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    Sinusitis

    Overview
    Causes
    Complications
    Symptoms
    Diagnosis
    Treatment
    Where To Seek Treatment
    Singapore General Hospital
    Contributed by Dept of Otolaryngology

    Overview

    Sinuses are naturally occurring airfilled spaces in the skull. Each sinus is covered with a mucosal covering. The sinuses are all connected to the nose and mucus produced in the sinuses naturally drain out through the nose.

    In sinusitis, the mucous membranes become inflamed and swollen. This obstructs the flow of mucus out of the sinuses and leads to build-up of mucus in the sinuses leading to sinusitis.


    Causes

    Viruses are the most common cause of sinusitis and these infections usually resolve fairly quickly with just symptomatic treatment.

    Bacterial sinusitis usually has a longer duration of symptoms and may be treated with oral antibiotics.

    Fungal sinusitis is the least common of the three and usually occurs in those with a weakened immune system. Some pre-existing conditions may make an individual more likely to suffer from sinusitis, these include anatomical abnormalities of the nose, uncontrolled allergic rhinitis, and those with depressed immunity and some tooth infections.


    Complications

    Occasionally, complications may arise from untreated sinusitis. This occurs when the infection spreads. These complications include meningitis, infections to the eye and worsening of pre-existing asthma.


    Symptoms

    Symptoms of sinusitis include:

    • Difficulty breathing through the nose
    • Fever
    • Throbbing pain in the cheek, forehead area between the eyes
    • Sensation of heaviness in the head
    • Sensation of fullness in the face
    • Thick yellowish or greenish nasal discharge - there may be mucus dripping to the back of the throat, often causing a cough that is worse on lying down.

    Some people may also experience aching pain in the jaw, teeth or ears or a reduced sense of smell and taste. Other general symptoms include:

    • Bad breath
    • Fever
    • Nausea
    • Fatigue

    In situations where there is significant inflammation of the mucosa membrane, the drainage pathway may be blocked, leading to trapping of mucus within the sinuses. This leads to the symptoms of blocked nose, nasal congestion, facial pain as well as foulsmelling discharge. The cause may be viral, bacterial or fungal in nature.


    Diagnosis

    A nasoendoscopic examination, may be performed to access the drainage pathways of the sinuses. The nasoendoscope is a small tubular flexible scope that is introduced into the nose to visualise the nasal passages. It is not a painful procedure but some patients may experience a little discomfort. An examination of the nasal passages will also reveal the presence of any purulent nasal discharge.

    In cases of persistent sinusitis, a specimen of the discharge may be taken for culture to identify the bacteria and help in the selection of antibiotics.

    A computed tomographic scan (CT scan) may also be done to show any anatomical abnormalities that may lead to recurrent or prolonged episodes of sinusitis.


    Treatment

    sinusitisAcute sinusitis
    Acute sinusitis may be treated with antibiotics and decongestants. The aim is to control the infection, reduce the mucosal inflammation and restore the natural mucus flow in the sinuses.

    Chronic sinusitis
    In chronic sinusitis, the obstruction may not be completely reversed with medications and some form of surgery may be necessary to reverse the disease process. Hence, some cases of chronic sinusitis or recurrent sinusitis may need surgery in the form of a Functional Endoscopic Sinus Surgery (FESS).

    Most sinus surgeries are performed through the nose with the aid of scopes and specialised instruments that enable the procedures to be done with no external scars.

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