The sinuses are paired air pockets located within the bones of the face. They are:
- The frontal sinuses. Located above the eyes, in the center region of each eyebrow.
- The maxillary sinuses. Located within the cheekbones, just to either side of the nose.
- The ethmoid sinuses. Located between the eyes, just behind the bridge of the nose.
- The sphenoid sinuses. Located just behind the ethmoid sinuses, and behind the eyes.
The sinuses are connected with the nose. They are lined with the same kind of skin found elsewhere within
the respiratory tract. This skin has tiny little hairs projecting from it called cilia. The cilia beat constantly to help move the mucus produced in the sinuses into the respiratory tract. The ciliary action sweeps mucus along the respiratory tract and helps to clear the tract of debris or any organisms which may be present. When the lining of the sinuses swells,, the swelling interferes with the normal flow of mucus. Trapped mucus can then fill the sinuses, causing an uncomfortable sensation of pressure and providing an excellent environment for the growth of infection-causing bacteria.
Causes & symptoms
Although swelling from allergies can mimic the symptoms of pressure, pain, and congestion, allergies can set the stage for a bacterial infection. Bacteria have usually been considered the most common cause of sinus infection; however, recent research has suggested that fungi are the most common cause. Streptococcus pneumoniae causes about 33% of all cases, while Haemophilus influenzae causes about 25% of all cases. Twenty percent of sinus infections in children may be caused by Moraxella catarrhalis. In people with weakened immune systems (including patients with diabetes; acquired immunodeficiency syndrome or AIDS; and patients who are taking medications that lower their immune resistance, such as cancer and transplant patients), sinus infections may be caused by fungi such as Aspergillus, Candida, or Mucorales. Additionally, those repeatedly on antibiotics may be predisposed to sinus infections.
Acute sinus infections usually follow some type of upper respiratory tract infection or cold. Instead of ending, the cold seems to linger, with constant or even worsening congestion. Drainage from the nose often changes from a clear color to a thicker yellowish-green discharge. There may be fever. Headache and pain over the affected sinuses may occur, as well as a feeling of pressure that may worsen when the patient bends over. There may be pain in the jaw or teeth. Some children, get upset stomachs from the infected drainage going down the back of their throats and into their stomachs. Other patients develop a cough. In recent years, however, physicians have cautioned patients not to assume that the presence of colored mucus or pain automatically means a bacterial infection. It may be of viral origin, and patients can avoid overusing antibiotics with proper diagnosis.
Medical practitioners have differing levels of trust in certain basic examinations commonly conducted in the office. For example, tapping over the sinuses may cause
X-ray pictures and CT scans of the sinuses are helpful for both acute and chronic sinus infections. Those experiencing chronic sinus infections may need a procedure with a scope to see if any kind of anatomic obstruction is causing their illness. For example, the septum (the cartilage that separates the two nasal cavities) may be slightly displaced. This condition is called a deviated septum. It can result in chronic obstruction, setting the person up for the recurrent development of infection.
A 2001 telephone survey in northern California revealed that use of alternative treatments for rhinosinusitis and asthma is common in the population, with 52% reporting use of alternative treatment in the past 12 months to treat breathing or nasal symptoms. Of these, most used herbal treatments, primarily ephedra-containing products.
Chronic sinus inflammation often is associated with food allergies. An elimination/challenge diet is recommended to identify and eliminate allergenic foods. Irrigating the sinuses with a salt water solution is often recommended for sinusitis and allergies, in order to clear the nasal passages of mucus. Another solution for nasal lavage, or washing, utilizes powdered goldenseal (Hydrastis canadensis) added to the salt water solution. Other herbal treatments taken internally include a mixture made of eyebright (Euphrasia officinalis), goldenseal, yarrow (Achillea millefolium), horseradish, and ephedra (Ephedra sinica); or, when infection is present, a mixture made of echinacea (Echinacea), wild indigo, and poke root (Phytolacca decandra-americana).
Homeopathic practitioners find a number of remedies useful for treating sinusitis. Among those they recommend are: Arsenicum album, Kalium bichromium, Nux vomica, Mercurius iodatus, and silica. Andrographics paniculata, commonly known as Kalmegh, is a herbal remedy from India that is recommended for fighting winter infections and sinus infection. It is usually combines with Echinacea.
Acupuncture has been used to treat sinus inflammation, as have a variety of dietary supplements, including vitamins A, C, and E, and the mineral zinc. Contrast hydrotherapy (hot and cold compresses, alternating 3 minutes hot, 30 seconds cold, repeated 3 times always ending with cold) applied directly over the sinuses can relieve pressure and enhance healing. A direct inhalation of an essential oil solution using a combination of two cups of water and two drops of a mixture of thyme, rosemary, or lavender essential oils can help open the sinuses and kill bacteria that cause infection.
Antibiotic medications are often used to treat an acute sinus infection, once it has been diagnosed as a bacterial infection. Suitable antibiotics include sulfa drugs, amoxicillin, and a variety of cephalosporins. These medications are usually given for about two weeks but may be given for even longer periods of time. A 2001 study found that the type of antibiotic used for mild to moderate sinus infection did not seem to matter. In other words, any of about 16 antibiotics stopped the infection, so cost could help physicians determine the best therapy. Also, the study suggests that physicians might sometimes delay giving antibiotics to patients with milder symptoms and prescribe them only when moderately severe symptoms last seven days or more or severe symptoms occur.
Decongestants, or the short-term use of decongestant nose sprays, can be useful. Acetaminophen and ibuprofen can decrease the associated pain and headache. Also, running a humidifier can prevent mucus within the nasal passages from uncomfortably drying out, and can help soothe an accompanying sore throat or cough.
Chronic sinus infections are often treated initially with antibiotics. Steroid nasal sprays may be used to decrease swelling in the nasal passages. If an anatomic reason is found for chronic infections, it may require corrective surgery. If a surgical procedure is necessary, samples are usually taken at the same time to allow identification of any organisms present which may be causing infection.
Fungal sinus infection may require surgery to clean out the sinuses. Then, a relatively long course of a very strong antifungal medication called amphotericin B is given intravenously through a needle in the vein. This type of infection also can be treated with botanical medicine.
Prognosis for sinus infections is usually excellent, although some individuals may find that they are particularly prone to contracting such infections after a cold. Fungal sinus infection, however, has a relatively high death rate.
Prevention involves maintaining usual standards of good hygiene to cut down on the number of colds an individual catches. Avoiding exposure to cigarette smoke, identifying and treating allergies, and avoiding deep dives into swimming pools or other aquatic areas may help prevent sinus infections. Prevention may include avoiding dairy products and/or wheat products. During the winter, it is a good idea to use a humidifier, as dry nasal passages may develop breaks in the tissues, allowing bacteria to enter. When allergies are diagnosed, a number of nasal sprays are available to try to prevent inflammation within the nasal passageways, thus allowing the normal flow of mucus. A 2003 report from Sweden recommended regular humming. It appears that when people hum, they exhale about 15 times more air and thus expel potentially harmful microbes from nasal passages.
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American Academy of Otolaryngology-Head and Neck Surgery, Inc. 1 Prince Street, Alexandria, VA 22314–3357. (703) 836–4444.
Kathleen D. Wright
Teresa G. Odle