Sinusitis categories depend on many features. The correct diagnosis and treatment of this illness can be a problem for patients and doctors.
What is sinusitis?
Sinusitis is the inflammation of paranasal sinuses that are located within the ensembled bones that form the skull. These bones that are nearby the nose underwent a “pneumatization” process, which consists in a change of the inner parts of the bone, from solid to a pore-like structure that would ultimately form them. This process begins in early childhood and finishes in early adulthood.
A complete formation of these pore-like structures ends in the creation of the frontal, ethmoid, sphenoid and maxillary sinuses. For instance, in normal conditions, there isn’t any bacteria residing within the paranasal sinuses. However, all these new pore-like structures hold direct communication to the nasal cavity, where bacteria are a usual guest. Therefore, there is an underlying chance for bacteria to migrate, reside, multiply, and eventually cause an infection in paranasal sinuses.
Is sinusitis the same as a sinus infection?
Not precisely, the sinusitis term is for describing an inflammation, and this can have multiple causes. One of them is the sinus infection.
So, what would be a sinus infection?
Sinus infection would be the inflammation of a paranasal sinus due to the invasion of harmful microorganisms such as bacteria, viruses, or fungi. However, inflammation of sinuses seldomly occurs without the involvement of the nose tissue; therefore, right now, the preferred term for this disease is “rhinosinusitis.” This term highlights the fact that very often, there is nose involvement with the sinus infection.
There is a dominance of rhinosinusitis infections by viral microorganisms in comparison to bacterial infections of nearly 98% for the former. Regarding the viruses that can cause a sinus infection, the list is extensive, comprising the same ones of other upper respiratory tract infections as the common cold and the flu. This situation could be expected. These viruses typically infect the nose and pharynx, which are nearby from a non-stop communication to paranasal sinuses. Some of the viruses are rhinovirus, coronavirus, influenza virus, adenovirus, respiratory syncytial virus, among others.
From all the viral rhinosinusitis infections, approximately 2% of them could progress to bacterial sinusitis. Not only that, but a viral infection of the nose and throat, which accounts for an upper respiratory tract infection, allergies, trauma, and inflammatory diseases are all related to a bacterial sinus infection. The most common bacteria causing bacterial sinusitis is Streptococcus pneumoniae, but many others can also infect the sinus. Rarely, there could be fungal sinusitis predominantly by Aspergillus and Alternaria species, mostly in diabetic patients. And, this fungal infection can be misleading due to its similarity to other respiratory diseases, therefore confusing the doctors.
Why bacteria grow in this infection?
Bacteria grow by one particular mechanism in the sinus cavity, which can be triggered by many factors. Basically, there is a production of mucus by the sinus, including all of them, such as the frontal sinus, sphenoid sinus, ethmoid sinus, and maxillary sinus. This mucus should pass through a little hole called sinus ostium to the nasal passage for then getting out of the body. But when there is a blocked sinus, or some diseases impair the mucus clearing mechanisms within the cells, that mucus becomes stationary and the levels of oxygen decrease. This situation is a perfect scenario for bacteria to grow.
All the sources of nose inflammation or sinus blockages, such as allergic rhinitis or allergic sinusitis, nasal polyps, and viral infections, can promote this pathological mechanism.
What are the symptoms?
Sadly, even on these days of incredible advancements and technologies, the specific symptoms for sinusitis are still lacking. Even worst, no accurate diagnostic tool is available. The diagnosis still relies on a careful medical assessment by your doctor. Nevertheless, some guidelines within reach of the physicians intend to pilot them through the sinus infection diagnosis.
The unspecific symptoms are dynamic and would depend on if it is a viral or bacterial sinus infection. The common symptoms for both germs include pain over the cheek that worsens with incorporation from the bed or bending down, pain to finger-pressure over the closed-eye in the nearest part to the nose, nasal congestion, nasal obstruction, facial pain, runny nose, coughing that persists over time and a decrease in the capacity of smell.
Furthermore, there are three situations in which bacterial sinusitis is foreseen regardless of the symptoms. Firstly, when the sinusitis symptoms begin ten days after just passing an upper respiratory tract infection (common cold, for example). Secondly, the sinusitis symptoms worsen within ten days after initial progress towards relief. Thirdly, the presence in any case of purulent secretion through the nasal openings. The purulent secretion would be yellow or green mucus, which is a shared referral by patients.
