Sinusitis: Treatment and symptoms
A sinusitis is an inflammation of the mucous membrane in the sinuses. These are the air-filled cavities in the facial skull, which are connected to the nose via narrow openings. Depending on the course of the disease, a distinction is made between acute and chronic sinusitis. The doctor usually treats the former with decongestant and/or expectorant drugs. Chronic sinusitis may require surgical intervention. Here you can read all the important information on the topic: What are the symptoms of sinusitis? What to do about the complaints? How can sinusitis be prevented?
- What is sinusitis? Inflammation of the mucous membrane of the sinuses; acute and chronic course possible
- Causes: mostly viruses, sometimes also bacteria, fungi or allergies; promoting factors: anatomical constrictions in the nose, diseases of the immune system, allergic swelling of the mucous membranes or respiratory diseases
- Symptoms: Headache, feeling of pressure in the head, restricted sense of smell, secretion production, possibly fever, general exhaustion
- Treatment: Acute sinusitis often heals on its own; decongestants and expectorants have a supportive effect. In case of chronic course possibly surgery
- Attending physician: ENT physician
- Prognosis: Good in acute cases; rarely the inflammation spreads to neighbouring structures (bones, eye socket, brain etc.).
- Prevention: Keep nasal mucous membranes moist, healthy lifestyle (no smoking, lots of exercise in the fresh air, sufficient sleep, etc.);
There are two types of sinusitis, depending on their duration. They are treated differently:
Acute sinusitis often subsides on its own within two to four weeks. The healing process can be supported with medication: These include remedies that reduce the swelling of the mucous membrane. With their help, the excretory ducts of the paranasal sinuses are freed and the sinuses are ventilated again.
Antibiotics are sometimes prescribed by the doctor in cases of bacterial sinusitis.
Drugs to dissolve mucus liquefy the secretion in the sinuses. It can be better that way. The same effect is achieved by nasal sprays and inhalations with 0.9% salt water.
The jaw flushing that used to be performed frequently is now only rarely necessary.
Treatment for chronic sinusitis depends on the cause of the disease. If allergies or dental inflammations are behind it, these must be treated specifically. If anatomical changes favour sinusitis, these should be corrected if possible: For example, a crooked nasal septum can be straightened surgically, narrow excretory ducts of the sinuses can be widened and large nasal polyps can be removed.
Nasal rinses and inhalations with salt water can help to loosen the stuck mucus in chronic sinusitis.
Sinusitis: Home remedies
With sinusitis therapy, it does not always have to be (only) one drug. With home remedies you can alleviate the symptoms of an acute inflammation yourself and support the healing process. Helpful is for example the essential oil of myrtle with its anti-inflammatory effect. It is available in capsule form in the pharmacy.
In contrast, a tea made from primrose root (primrose root) has a secretion-dissolving effect. A steam bath with decongestant and soothing essences (lavender, chamomile, thyme etc.) or inhalation of warm water vapours is also recommended for sinusitis.
You can read more about home remedies and complementary cures for sinusitis, their use and possible risks in the article Sinusitis: Home remedy.
Together with allergic and viral diseases of the upper respiratory tract (flu, cold), sinusitis is one of the most common diseases of the respiratory tract. In the case of acute sinusitis, those affected have survived after a maximum of twelve weeks. Within this period the sinusitis symptoms disappear completely. The chronic sinusitis is more persistent. It lasts longer than twelve weeks, and the symptoms never completely disappear in the meantime. Even if the symptoms recur more than four times a year, it is called chronic sinusitis.
Acute sinusitis: symptoms
Acute sinusitis is usually preceded by a cold (rhinitis), i.e. a pure inflammation of the nasal mucous membrane. This usually continues when the inflammation spreads to the paranasal sinuses. This simultaneous inflammation of the mucous membranes of the nose and paranasal sinuses is called rhinosinusitis.
