Sinusitis

Sinusitis is the infection of the sinus cavities. It usually starts as a viral infection of the upper respiratory tract which is then superseded by bacteria. There are 4 pairs of sinuses; maxillary (below the eyes), ethmoidal (between the eyes), frontal (above the eyes) and sphenoidal (behind the eyes). These are normally filled with air. When infected, they become filled with pus and swollen mucosa. If severe, swollen mucosa from the sinuses can protrude into the nasal cavity as polyps. Sinusitis is one of the commonest reasons for patients’ visits to the ENT doctor.

Symptoms
Sinusitis can be acute (symptoms less than one month), subacute (1 to 3 months) or chronic (more than 3 months)

  1. Purulent nasal discharge – this is yellowish/ greenish, thick and mucoid from one or both nasal cavities.
  2. Nasal blockage – from swollen turbinates, polyps or discharge.
  3. Cheek pain, upper tooth ache (maxillary sinusitis), pain between eyes (ethmoidal sinusitis), frontal headache (frontal sinusitis),
    vertex headache (sphenoiditis)
  4. Persistent cough, sore throat and phlegm in throat from back drip of mucopurulent discharge from the nose to the throat.
  5. Other associated symptoms include epistaxis, hyposmia (poor sense of smell), bad breath, fever, general lethargy, middle ear infections, snoring and poor sleep.

Diagnosis

The goal standard investigation for sinusitis is a CT scan. MRI scans are not useful in sinusitis.

Treatment

  1. Medical Treatment– the mainstay is antibiotic therapy although it should only be started if the symptoms do not resolve after 5 to 7 days.
  1. Supportive Treatment – nasal douching with saline and intranasal steroid sprays have been shown in studies to hasten recovery. Mucolytics, steroids, antihistamines, decongestant drops are often used and have varied response and effect.
  1. Surgery– this is reserved for patients whose infections have failed to respond to standard medical treatment. Sinus washouts can be done in clinic under local anaesthesia in adults. Children require general anaesthesia. However, definitive surgery is recommended if sinusitis does not resolve after 3 months of persistent symptoms or if acute infections occur more than 3 times a year. The surgery of choice is Functional Endoscopic Sinus Surgery (FESS). The aim of FESS is to open and unblock obstructed sinuses. To allow drainage of infection and allow healing. In selected patients, success rates can reach 90%.