SINUSITIS

Article published in KPJ Klang Specialist Hospital website
Link to article Sinusitis authored by Dr Mazita Ami

Sinuses are air-filled spaces located within the skull bones.  These sinuses are situated behind the forehead, cheek, around the eyes and nasal bones. Sinusitis occurs when there is inflammation of the sinuses due to viral, bacterial or fungal infection.

These sinuses (frontal, maxillary, ethmoid and sphenoid) are usually lined with mucosal membranes and drain into the nasal cavities. The mucous clearance from the sinuses occurs by the sweeping mechanism of small hair like structures called cilia. This ciliary mechanism can be affected by certain medical conditions such as cystic fibrosis and Kartagener’s syndrome. Upper respiratory tract infection, allergies and deviated nasal septum can also cause blockage of the sinuses. Chronic smoking can also affect the ciliary function

and lead to sinusitis.

Symptoms of sinusitis

Sinusitis usually follows a cold that does not improve after 5-7 days. The symptoms include

• Nasal block
• Post nasal drip
• Nasal drip (rhinorrhoea)
• Headache
• Cough
• Bad breath or loss of smell
• Fever
• Fatigue

How is sinusitis diagnosed?

The doctor would obtain a complete medical history and ask for the above symptoms.

Nasal endoscopic examination can be performed which enables close inspection of the nasal cavities and the sinus openings. Features of sinusitis would include inflamed turbinates and nasal mucosa with yellowish discharge (mucopus). Presence of nasal polyps would also be inspected.

Computed tomography (CT scan) of the sinuses can further confirm the diagnosis and will show the extent of the sinuses involved. It can also show the anatomy of the sinuses and determine if surgery is necessary. Magnetic resonance imaging (MRI) may also be performed if there is suspicion of tumour or fungal infection.

Treatment

Treatment of sinusitis would be directed at decongesting the nose and treating the infection.

Broad-spectrum antibiotic is prescribed for 10-14 days. Oral decongestants are also given to help open up the blocked sinus openings. Nasal decongestant sprays are also beneficial. However caution is taken that it is not used for more than 3-5 days as it cause worsening of the nasal congestion. Other medications would include analgesics (painkillers), nasal saline sprays and mucolytics. Nasal corticosteroid sprays have also been shown to be beneficial in acute sinusitis, more so in patients with allergies and nasal polyps.

If fungal infection is suspected, treatment is more intensive and often surgery is advised. Invasive fungal infection is life threatening and would require inpatient treatment and immediate sinus surgery.

Is sinusitis a serious condition?

Sinusitis especially when acute can lead to life-threatening complications. Because of the close proximity of the sinuses to important structures, infections can easily spread with devastating effects. The complications include eye infections, eye abscess, blindness, meningitis, brain abscess and encephalitis.

Symptoms of possible complication are swelling or redness around the eyes, headache not relieved with over-the-counter medicine, nausea, vomiting or changes in vision. These symptoms require immediate medical attention.

Does sinusitis require surgical treatment?

Most cases of acute sinusitis would resolve with adequate medications. However patients with nasal polyps, anatomical blockage of sinuses and allergies are prone to get recurrent or chronic sinusitis. This category of patients would often require sinus surgery.

How is sinus surgery performed?

Sinus surgery is performed with the use of nasal endoscopes (Endoscopic sinus surgery). This enables the ENT Surgeon to perform the surgery via the nostrils without any external skin incisions. The surgery is aimed to open the blocked or narrowed sinus openings, correction of deviated nasal septum, removing nasal polyps and drainage of the sinuses.

Nowadays, balloon sinuplasty is also being performed to widen the narrowed or blocked sinus openings. The ENT Surgeon would be able to advise if this type of sinus surgery is suitable for the patient.