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Sinusitis?

Sinusitis, inflammation of the paranasal sinuses, is a common disease that may afflict people throughout their lives.

What is the prevalence of sinusitis?

Sinusitis is a common condition, affecting approximately 30% of the population at some point. Sinusitis can occur in infants and children, but is more common in adults as sinuses are undeveloped in infants and start forming during childhood.

The average adult has 3-4 upper respiratory infections each year, about 1% of which are complicated by sinusitis. In addition to sinusitis associated with viral respiratory infections, many more people suffer inflammation of the sinuses because of seasonal allergic problems.

The paranasal sinuses and sinusitis

The paranasal sinuses are air-filled cavities inside the bones of the skull. They are located on either side of the nose, behind and between the eyes, and in the forehead; there is also one further back in the head. They probably function to reduce skull weight and to enhance vocal resonance. They also have a protective function, as they absorb severe impact from the front and prevent it being transmitted to the brain.

They are lined with mucus-secreting cells, and they warm, moisten and filter air breathed in. Air reaches the sinuses through small openings in the bones (ostia) that connect to the nasal passageways. The mucus-producing cells have small hairlike fibres (cilia) that beat back and forth to help mucus move towards the ostia and out of the sinuses.

If these openings become blocked, air can't properly pass into the sinuses and mucus can't drain out. Mucus builds up in the sinus, causing pressure or pain. Also, the mucus is an excellent culture medium for bacteria, and infection can result.

The course of sinusitis

Typically, early in the development of a sinus infection, the cilia lining the sinuses are lost and mucus becomes increasingly thick. Consequently, mucus is retained in the sinus. If the sinus infection lasts long enough, the sinus lining may physically change, causing even thicker mucus to develop. Bacteria become trapped and proliferate. Once this happens, antibiotics will be needed, and possibly surgery.

Types of sinusitis

Sinusitis may be classified based on time span of the problem (acute, sub-acute or chronic), and the type of inflammation (infectious or non-infectious).

•    Sinus headache – typically lasts a few hours until the ostia unblock and allow equalisation of air pressure in the sinus.
•    Acute sinusitis – typically lasts up to a month.
•    Sub-acute sinusitis – lasts longer than one month, but less than three months' duration.
•    Chronic sinusitis – longer than three months' duration.
•    Infectious sinusitis – usually caused by bacterial growth.
•    Non-infectious sinusitis – caused by irritants and allergic conditions.
•    Acute sinusitis is commonly secondary to either allergic rhinitis (hay fever) or viral infection of the nasal passages. Sub-acute and chronic forms of sinusitis usually result from incomplete treatment of acute sinusitis.

The most common complaint is that of a sinus headache. This occurs typically occurs as a result of nasal congestion or sinus mucus which obstructs the ostea leading to a blockage of air flow and equalisation of air pressure in the sinus and the environment. The air in the sinus is absorbed which causes a negative pressure in the sinus, leading to symptoms of a sinus headache.

Once the obstruction is relieved, the pressure equalises and the sinus headache improves immediately. The second most common cause for sinus symptoms is when the sinus starts producing mucus in response to irritation or constant blockage.

At this stage an antibiotic is not usually required. Infection of the sinus usually is accompanied by a temperature, which may suggest that an antibiotic is required.

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