Paranasal sinuses are air-filled spaces within bone. There are four named sinuses and these are the maxillary, frontal, ethmoidal, and sphenoidal sinuses. These sinuses are named after the bones in which they are located. The paranasal sinuses open into the nasal cavity and are lined with a mucus membrane. There are three primary functions of the sinuses. First, they decrease the weight of the skull. Second, they produce mucus. And third, they also affect the quality of out voice by acting as resonating chambers. The sinuses are involved in many upper respiratory tract infections.
Para-nasal sinuses are air-filled spaces within bone. There are four named sinuses and these are the maxillary, frontal, ethmoidal, and sphenoidal sinuses. These sinuses are named after the bones in which they are located. The paranasal sinuses open into the nasal cavity and are lined with a mucus membrane. There are three primary functions of the sinuses. First, they decrease the weight of the skull. Second, they produce mucus. And third, they also affect the quality of out voice by acting as resonating chambers. The sinuses are involved in many upper respiratory tract infections.
Sinusitis is an inflammation of the mucous membrane of any sinus, especially one or more paranasal sinuses. It often follows an upper respiratory infection or cold, or an exacerbation of allergic rhinitis. It can result from inflammation due to allergies or polyps that obstruct a sinus opening into a nasal cavity. The inflammation can also be caused by viral infections like the common cold. The viral infection can cause mucous membranes to become inflated, swell, and produce excess mucus. As a result, the sinus opening into the nasal cavity can be partially or completely blocked.
When mucus accumulates within the sinus, it can provide an excellent medium for bacterial growth, thus, it can promote the development of a bacterial infection. The upsurge of mucus and the inflammation of mucus membranes due to the infection produce pain. Other conditions that can obstruct the normal flow of sinus secretions include abnormal structure of the nose, enlarged adenoids, diving and swimming, tooth infection, trauma to the nose, and the pressure of foreign objects.
If their openings into the nasal passes are clear, the infections resolve immediately. However, if the drainage is obstructed due to certain conditions like deviated septum, nasal polyps or tumors, sinus infection may persist as a secondary infection or progress to an acute suppurative process, causing purulent discharge.
Four types of sinusitis have been identified – acute, subacute, chronic, and allergic sinusitis. Acute sinusitis refers to rapid-injury infection in one or more of the paranasal sinuses that resolves with treatment. Subacute sinusitis is a persistent purulent nasal discharge lasting therapy with symptoms lasting for less than three months. Chronic sinusitis occurs with episodes of prolonged infection and with repeated oradequate treatment of acute infections. An irreversible damage to the mucosa may also occur. The symptoms last for longer for three months. Bacterial organisms like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most commonly associated organisms with sinusitis. Less common organizations include Streptococcus pyogenes, Chlamydia pneumoniae, and aspergillus fumigatus (fungi). Fungal infections may occur in immuno-suppressed patients.
The symptoms of sinusitis differ from people to people and depend on the age of the person. In adults, most infections involve the maxillary and anterior ethmoidal sinuses. Symptoms may include facial pain or pressure over the affected area, fatigue, facial pain, nasal obstruction, purulent nasal discharge, fever, headache, ear pain, and a sense of fullness. Other symptoms may also include dental pain, diminished sense of smell, sore throat, a periorbital edema in the morning, and a cough that becomes worse when the patient is in supine position. Acute sinusitis can be difficult to distinguish from an upper respiratory infection or allergic rhinitis. If fewer than two symptoms are present, then acute bacterial sinusitis is ruled out. However, the presence of four or more symptoms suggests acute bacterial sinusitis.
If not raised, acute sinusitis may lead to severe and rare life-threatening complications such as meningitis, brain abscess, ischemic brain infarction, and osteomyelitis. Other complications of sinusitis include severe orbital cellulitis, subperiostal abscess, cavernous sinus thrombosis, and meningitis. Brain abscess may take place by direct spread and can be critical. Frontal epidural abscesses are typically inactive. The goal of treatment of acute sinusitis is focused the treatment of the infection, reduction of the inflammation, and relief of pain.
Antibiotic therapy is utilized to get rid of the infecting organism. First-line antibiotics include amoxicillin, ampicillin, and erythromycin. Second-line antibiotics include cephalosporins like cefuroxime, cefprozil, and amoxicillin. Newer and more expensive antibiotics like macrolides, azithromycin, and quinolones such as levofloxacin can be used if the patient has a certain allergy to penicillin. Careful consideration must be given to the potential pathogen before antimicrobial agents are prescribed because of the resistance that has occurred.
Decongestants are also prescribed to promote sinus drainage, reduce tissue swelling, and relieve edema. When mucous membranes are less swollen, breathing is much easier and the movement of mucus out of the nasal cavity is increased. An example of a decongestant is Pseudo-ephedrine Hydrochloride. It acts by reducing the swelling by causing the release of norepinephrine from sympathetic neurons supplying blood vessels. It will increase the vaso-contradiction of blood vessels in the mucus membranes. As a result, there would be reduction of blood flow as well as fluid movement from the blood into tissues. Nasal saline sprays are also available and these can improve the drainage of the sinuses. Topical decongestants should only be used in adults and should not be used for more than three to four days. Oral decongestants must be used cautiously in patients with hypertension. If an allergic component is suspected, antihistamines like diphenhydramine (Benadryl).
It is also advised to drink liquids like water and juice to maintain hydration. Steam inhalation is also considered in order to relieve the discomfort associated to the explosion and these may be effective for opening blocked passage. If the patient continues to have symptoms after seven to ten days, the sinuses may need to be irrigated and hospitalization may be necessary.