Sinusitis, also known as rhinosinusitis and commonly known as a sinus infection, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include production of thick nasal mucus, nasal congestion, facial congestion, facial pain, facial pressure, loss of smell, or fever. Sinusitis is a condition that affects both children and adults. It is caused by a combination of environmental and health factors. It can occur in individuals with allergies, exposure to environmental irritants, structural abnormalities of the nasal cavity and sinuses and poor immune function. Most cases are caused by a viral infection. Recurrent episodes are more likely in people with asthma, cystic fibrosis, and immunodeficiency. A diagnosis of sinusitis is based on the symptoms and their duration along with signs of disease identified by endoscopic and/or radiologic criteria. Sinusitis is classified into acute sinusitis, subacute sinusitis, and chronic sinusitis. In acute sinusitis, symptoms last for less than four weeks, and in subacute sinusitis, they last between 4 and 12 weeks. In chronic sinusitis, symptoms must be present for at least 12 weeks. In the initial evaluation of sinusitis an otolaryngologist, also known as an Ear, Nose and Throat (ENT) doctor, may confirm sinusitis using nasal endoscopy. Diagnostic imaging is not usually needed in the acute stage unless complications are suspected. In chronic cases, confirmatory testing is recommended by use of computed tomography. Prevention of sinusitis focuses on regular hand washing, staying up-to-date on vaccinations, and avoiding smoking. Analgesics such as naproxen, nasal steroids, and nasal irrigation may be used to help with symptoms. Recommended initial treatment for acute sinusitis is watchful waiting. If symptoms do not improve in 7–10 days or worsen, then an antibiotic may be implemented or changed. In those in whom antibiotics are indicated, either amoxicillin or amoxicillin/clavulanate is recommended first line, with amoxicillin/clavulanate being superior to amoxicillin alone but with more side effects. Surgery may be recommended in those with chronic disease who have failed medical management. Sinusitis is a common condition. It affects between about 10 and 30 percent of people each year in the United States and Europe. The management of sinusitis in the United States reportedly results in more than $11 billion in costs.
Signs and symptoms Acute sinusitis can present as facial pain and tenderness that may worsen on standing up or bending over, headache, cough, bad breath, nasal congestion, ear pain, ear pressure or nasal discharge that is usually green in color, and may contain pus or blood. Dental pain can also occur. A way to distinguish between toothache and sinusitis is that sinusitis-related pain is usually worsened by tilting the head forward or performing the Valsalva maneuver. Chronic sinusitis presents with more subtle symptoms of nasal obstruction, with less fever and pain. Symptoms include facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or yellow nasal discharge, feeling of facial fullness or tightness that may worsen when bending over, dizziness, aching teeth, and bad breath. Often, chronic sinusitis can lead to anosmia, the loss of the sense of smell. A 2005 review suggested that most "sinus headaches" are migraines. The confusion occurs in part because migraine involves activation of the trigeminal nerves, which innervate both the sinus region and the meninges surrounding the brain. As a result, accurately determining the site from which the pain originates is difficult. People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection.
By location The four paired paranasal sinuses are the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The ethmoidal sinuses are further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle nasal concha. In addition to the severity of disease, sinusitis can be classified by the sinus cavity it affects:
Maxillary – may cause pain or pressure in the maxillary (cheek) region, often experienced as a toothache or headache. Frontal – may cause pain or pressure in the frontal sinus cavity (above the eyes), often experienced as a headache, particularly in the forehead area. Ethmoidal – may cause pain or pressure between or behind the eyes, along the sides of the upper nose (medial canthi), and headaches. Sphenoidal – may cause pain or pressure behind the eyes, though it is often felt at top of the head, over the mastoid processes, or the back of the head.
Complications
Complications are thought to be rare (1 case per 10,000). Infectious complications of acute bacterial sinusitis include eye, brain and bone complications.
Orbital complications The Chandler classification is used to group orbital complications into five stages based on their severity. Stage I, known as preseptal cellulitis, occurs when an infection develops in front of the orbital septum. It is thought to result from restricted venous drainage from the sinuses and affects the soft tissue of the eyelids and other superficial structures. Stage II, known as orbital cellulitis, occurs when infection develops behind the orbital septum and affects the orbits. This can result in impaired eye movement, protrusion of the eye, and eye swelling. Stage III, known as subperiosteal abscess, occurs when pus collects between walls of the orbit and the surrounding periosteal structures. This can result in impaired eye movement and acuity. Stage IV, known as orbital abscess, occurs when an abscess forms within the orbital tissue. This can result in severe vision impairment. Stage V, known as cavernous sinus thrombosis, is considered an intracranial complication. It can occur as bacterial spread progresses, triggering blood clots that become trapped within the cavernous sinus. This can result in symptoms within the opposite eye and, in severe cases, meningitis.
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