Acute Sinusitis

A sinus infection occurs when a pathogenic organism (virus, bacterium, or a fungus) causes the lining of the nose to become inflamed and swollen (rhinitis). 

When the sinus becomes inflamed or infected, mucus thickens and clogs up the openings of one or more sinuses.  Bacteria grows due to a buildup of secretions. Pus forms and accumulates under pressure and infects the lining causing discomfort and gives rise to the discharge that is seen in sinusitis.

Inflammation of the air cavities within the passages of the nose (paranasal sinuses) is referred to as sinusitis.

Symptoms of Sinusitis vary from person to person. While one person may have all the symptoms, someone else may have only one or two of them.

The most common symptoms are:

• Stuffy or runny nose/blocked nose
• Postnasal drip
• Discharge from the nose or thick yellow or green discharge from the nose, sometimes, tinged with blood
• Cheek pain or dental pain associated with Maxillary sinusitis.
• Forehead pain indicates frontal sinusitis.
• Pain at the bridge of the nose or behind the eye suggests ethmoid sinusitis. Pain is often referred to the top of the head with sphenoidal involvement.
• Headache
• Eye pain due to a spread of infection from the sinuses to the eye
• Postnasal drip from the nose into the throat
• Reduced sense of smell or/and taste
• Bad breath
• Cough
• Ear ache, feeling of fullness in the ear, swelling and tenderness behind the ear, and/or ear popping due to mucus in the eustachian tube of the ear.

Sinusitis is subdivided into:

• Acute sinusitis – symptoms lasting < 4 weeks
  This is common and many people may experience it a few times a year after an upper respiratory viral infection.

• Subacute sinusitis – symptoms lasting between 4 weeks to 3 months
  
• Chronic sinusitis – symptoms lasting more than 3 months

The most common cause of sinusitis is allergic rhinitis, which accounts for up to 80% of sinus infection. Other causes of sinusitis include the following:

• Smoking
• Dental infections
• Air pollutants

Besides taking down their medical history, ENT specialist will do a physical examination of the nose, throat, sinuses to check for signs of infections.

To examine the nose and sinus openings, a nasal endoscopy is usually conducted. This involves inserting a long, thin, flexible tube with fiber optic cables down the nasal cavities.  It connects to a video camera and light source where magnified images are projected onto a screen.  This allows the ENT doctor to evaluate the sinus and nasal passages.

The procedure is not painful and well tolerated.  

If the infection has been persisting for a period of time, sometimes, a sinus CT scan may be needed to help evaluate sinuses that are filled with fluid or to detect the presence of inflammatory diseases.

Acute sinusitis is typically treated with medication. Some examples of medication prescribed include:

• Antibiotics
Your ENT doctor may prescribe antibiotics if your sinusitis is due to bacteria infection. Antibiotics help eliminate the source of the infection by attacking the bacteria causing it. They do not alleviate symptoms immediately and may sometimes worsen symptoms as the sinuses drain before symptoms start to improve. Increased drainage is good for the sinuses but may actually increase postnasal drip and cough initially.

• Nasal decongestants
Nasal decongestants reduce the swelling of your nasal blood vessels, thus reducing congestion. If used excessively, it can cause permanent damage to your nasal cells and lead to chronic sinusitis if inadequately treated.

• Nasal sprays/steroid sprays
Steroidal nasal sprays decrease swelling around the nasal area and reduce symptoms of allergy. They are very safe for long term use to prevent recurrence of infections and symptoms.

• Antihistamines
Antihistamines help to alleviate symptoms such as runny nose, tearing and sneezing by preventing the effects of histamine.

A sinus washout is a minor procedure that involves rinsing the nasal passage with saline to remove any allergens or mucus.

How it works
A thin metal tube will be inserted into the nose and the saline solution will be used to flush out any infections. Once this is done, the metal tube will be removed.

Sinus surgery is a minimally invasive surgery done through the nose without any external cuts on the nose or face.  It aims to fix defects with the nasal passages, removes nasal polyps and open up closed sinus osia.

1. Understand why your nose & sinus is blocked

In this video, Dr Kevin Soh reveals the different causes for block nose. He illustrates with interesting graphics and videos. Understand deviated nasal septum, nasal polyps, enlarged adenoids.

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