You may also want to see: Acute pharyngitis
What color is your mucus when you have this infection?
Nasal discharge can be from any color and consistency. What do I mean with this? It would depend on the microorganism. The mucus could be white, yellow, or green and still be acute bacterial rhinosinusitis. Also, the consistency could be thin or thick; what is more important is the timeline of the presentation of the symptoms.
Why is this bacterial infection essential for me to know?
That is very clever for you to ask, and the answer is the whole purpose of this article. All the bacterial sinusitis are the ones requiring antibiotic treatment.
Additionally, you now know that bacterial sinusitis account for a much lesser number of infections in comparison to viral infections. And that is great because the vast number of viral sinusitis only requires treatment of their symptoms till it passes. While bacterial sinusitis indeed requires both antibiotic and symptoms treatment.
Besides, if bacterial sinusitis is without identification and treatment, it’s a progression over time that could cause serious complications. But that isn’t an excuse to start taking antibiotics because of your own suspicion of having acute sinusitis. Please remember that nearly all of them are viral infections, and antibiotics don’t eliminate at any time the viral microorganisms.
What are the possible complications of sinusitis?
This disease manages to cause a wide array of complications throughout the body, even though most of the infections are uncomplicated sinusitis; its classification is either locally, orbital, intracranial, and systemic complications.
These complications arise from bacterial infections without treatment, and inadequately, or just partial treatment. This lack of effective treatment may lead to chronic sinusitis and brain infections.
Local complications mean that they are within the sinus. One of them is mucoceles, which can eat away the bone where it’s located, and osteomyelitis, which is a dangerous bone infection.
Orbital complications are by far the most common for bacterial rhinosinusitis. The orbit is the place where the eye rests in the body, and both of them very close to the ethmoid and frontal sinuses. So when the infection is in those locations, it could affect orbital tissues. Indeed, it can thoroughly affect the eye, with the patient experiencing fever, loss of sight, pain, and ultimately represent a life-threatening situation.
Intracranial complications are brain infections that comprise massive collections of pus within the brain. Moreover, the systemic complications include the ones outside the skull; it can cause pneumonia and organ failure. So sinusitis has a very close relationship with death if it doesn’t receive treatment.
Which types of doctors treat sinusitis and sinus infections?
In children, sinusitis could have treatment by a pediatrician, while in the adult population, the assessment should be by an otorhinolaryngologist. The evaluation of the complications has a multidisciplinary team of neurologists and ophthalmologists. But the handling of simple sinus infection cases by the general practitioner is always a possibility.
What is the treatment for this infection?
After the initial diagnosis of what is the possible microorganism causing the infection, treatment would be the next step. There are treatments for the relief of symptoms, antibiotics, and surgical options available.
Patients with just mild or moderate symptoms that don’t have an unequivocal bacterial diagnosis, watchful waiting is used with symptom treatment. This symptom relief treatment is a nasal steroid and nasal irrigation with salty water (saline solution). This therapy would help for the symptoms, so if this is just a viral infection, that should be enough. For bacterial infection, the use of both symptoms and antibiotic treatment is a must. The first line of antibiotic therapy should be amoxicillin with or without clavulanate for five to ten days.
When bacteria produce purulent secretions, and the sinus is overwhelmed by this material, another option is the sinus drainage. This technique is used for diagnostic or therapeutic reasons because the retrieved secretions allow the doctor to perform a microbiological exam. It just requires local anesthesia, and with a needle, a puncture right in the face would aid in the patient’s symptoms, just like when you open up an abscess in the skin. All this pus material drainage would benefit the patient to recover faster and avoid complications.
It is important to note that, depending on many risk factors, several types of bacteria could be infecting the sinus. Including many at the same time; therefore, in patients that don’t respond to first-line therapy, they must undergo thorough studies by specialized doctors.
Sinus surgery is only an option when standard therapy fails, and the sinus infection becomes frequent. The surgery is a functional endoscopic sinus surgery (FESS), there is a wide range of indications for it, with excellent outcomes for complicated cases.
What can I do if I am presenting symptoms?
I develop this tool, an acute sinusitis symptoms checker, that would help you determine the odds of having acute sinusitis. It is free and would only take a few minutes.