Sinusitis: Causes, symptoms and management

February 5, 2014 by Rotimi Adesanya

 credits: File copy

A young man shared this story with me during a medical mission on an island in Epe, Lagos. He has been sent by the community health worker to our diabetes and hypertension screening. His test was within normal range and he was counselled on the need to be referred to a secondary facility for treatment. He later opened up and told me his medical history.

The man’s story: “I am 38 years old and I have suffered from chronic sinusitis my entire life. As a child, I was always going to the paediatrician, but as soon as one infection cleared up, another would start and it has been this way ever since.

“I was scheduled for surgery by ENT surgeon but declined due to fear. I have had allergy injections thrice a week for my whole life. I’m allergic to pet, dust mite, groundnut and mould. Of course, irritants like smoke, air pollution and smells of chemical substances make life even worse.

“I’m constantly on antibiotics, steroids, nasal spray, and allergy medication. My sinus infections often turn into bronchitis (lung infection) and this last time, into viral pneumonia. I cough constantly, lose sleep, miss work, and catch any virus going around. Now, I’ve been diagnosed with migraine and cluster headaches that are triggered by the sinus headaches. All this has made me become frustrated.”

This piece is to sensitise the general population to how debilitating sinus infections can be or how much we suffer as a result.

Sinusitis, or a sinus infection, occurs when the sinuses and nasal passages become inflamed and swollen (as illustrated in the picture). Acute sinusitis can last up to four weeks, while chronic sinusitis typically lasts more than four weeks and occurs more than four times in a year.

Causes

Acute sinusitis can be caused by upper respiratory tract viral infection, such as the common cold; or bacterial/fungal infections, allergies, and environmental irritants.

Chronic sinusitis can result from recurring episodes of acute sinusitis or it can be caused by other health conditions such as asthma and allergic rhinitis, immune disorders, or structural abnormalities in the nose, such as deviated septum or nasal polyps.

 Enlarged adenoids, cleft palate and tumours can also lead to chronic sinusitis.

Risk factors

-Young children are prone to colds and may have between eight and 12 bouts every year. Smaller nasal and sinus passages make children more vulnerable; while ear infections such as otitis media are also associated with sinusitis. Nevertheless, true sinusitis is very rare in children under nine years of age.

-The elderly are at specific risk for sinusitis. Their nasal passages tend to dry out with age. In addition, the cartilage supporting the nasal passages weakens, causing airflow changes. They also have diminished cough and gag reflexes and weakened immune systems

-People with asthma or allergies are at higher risk for non-infectious inflammation in the sinuses. The risk for sinusitis is higher in patients with severe asthma.

-Some hospitalised patients are at higher risk for sinusitis, particularly those with head injuries, or those whose conditions require insertion of tubes through the nose. Again, those who breathe aided by mechanical ventilators, and those whose immune system have been weakened are all susceptible to sinusitis.

-People who experience changes in atmospheric pressure, such as while flying, climbing high altitudes, or swimming, risk sinus blockage and therefore an increased risk of developing sinusitis

-Air pollution from industrial chemicals, cigarette smoke, or other pollutants can damage the cilia responsible for moving mucus through the sinuses.

General symptoms

Sinus symptoms are very common during a cold or the flu, but in most cases, they are due to the effects of the infecting virus and resolve when the infection does. Nasal congestion or discharge, itchy nose, eyes, facial pain or pressure, cough or scratchy throat, fever, diminished or absent sense of smell, recurrent sneezing, sinus headache,  migraine and or cluster headaches, ear pain or pressure, dental pain, bad breath, fatigue, are common symptoms of sinusitis.

Symptoms indicating medical emergency

Eyes may be red, bulging, or painful if the sinus infection occurs around the eyes. Swelling and drooping eyelid, loss of eye movement (possible orbital infection, which is in the eye socket), development of severe headache, altered vision, a soft swelling over the bone (indicative of bone infection) are all signs that you should see your doctor immediately.

 

To be concluded.