Sinusitis

Sinuses are cave like pockets in the skull which are lined with much the same material as our respiratory tracts. 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. 

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. It can be caused by allergies, nasal polyps and septal deviation as well as other conditions that have weakened the immune system. The symptoms are very similar to those of acute sinusitis but last for at least 3 months.

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

There are four sinuses found on the each side of the face called the maxillary, frontal, sphenoid and ethmoid.  When each (or all) is inflamed from infection or allergic challenge different symptoms are experienced. 

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

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.

Other symptoms associated with Sinusitis

  • Prolonged cold symptoms
  • Green, yellow or blood streaked mucus from the nose
  • Head pain that worsens when lying down or bending over

The condition of Rhinitis is associated with Sinusitis as inflammation of the nose can progress into the adjoining sinuses.

In the digital 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 and ‘wheeziness’.  Treatment involves first restoring the nasal lining to normal, then stabilising the area and deciding what the cause is.  In this case the inflammation was triggered by an aggressive allergy to dust mites and grass pollens. 

Fungal Sinusitis

Fungal Sinusitis was once considered a rarity but may be more common than previously realised. Symptoms are often similar to those of bacterial sinusitis and the fungal infection may trigger fleshy (benign) growths inside the nose called polyps. People who are allergic to fungi are often more susceptible to this particular form of sinusitis. A CT scan commonly determines whether or not a fungal infection has occurred and standard procedures such as endoscopic surgery are considered to clear the offended fungus and resume normal sinus drainage.

Nasal Polyps

These are benign fleshy, grape-like growths that form inside the nose and sinuses.  There is no agreement on the causes of nose polyps but some researchers believe that an allergic response to fungal spores may be one explanation.

Treatments

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 initially with antibiotics. Steroid nasal drops and sprays may be used to decrease swelling in the nasal passages. Allergic nose and sinus issues may now be treated using non-drug treatments such as Rhinolight and Immunotherapy desensitisation. If an anatomic reason is found for chronic sinusitis, it may need to be corrected with surgery. If a surgical procedure is necessary, samples are usually taken at the same time to identify any organisms present which may be causing infection.

Fungal sinusitis will require surgery to clean out the sinuses. Then, a relatively long course of a strong antifungal medication may be offered.

We take your sinus issues seriously.  When you attend you will be quizzed about symptoms such as:

  • Snoring
  • Mouth breathing
  • Dry mouth every morning after sleep (suggesting night time mouth breathing)
  • Runny nose
  • Post nasal drip
  • Blood stained mucus
  • Diminished (or lost) senses of smell and taste
  • Associated asthma, shortness of breath or night cough
  • Associated skin hives (urticaria)
  • Aspirin or dispirin or similar pain killer allergy

This information gives us valuable insights as to what type of sinus problem you have.  We then inspect the nose and sinuses with an Olympus ENF fiberscope (see photo below).  This is a 3mm in diameter fiberoptic instrument that allows us visually check the breathing tract from the tip of the nose to the vocal cords.  Our fiberscope is connected to an LCD screen that allows the patient follow the procedure.  The screen can display an image ‘freeze’ so we can discuss an area of particular importance.

Olympus fiberoptic scope in action.  The flexible tip measures 3 mms and passes easily along the nose, into the back of the throat and down to the vocal cords.  On the screen all areas can be viewed.  Specific zones of interest can be photographed and recorded to assess treatment strategies.  This has been used on children as young as 5 years and adults over 80 years.

We combine this with a full allergy screening.

Below are examples of images we captured on patients illustrating just how troublesome their sinus problems were at the first consultation.

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 sets in ON TOP of the background changes considerable extra damage can be inflicted on the soft tissue.

A nasal polyp.  This is a benign but nuisance growth inside the nose that causes symptoms of obstruction, loss of senses of smell and taste and may trigger asthma.

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 this may trigger off asthma.  If the nose and sinus problems are corrected the asthma usually abates significantly.