Sinusitis

Sinuses are cave like pockets in the skull which are lined with much the same material as our respiratory tracts. There are four sinuses found on each side of the face called the maxillary, frontal, ethmoid and sphenoid sinuses. The function of sinuses is uncertain but may include warming and humidifying inspired air, improving vocal sound resonance and reducing the weight of the skull.

Almost all sinus problems begin inside the nose. The sinuses connect with the internal lining of the nose via small tubes. These tubes must stay clear otherwise sinus obstruction occurs, leading to various unpleasant and stubborn medical conditions. Tiny hairs along the respiratory tract push mucus up towards our nose and mouth. When the lining of the sinuses swells this mucus becomes stuck and causes uncomfortable pressure. It also produces a perfect breeding ground for bacteria. When each or all of the sinuses are inflamed from infection or allergic challenge then different symptoms may be experienced. 

When you attend Allergy Ireland our doctors will ask you about symptoms such as:

  • Snoring
  • Mouth breathing
  • Dry mouth every morning after sleep (suggesting nocturnal mouth breathing)
  • Nasal Congestion
  • Post nasal drip
  • Diminished senses of smell and taste
  • Associated asthma, shortness of breath or nocturnal cough
  • Associated skin hives (urticaria)
  • Aspirin or similar pain killer allergy

Acute Sinusitis refers to a new viral or bacterial infection of the mucosa lining the nasal cavity and paranasal sinuses. The symptoms usually include green nasal discharge accompanied by facial sinus pain and sometimes a fever.

Chronic Sinusitis is long term inflammation of the sinuses and nasal cavity. The majority of these causes are caused by allergies but it can also be caused various other problems. This includes structural issues such as septal deviation and nasal polyps but also hormonal changes such as during puberty, pregnancy or menopause. The symptoms are very similar to those of acute sinusitis but last for at least 3 months and beyond.

Patients of all ages with long standing nose and sinus problems often worsen during the change of seasons March/April and September/October. 

In order to establish the correct diagnosis our doctors combine thorough history taking with comprehensive skin prick allergy testing and endoscopy assessment of the nasal passages. In order to inspect the nose and sinuses we use an Olympus ENF fibreoptic endoscope. This is a 3mm diameter instrument that allows us to painlessly check the nasal passages. The endoscope displays the images on a screen which allows the patient to follow the procedure. Images can be frozen to allow us explain any findings of particular importance. 

Treatment of Sinusitis

Acute Bacterial Sinusitis is treated with antibiotic medications which are usually given for about two weeks. Aggressive sinusitis may require longer courses. Decongestants, or the short-term use of decongestant nose sprays, can be useful. Analgesics decrease the associated pain and headache.  Also, running a humidifier can prevent mucus within the nasal passages from drying out uncomfortably, and can help soothe any accompanying sore throat or cough.

Chronic Sinusitis is often treated with steroid nasal drops and steroid sprays to decrease swelling in the nasal mucosa. Non-drug options such as Rhinolight and Immunotherapy desensitisation are also available. If an anatomical reason is found for chronic sinusitis then this may need to be surgically corrected. 

What might I experience when my sinuses become inflamed or infected?

The green colour shows the maxillary sinuses which are located just behind the cheekbones on the face. 

If inflammation and swelling occurs in the maxillary sinuses you may experience:

  • Cheek pain/pressure
  • Toothache
  • Headache

The red colour identifies the frontal sinuses. These cavities are located just above the bone at the centre of each eyebrow. If inflammation and swelling occurs in the frontal sinuses you may experience:

  • Pain around and behind the eyes
  • Headaches

The orange colour identifies the ethmoid and sphenoid sinuses. The ethmoids are located between the eyes and just behind the bridge of the nose. Behind the ethmoid sinuses, tucked in behind the eyes are the sphenoid sinuses. If inflammation and swelling occurs in either or both you may experience:

  • Pain/pressure between and behind the eyes
  • Headaches

Case 1

17 year old male with long history of nasal obstruction, headaches and runny nose.  Photo shows grossly swollen nasal lining obstructing the sinus openings.  CT imaging showed that the ethmoid and maxillary sinuses were thickened from long term obstruction.

Case 2: Rhinitis is often associated with Sinusitis as inflammation of the nose can progress into the adjoining sinuses.

In this image there is severe swelling of all the lining in the nasal cavity causing symptoms such as blockage, mouth breathing, diminished sense of smell and taste’.  The management involves first taking a detailed history and clinical examination together with skin prick allergy testing to help identify the cause. The inflammation is then treated to help restore the nasal lining to normal function. In this case the inflammation was triggered by an aggressive allergy to dust mites and grass pollens. 

Nasal Polyps

These are are benign fleshy growths that form inside the nose and sinuses. They are non cancerous and may be triggered as a result of chronic inflammation of the nasal passages. They are associated with asthma, recurrent infection and allergies such as House Dust Mite and Pollen.

Although they are non cancerous they can cause mechanical problems in the nose by obstructing the nasal passages and connections to the sinuses. This can result in reduced airflow, diminished sense of smell and taste, sinus pressure and acute sinusitis. It is therefore important that conditions that causes chronic inflammation of the nasal passages such as dust mite and pollen allergy are treated effectively.

Case 3

25 year old with the internal surface of the nose so allergically challenged fluid is beginning to swell the lining.  Left untreated the shiny bubble-like area at 8 o’clock will become a polyp. In long standing nose and sinus allergic challenge, if an infection occurs in addition to the background changes then considerable extra damage can be inflicted on the soft tissue.

Case 4

Even in children as young as 5 years considerable swelling can occur within the nasal cavity. This in turn obstructs the sinus openings causing sinus problems. And in turn act as a trigger for asthma. If the nose and sinus problems are corrected then asthma may improve significantly.