The main signs of acute sinusitis (or rhinosinusitis) are
- Headache or feeling of pressure in the head: In severe cases, the pain throbs above the forehead, in the cheek area, behind the eyes or less frequently in the back of the head. The pain increases as soon as you tilt your upper body forward (for example when bending down) or step firmly with your foot. If you exert light pressure on the affected areas from the outside or tap them, the pain also increases.
- Sniffles: often with purulent nasal discharge; often the nose is completely blocked.
In the case of a severe sinusitis, symptoms such as fever, fatigue and visual disturbances can be added. Sometimes a painful, externally visible swelling develops.
Chronic sinusitis: symptoms
Chronic sinusitis is often accompanied by much weaker symptoms than acute sinusitis. Affected people do not even necessarily have pain. However, nasal breathing is impaired for more than twelve weeks and is usually accompanied by a mucous and purulent nasal discharge. Sometimes in chronic sinusitis there are also acute attacks of infection with severe pain.
Another typical feature of chronic sinusitis is impaired smell and taste: those affected smell and taste less or even nothing at all than usual.
Forms of sinusitis
Paranasal sinuses include
- the two frontal sinuses: in the middle just above the nose above the eyebrows
- the two maxillary sinuses: right next to the nose; the largest paranasal sinuses
- the ethmoidal cells (ethmoidal cavities or ethmoidal labyrinth): between the nose and the inner corner of the eye
- the two sphenoid sinuses: above the posterior end of the main nasal cavity
If the sinusitis includes several sinuses, doctors refer to it as polysinusitis. If all sinuses are affected, the diagnosis is pansinusitis.
Sometimes the inflammation extends only to individual sinuses: The most common forms of sinusitis are sinusitis maxillaris and ethmoidal sinusitis. Inflammation of the frontal sinuses (sinusitis frontalis) is rarer, and sphenoidal sinusitis is the least common.
We have a total of seven paranasal sinuses. These air-filled cavities in the bones of the skull are lined with mucosa. The maxillary and ethmoid sinuses are most frequently affected by inflammation.
The maxillary sinuses lie directly next to the nose and resemble inverted pyramids. If they become inflamed, the cause is usually fungi, bacteria, viruses or allergies. However, injuries to the mucosa of the maxillary sinus can also trigger an inflammation of the maxillary sinus. This can happen, for example, when pulling a tooth in the upper jaw or when a bone fracture occurs in the area of the middle facial skull. Rarely is root inflammation in the area of the upper teeth the trigger of this form of sinusitis. Toothache can accompany this odontogenic or dentogenic sinusitis.
An inflammation of the maxillary sinus manifests itself in dull to throbbing pain and a feeling of pressure in the cheek area. These complaints increase when bending or jumping. Toothache, headaches and purulent nasal secretions can also indicate a disease.
You can read more about the symptoms, causes and treatment of this form of sinusitis in the article sinusitis.
A sinus infection can occur, for example, if the ventilation of these sinuses is permanently impaired. This is the case, for example, if someone has a severely curved nasal septum or large nasal polyps. Nasal infections and allergies are also among the possible causes of this form of sinusitis.
In the case of an acute frontal sinusitis, strong, stabbing and pulsating pain develops within a few hours on the affected frontal side and around the eye. Other possible complaints are a slimy, purulent cold, a reduced sense of smell and conjunctivitis.
If the inflammation is chronic, those affected report headaches. Odours are also reduced or wrongly perceived. Mucilaginous and purulent nasal secretions can also form.
You can read everything important about this form of sinusitis under sinusitis.
Paranasal sinusitis: Causes & risk factors
The paranasal sinuses are air-filled cavities in the facial bones that lead to the nose. They reduce the weight of the head and serve as a resonance chamber when speaking and singing. Normally they are well ventilated and are cleaned by the body itself: they are lined with the same mucous membrane as the nose. This mucous membrane produces a secretion. It is transported from the paranasal sinuses to the nasopharynx by means of the fine cilia on the surface of the mucous membrane – an effective cleaning mechanism. However, if this path is blocked, the secretion accumulates in the cave. This favours the growth of bacteria and other pathogens – the mucous membrane becomes inflamed and sinusitis develops.
