Acute sinusitis- Diagnosis and Treatment

Acute sinusitis, often caused by the common cold, is the inflammation of the paranasal sinuses. Paranasal sinuses are a group of pairs of air spaces that surround the nasal cavity in front of the face. Usually, acute sinusitis can last up to four weeks, subacute sinusitis lasts between one and three months and chronic sinusitis lasts more than three months.

When we breathe in, air flows through the nostrils and enters the nasal cavity which is lined by mucus membranes. Mucus membranes contain goblet cells that release mucus. Mucus is an aqueous secretion that is sticky and slippery. Mucus also contains lysozymes. Lysozymes are organelles enclosed in membranes and contain various enzymes. These enzymes are capable of breaking all types of polymers such as proteins, lipids, carbohydrates, and nucleic acid. Therefore, these enzymes help in eliminating bacteria. Humans develop nose hair or nasal hair in the nostrils. The main function of nose hair is to trap allergens such as dust particles and pollens. The nose hair is also covered with a thin layer of mucus that eliminate bacteria. 

The nasal cavities are connected to four paired paranasal sinuses named maxillary, ethmoidal, sphenoidal, and frontal sinuses. During a cold they also allow the inspired air to circulate for a bit so it has time to get warm and moist like the rest of the respiratory tract. The walls of the paranasal sinuses are made up of a mucosal epithelium which produces mucus to trap small foreign particles as well as columnar cells which have hair-like projections called cilia that move mucus draining into the nasal passages.

It is observed that most cases of acute sinusitis are caused due to viral infections. The most common viruses include rhinovirus and para influenza virus which causes the common cold. Another common virus is the influenza virus which causes the flu. Bacterial infections are another cause of acute sinusitis. The most common bacterial strains causing acute sinusitis are streptococcus pneumonia hemophilus influenza and rexella catarralis. In some cases, bacterial sinusitis develops during or after a viral infection. In most cases, bacterial sinusitis develops due to a blockage of the normal flow- out of the sinuses. The most common case is that with a deviated septum in acute sinusitis. An invading pathogen often causes an inflammatory response which causes the goblet cells to over-secrete mucus which also leads to congestion. Congestion is a condition where the nasal cavity, adjoining tissues, and blood vessels gets swollen due to a deposit of excessive fluids. Simultaneously, the immune cells try to fight off these pathogens which creates pus. Pus is a mixture of pathogens, immune cells, and dead tissue. If acute sinusitis doesn’t resolve quickly then it’s considered subacute or chronic sinusitis. In addition to infections, another cause of acute sinusitis is environmental allergies like dust pollution, fungi like aspergillus, and some immunocompromised conditions. Finally, in response to allergies, some individuals develop chronic hyperplastic sinusitis which is where the connective tissue of the sinuses undergoes Hyperplasia. Hyperplasia is a condition where the tissues start proliferating faster than usual. This can give rise to nasal polyps which are non-cancerous outgrowths of inflamed tissue in the nose or sinuses. 

Symptoms of sinusitis are mainly associated with the build-up of mucus which can cause the feeling of pressure in the face, nose, throat, or behind the eyes. Acute sinusitis may even cause a headache. When acute sinusitis is caused due to an infection, particularly a bacterial infection, it can cause fever. There can also be changes in voice, changes in sense of smell and taste, or a cough that’s often worse at night. The coughs are worst at night because due to lying down the mucus starts to pool in the throat. 

If you feel that you or any of your family members are experiencing any of the above mentioned symptoms, you should visit an ENT specialist. In India, one can look for the best ENT hospital in Bangalore, Mumbai, or Delhi as these cities are known for their specialized treatment centers.

Diagnosis of acute sinusitis is mainly based on the symptoms. In severe cases of acute sinusitis or in cases of subacute or chronic sinusitis it can be helpful to get a CT scan or a nasal endoscopy. Nasal endoscopy is when a camera, mounted on a narrow tube, is inserted into the nose to directly see the nasal passages. These would show evidence of clogged-up sinuses that might be filled with mucus or pus.

The main treatment for acute sinusitis is ample rest as the condition subsides on its own. A course of antibiotics is only prescribed if the patient has no relief from symptoms and the fever starts to set in. In addition, decongestants are used to help reduce congestion. Corticosteroid nasal spray and antihistamine medicines are given to treat swelling and promote better drainage of the mucus. If there is an underlying allergy or if there are nasal polyps, steroid medication or allergy medications can be helpful as well. Finally in cases of chronic or recurrent sinusitis sinus surgery can be used to open the wall of the infected sinus to allow it to drain more easily into the nasal cavity.