Sinusitis

Sinusitis is an inflammation of the sinuses (the paired air pockets within the bones of the face). Sinusitis is most often due to an infection within these spaces.

The sinuses, which are connected to the nose, are lined with the same kind ofskin found elsewhere within the respiratory tract. This skin has tiny littlehairs projecting from it called cilia. As the cilia beat constantly, they help move the mucus produced in the sinuses into the respiratory tract. As themucus is swept along the respiratory tract, they help clear the respiratory tract of any debris or organisms.

When the lining of the sinuses is swollen, the mucus can't flow normally. Trapped mucus then fills the sinuses, causing an uncomfortable sensation of pressure and providing an excellent environment for the growth of infection-causing bacteria.

Sinusitis is almost always due to an infection, although swelling from allergies can mimic the symptoms of pressure, pain, and congestion; allergies alsocan set the stage for a bacterial infection. Bacteria are the most common cause of sinus infection. People with weakened immune systems (including patients with AIDS) or patients who are taking medications which lower their immuneresistance may develop sinusitis caused by fungi.

Acute sinusitis usually follows some type of upper respiratory tract infection or cold. Instead of ending, the cold seems to linger on, with constant or even worsening congestion. Drainage from the nose often changes from a clear color to a thicker, yellowish-green. There may be fever, headache and pain over the affected sinuses, as well as pressure which may worsen when the patientbends over. There may be pain in the jaw or teeth. Some children, in particular, get upset stomachs from the infected mucus draining into the throat andstomach. Some patients develop a cough.

Chronic sinusitis occurs when the problem has existed for at least three months. There is rarely a fever with chronic sinusitis, but nasal congestion andsinus pain and pressure are frequent. Because of the nature of the swelling in the sinuses, mucus may drip constantly down the back of the throat, resulting in a constant sore throat and bad breath.

It can be hard to diagnose sinusitus because the symptoms so often resemble those of a common cold, but sinusitis should be strongly suspected when a coldlingers beyond a week. Doctors disagree about the value of certain basic office exams for sinusitis. For example, tapping over the sinuses may or may notcause pain in patients with sinusitis.

X-rays and CT scans of the sinuses are helpful for both acute and chronic sinusitis. People with chronic sinusitis also should be checked for allergies and the possibility of a physical obstruction that could be causing the illness. For example, the septum (the cartilage which separates the two nasal cavities from each other) may be slightly displaced. Called a deviated septum, thiscan cause chronic obstruction and constant infections.

Antibiotics are used to treat acute sinusitis. These may include sulfa drugs,amoxicillin, and a variety of cephalosporins. These medications are usuallygiven for about two weeks, but may be given for even longer periods of time.Decongestants, or the short-term use of decongestant nose sprays, can be useful. Acetaminophen and ibuprofen can decrease the pain and headache, and a humidifier can prevent keep mucus moist, soothing any sore throat or cough.

Chronic sinusitis is often treated at first with antibiotics; steroid nasal sprays may be used to decrease swelling in the nasal passages. If an anatomicreason is found for chronic sinusitis, it may need to be corrected with surgery.

Fungal sinusitis requires surgery to clean out the sinuses followed by a relatively long course of a very strong antifungal medication called amphotericinB given through a needle in the vein.

Chronic sinusitis is often associated with food allergies, so identifying andeliminating the offending food can help. Irrigating the sinuses with a saltwater solution or powdered goldenseal is often recommended for sinusitis andallergies in order to clear the nasal passages of mucus.

Acupuncture has been used to treat sinusitis, as have a variety of dietary supplements including vitamins A, C, and E, and the mineral zinc. Hot and coldcompresses (3 minutes hot, 30 seconds cold, repeated 3 times always ending with cold) can be applied directly over the sinuses to relieve pressure and enhance healing. Inhalating essential oils (2 drops of oil to 2 cups of water) using thyme, rosemary, and lavender can help open the sinuses and kill bacteria that cause infection.

Prognosis for sinus infections is usually excellent, although some people mayfind that they are particularly prone to contracting such infections after acold. Fungal sinusitis, however, has a relatively high death rate.

Prevention involves good hygiene to cut down on the number of colds an individual catches. Avoiding exposure to cigarette smoke, identifying and treatingallergies, and avoiding deep dives in swimming pools may help prevent sinus infections. During the winter, it is a good idea to use a humidifier to prevent dry nasal passages from cracking and allowing bacteria to enter. When allergies are diagnosed, a number of nasal sprays are available to try to preventinflammation within the nasal passageways, thus allowing the normal flow of mucus.

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