The main causes of acute sinusitis are viral or bacterial infections of the nose. Even with a simple cold, the sinuses are usually also affected (rhinosinusitis). Bacterial sinusitis is usually the result of viral rhinosinusitis: the viral infection causes the mucous membrane to swell. In addition, bacteria can easily colonize and multiply on this surface. Then a sinus infection develops.
More rarely, pathogens in water, when swimming or bathing, can also cause sinusitis. Then doctors speak of bathing sinusitis.
If germs are the cause, a sinusitis is contagious.
In contrast, so-called barosinusitis is caused by strong pressure fluctuations, such as those occurring during diving or flying.
Inflammation of the maxillary sinus can also be caused by an inflammation of the tooth root: The roots of the upper molars are in close spatial relationship with the maxillary sinuses.
Chronic sinusitis is often due to anatomical narrowing of the nose, which hinders the ventilation of the sinuses. These include, for example, curvatures of the nasal septum or large nasal polyps.
Other causes of sinusitis can be allergic swelling of the mucous membranes, cystic fibrosis or diseases of the immune system. People with respiratory diseases such as COPD or asthma are more likely to have (chronic) sinusitis. People who suffer from asthma in combination with nasal polyps and an intolerance of ASS (acetylsalicylic acid) are particularly often affected. This trio is also known as the Samter Trio.
Sinusitis: examinations & diagnosis
In many cases, sinusitis heals without treatment. If you suspect a sinusitis, you should still go to the (ENT) doctor. He can clarify the exact cause of the complaints, prescribe necessary medication and detect possible complications early on.
The doctor first takes your medical history (anamnesis) in consultation with you: He asks about the type, duration and extent of the symptoms and whether you have had such symptoms before. He also inquires about any previous illnesses (such as allergies).
The doctor will then examine your nose from the inside using a rhinoscopy: He inserts a thin, usually rigid tube (endoscope) into the nose, which has a light source and a small camera at the front end. This allows an inspection of the excretory ducts of the paranasal sinuses.
Purulent rhinitis indicates a bacterial infection. The doctor then takes a swab to have it examined in the laboratory for the bacteria causing the disease. Bacteria frequently involved in sinusitis include Streptococcus pneumoniae and Haemophilus influenzae.
An x-ray shows whether fluid has accumulated in the sinuses. However, X-rays are no longer routinely recommended for the diagnosis of sinusitis. The examination exposes patients to a certain level of radiation. Instead, the doctor can do an ultrasound examination: Although this does not provide such accurate images of the sinuses, it is more gentle. Ultrasound is used especially during pregnancy and in children. The examination is also suitable for monitoring the course of sinusitis.
Other imaging examinations include computer tomography (CT) and magnetic resonance imaging (MRI). However, they are only carried out in certain cases, such as complications, for planning an operation or in the case of chronic sinusitis. Even the suspicion of a rare tumour as the cause of the symptoms can be clarified by a CT or MRI.
If the cause of a sinusitis is (probably) an allergic reaction, an allergy test is useful. As a rule, it is possible to find out which allergen is responsible for the excessive immune reaction. For example, the prick test or a provocation test can be used as an allergy test.
Sinusitis: course & prognosis
Acute sinusitis usually subsides after a short time – within two weeks in 60 to 80 percent of all cases of acute sinusitis, within six weeks in 90 percent of all cases of acute sinusitis. The duration of chronic sinusitis, on the other hand, can extend over years. Some patients even suffer from it for life. The decisive factor here is whether the cause of the chronic inflammation (such as constrictions in the nose) can be eliminated.
