Sinusitis or Sinuses ?

Inflammation or Infection of the Nose and Sinuses is called Rhino-Sinusitis. At birth, the Sinuses are rudimentary and pea sized cavities that gradually form and grow through childhood into young adulthood and become air filled cavities that are lined by the same lining mucosa as the nose. Therefore Sinusitis always occurs with Rhinitis and hence is called Rhinosinusitis. There are four pairs of Sinuses, namely Maxillary (Cheek bone), Frontal (forehead), Ethmoidal (between the eyes) and the Sphenoid sinuses (behind the ethmoid sinuses in the centre of the head). All these sinuses open into the nose through small openings called ostia. Small hair like structures called cilia on the lining mucosal cells helps drain the secretions.

What is their function? Thermoregulation,- ability to control the temperature and humidity of the air we breathe in, is believed to be the most important function of the Nose and Sinuses. The secretions of the lining mucosa traps the dust and other particles filtered in the nose and drains to the back of the nose. These secretions also have anti-inflammatory and antibacterial properties. The Sinuses are also believed to lighten the weight of the skull, add resonance and timbre to the voice and form a fragile bony structure that collapses to protect the brain in Trauma

What are the Types of Rhino-Sinusitis? Two types of Rhino Sinusitis are described. Acute Rhino-sinusitis is characterised by severe symptoms and lasts a short duration. It usually is described as a bad cold that does not resolve in 2 weeks. Usually there is greenish- yellow nasal discharge, severe pain, nasal obstruction, fever and may also have facial swelling. The second type is Chronic Rhino-Sinusitis and typically follows an acute episode that lingers on for many weeks or can also be due to an underlying allergy of the mucosal lining of the nose and sinuses. Symptoms include, nasal obstruction. low grade fever, nasal discharge, reduced sense of smell and bad breath. Facial pain is more likely due to other causes such as Tension Headaches. migraines, atypical midfacial pain, Jaw joint dysfunction or neuralgia (painful nerves).

What causes Rhino-Sinusitis? Blockage of the small sinus openings (ostia) due to swelling of the lining mucosa happens either due to Inflammation from underlying allergy, irritants or structural abnormalities. It can also happen due to infections, which could be Viral, Bacterial or Fungal. Children have more frequent infections while most adults can get up-to three episodes of colds or upper respiratory tract infections a year. Fungal infections are seen in immunocompromised patients (eg Diabetes, HIV, long term steroid users). Structural abnormalities can follow trauma while in some patients it can be developmental as the sinuses form and grow. Air pollution, smoke, chemical irritants ( perfumes, disinfectants and cleaning agents, pesticides, industrial chemicals) can cause inflammation and swelling of the lining mucosa and obstruction of the ostia. Allergies can cause blocked ostia due to inflammation and swelling of the lining mucosa. It is usually associated with a runny nose, sneezing, itchy and watery eyes. It can be associated with asthma in some patients

How is Rhinosinusitis Diagnosed and treated? Diagnosis is based on the history of the symptoms and clinical examination of the nose with an endoscope. Investigations in the form of a CT scan are needed when surgery is planned. Treatment is mostly Medical in the form of antibiotics, nasal decongestants, topical steroid sprays and anti inflammatory painkillers. Supportive treatment in the form of steam inhalation and sinus rinsing has been found to be very effective. Only after medical treatment has failed, surgery is considered especially in those with structural abnormalities. The preferred surgical treatment is FESS- Functional Endoscopic Sinus Surgery.

What are Nasal Polyps? Some patients with chronic Rhinosinusitis, especially chronic allergic rhinosinusitis can develop significantly swollen and oedematous mucosa which hangs down into the nose and causes nasal obstruction. Usually such patients may need surgery to clear the polyps. Unfortunately these polys can recur and they may need repeat surgery