Sinusitis

What is sinusitis?

The paranasal sinuses are the air-filled spaces in the bones of the skull that open into the nose. One pair lies in the cheeks and another in the forehead.

There are also a variable number of sinuses between the eyes and the nose. Sinusitis is the infection of these spaces.

Sinusitis may be a short illness (acute sinusitis) or a condition that continues for months or years (chronic sinusitis). Chronic sinusitis is relatively uncommon nowadays.

What causes sinuitis?

Acute sinusitis comes on following a cold.

If acute sinusitis fails to clear up completely, it may develop into chronic sinusitis.

Alternatively, chronic sinusitis may develop without any preceding illness. In both cases the development of infection follows blockage of the opening from the involved sinus into the nose.

Infection may spread to the sinuses in the cheek from an abscess on the root of a tooth. Occasionally, sinusitis can be caused by diving into polluted water.

What are the symptoms of sinusitis?

Pain is felt over the cheeks, forehead or the bridge of the nose. There may be partial nasal blockage and green catarrh. The pain is more severe in acute sinusitis.

How is sinusitis diagnosed?

Pressing on the affected sinus is painful in acute sinusitis.

Chronic sinusitis can only really be diagnosed by taking an X-ray or carrying out a CT scan of the sinuses, so it is very difficult for a GP to make a definite diagnosis of sinusitis.

What complications might arise from sinusitis?

Infection in the sinuses in the forehead or those between the nose and the eye may spread to other adjacent areas.

Spread of infection to the orbit (the bone surrounding the eye) causes swelling of the eyelids, and the eyeball may be pushed forwards by swelling. If this situation is left untreated, vision may be affected.

Infection may also be spread into the bones of the skull and inside the head causing formation of an abscess, but these complications are very rare.

What treatment is available?

Acute sinusitis will often settle on its own, but in severe cases may be treated with an antibiotic, such as amoxicillin (eg Amoxil), doxycycline (eg Vibramycin) or erythromycin (eg Erythroped).

Decongestant medication may help but should only be used for five to seven days in the case of nasal sprays or drops.

Chronic sinusitis usually requires surgical drainage of the sinuses involved.