibiotic or when serious side
-effect occurs.

In cases where the sinusitis persists after a course of antibiotic
treatment, the choice of antibiotic used needs to be reviewed and a
different antibiotic should be prescribed. This is due to the ability
of bacteria to develop resistance to a particular antibiotic if the
antibiotic had been used frequently or injudiciously in the past.

For cases of chronic sinusitis or where medication and antibiotics have
failed to treat the sinusitis, surgery or sinus washouts will be
employed. A sinus washout can only be used for maxillary sinusitis and
involves a large needle being pushed from inside the nose and through
the thin bone of the sides of the nose into the maxillary sinus. Once
inside the maxillary sinus, any pus or mucous is sucked out and saline
is flushed through the needle into the maxillary sinus to wash mucous,
pus or debris out through the ostium of the sinus. This is therefore
only possible if the ostium of the sinus is patent and not obstructed
by polyps or soft tissue swellings.

This procedure can be done under local anaesthesia in the clinic or
under general anaesthesia in the operating theatre. Sinus washout is a
simple procedure but it does not correct any underlying abnormality of
the sinus as it serves only to flush out the infected sinus. For this
reason, sinusitis may relapse after sinus washouts.

Surgery of the sinuses for sinusitis basically involves re-establishing
drainage and aeration of the sinuses. It involves widening of the ostia
of the sinuses, removing solidified debris, pus or fungal material from
the sinuses, and removal of polyps or tissues obstructing the drainage
routes of the sinuses.

Surgery of the sinuses can be broadly divided into two types, the
“external” or “internal” approach through the nose. The “external”
approach invariably requires an external incision on the face or in the
mouth, thereby creating a scar while the “internal” approach avoids an
external scar by approaching the sinuses from the interior of the nose.

Surgery to drain the maxillary sinus “externally” through the mouth was
first described in 1743 in France by Lamorier and since then, various
external approaches to the sinuses had been described and widely
practised.

Following surgery, care of the wound in the nose and sinuses is
important. If wound care is less than optimal, the healing can be
complicated by excessive scar tissue formation that can obstruct the
sinuses again.

Likewise, infections can occur after surgery and this will need adequate treatment with the appropriate antibiotics to prevent re-infection of the sinuses and excessive scarring.

As we can see from the above article, sinus infection, if left untreated can cause a lot of pain and suffering. In particular, chronic sinus infection sufferers will understand the pain and suffering they have to go through and indeed, the quality of life suffers too!

What you can do to maintain good sinus health?

You just need to read up on home remedy for sinus infection and nasal irrigation. Adopt nasal irrigation in your daily routine and you will not succumb to the common cold and influenza so easily!