Complications of sinusitis are rare – if treated early and correctly. For example, a persistent purulent sinusitis can spread to the adjacent periosteum and to the bone and soft tissue if left untreated. Serious problems can arise if, for example, the eye socket, the meninges (meningitis) or the brain itself (encephalitis) become inflamed. Such dangerous complications of sinusitis usually require hospital treatment.
Paranasal sinusitis in children
Sinusitis can also occur in children. The possible causes are the same as for adults. Which paranasal sinus area is affected varies according to the age of the child, because the paranasal sinuses only develop fully during childhood: In infants, only the ethmoidal cells and maxillary sinuses are already sufficiently developed that sinusitis can develop here. Sphenoid sinusitis and frontal sinusitis, on the other hand, are often only observed from schoolchild age.
Sinusitis in children: symptoms
The symptoms of sinusitis in children are similar to those in adults. However, the younger a child is, the less clear they are. Most common in children is an acute, virus-induced sinusitis, which is accompanied by general symptoms such as cough, sore throat, colds and possibly fever.
Sinusitis in children: Treatment
The treatment of sinusitis in children is similar to that for adults: If necessary, the doctor will prescribe decongestant medication and (for purulent sinusitis) antibiotics. The anti-inflammatory and pain-relieving active ingredient acetylsalicylic acid (ASA) is not suitable for children under twelve years of age. It can – in conjunction with a viral infection – trigger the rare but potentially life-threatening Reye’s syndrome.
Infrared treatments using red light lamps have proven to be effective in sinusitis therapy. Such heat treatment improves blood circulation and thus supports the body’s own immune response in the inflamed tissue. Inhalations, for example with chamomile or saline solution, have the same effect. They open the airways and promote the outflow of stuck secretions.
Essential oils should only be used in children after consulting a doctor. Under certain circumstances, they can cause allergies or (in the case of oils containing menthol or having a strong smell) even respiratory arrest.
Chronic sinusitis in children (and adults) can only be treated successfully if the cause is eliminated. For example, in a surgical procedure, constrictions between the sinuses and nasal cavity, nasal polyps or enlarged pharyngeal tonsils are removed.
Sinusitis in children: Forecast
Acute sinusitis in children generally heals without any problems. If it has developed into a chronic inflammation, the prognosis depends on how well the treatment of the cause is successful.
Without (adequate) treatment, paranasal sinusitis can cause complications similar to those in adults (for example, the inflammation can spread to bones, the eye socket or meninges). But that happens very rarely.
Healthy mucous membranes help to prevent sinusitis. Therefore you should not smoke because it chronically irritates the mucous membranes. In winter, you should avoid overheated rooms and ensure that the air in the room is sufficiently humid (e.g. by airing the room regularly). Dry mucous membranes are more susceptible to germs.
You can also moisten the mucous membrane with a pure salt-water solution (in the form of a nasal spray or nasal douche). This also helps to free them from dust particles and dirt.
In general, sinusitis can also be prevented by specifically strengthening the immune system. This can be achieved with sauna visits, alternating showers and lots of exercise in the fresh air. A vitamin-rich diet also strengthens the immune system and can thus prevent sinusitis. Avoid stress, lack of sleep and regular alcohol consumption – all factors that weaken the immune system.
If you have a cold, you should hold one nostril closed and not snort too much. Or you pull up the nasal secretion – according to many experts, this is gentler on the sinuses than blowing. Drink enough to keep the nasal secretion fluid. For severe cold complaints, nasal sprays to reduce swelling of the mucous membranes are also helpful. They facilitate the drainage of secretion. However, use such nasal sprays for a maximum of five to seven days. Otherwise the mucous membrane can get used to the product and swell even more. There are also herbal preparations that help to liquefy the mucus.
In case of recurrent sinusitis due to anatomical constrictions in the nose, you should talk to your doctor. Then an operation may be useful. For example, the straightening of a curved nasal septum can prevent sinusitis in the future.