Sinusitis and sinus congestion (5)

Introduction 

Sinusitis is a common cause of pain in and around the eyes and face. It is a condition in which the lining of the sinuses becomes inflamed, usually due to a viral infection in which case it often improves within two or three weeks, or allergy in which case it can persist for many months.
The sinuses are small, air-filled cavities behind your cheekbones and forehead.
The mucus produced by your sinuses usually drains into your nose through small channels. In sinusitis, these channels become blocked because the sinus linings are inflamed (swollen).
It's very important to minimise the inflammation in your sinuses as quickly as possible i.e. within a few weeks, rather than putting up with the symptoms and allowing the sinusitis to persist for months or years. This is because the inflammation itself gradually causes permanent blockage of the sinus drainage passages which then becomes much harder to treat and leads to self-perpetuating long-term sinusitis. See below under "How to treat your sinusitis promptly and properly".

What causes sinusitis?

Sinusitis is usually the result of a cold or flu virus spreading to the sinuses from the upper airways. Only a few cases are caused by bacteria infecting the sinuses.
An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed.
It's not clear exactly what causes sinusitis to become chronic (long-lasting), but it has been associated with:

• allergies and related conditions, including allergic rhinitis, asthma and hay fever
• nasal polyps (growths inside the nose)
• smoking
• a weakened immune system

Making sure underlying conditions such as allergies and asthma are well controlled may improve the symptoms of chronic sinusitis.

Signs and symptoms

Sinusitis usually occurs after an upper respiratory tract infection, such as a cold. If you have a persistent cold and develop the symptoms below, you may have sinusitis.
Symptoms of sinusitis include:

• a green or yellow discharge from your nose
• a blocked nose
• pain and tenderness around your cheeks, eyes or forehead
• a sinus headache
• a high temperature (fever) of 38C (100.4F) or more
• toothache
• a reduced sense of smell
• bad breath (halitosis)

Children with sinusitis may be irritable, breathe through their mouth, and have difficulty feeding. Their speech may also sound nasal (as though they have a stuffy cold).

When to see your GP

If your symptoms are mild and getting better, you don't usually need to see your GP and can look after yourself at home.
See your GP if:

• your symptoms are severe or getting worse
• your symptoms haven't started to improve after around 7-10 days
• you experience episodes of sinusitis frequently

Your GP will usually be able to diagnose sinusitis from your symptoms and by examining the inside of your nose.
If you have severe or recurrent sinusitis, they may refer you to an ear, nose and throat (ENT) specialist for further assessment.

How to treat your sinusitis promptly and properly

Most people with sinusitis will have it due to a virus, and will feel better within two or three weeks. These people can treat themselves at home as follows:

• you can relieve the pain by taking over-the-counter painkillers such as paracetamol or ibuprofen, and by holding warm packs to your face.
• using nasal decongestants – these shouldn't be used for more than a week, as this might make things worse
• inhaling steam, with/without menthol.
• regularly cleaning the inside of your nose with a saline solution; this is highly effective. One preparation that our patients find excellent for this is cheap HERE and the replacement sachets for it are extremely cheap HERE

If your symptoms aren't improving or are getting worse, your doctor may prescribe antibiotics or corticosteroid spray or drops to see if they help.
If your symptoms don't get better after trying these treatments, you may be referred to an ENT specialist for endoscopic examination, and perhaps surgery to improve the drainage of your sinuses.

Surgery

If your symptoms don't improve despite trying the treatments mentioned above, a type of surgery called functional endoscopic sinus surgery (FESS) may be recommended. This is a procedure to improve the drainage of mucus from your sinuses.
FESS is usually carried out under general anaesthetic. During the procedure, the surgeon will insert an endoscope into your nose. This is a thin tube with a lens at one end that magnifies the inside of your nose. It will allow the surgeon to see the opening of your sinuses and insert small surgical instruments.


The surgeon will then either:

• remove any tissues, such as nasal polyps (growths), that are blocking the affected sinus
• inflate a tiny balloon briefly in the drainage passages from your sinuses to widen them (this is known as a balloon catheter dilation)