SINUSITIS

The sinuses are air-filled spaces located in the front of the skull and within the bones of the face. The most important sinuses are situated above and below the eye sockets and behind the bridge of the nose. These cavities are lined with a mucus-producing membrane.

Under normal circumstances, mucus is continuously transported from the sinuses into the back of the nose and down the throat without being noticed. This drainage may amount to a litre or more per day. The primary function of the sinuses is to help humidify and moisturise the air we breathe.

Although often blamed, the sinuses are not usually the cause of nasal congestion or headaches. Older children and adults may, however, experience pain over an infected sinus, aching behind the eye, or toothache. Infection of the ethmoid sinuses may cause swelling of the skin around the eye or nose.

Individuals who appear to have repeated colds or persistent nasal symptoms may, in fact, be suffering from chronic sinusitis, which can flare up from time to time. These flare-ups may be triggered by factors such as cold exposure, swimming, fatigue, weather changes, or contact with allergens.

With appropriate treatment, nasal congestion and other symptoms should gradually improve over approximately 14 days. In some cases, a doctor may take a sample of the mucus for culture. Imaging of the sinuses, such as an X-ray or CT scan, may be required in more complex cases. Occasionally, when the mucus becomes excessively thick, it may need to be washed out of the sinuses.

 

ACUTE OR CHRONIC SINUSITIS

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What Is Sinusitis?

Sinusitis is inflammation of the mucous membranes lining the sinuses and is a very common condition. It is most often caused by infection, allergies, or irritation from airborne pollutants or toxins. There are two main forms of sinusitis, and understanding the difference is important in order to receive appropriate treatment.

 

What Are the Two Types?

The first type is acute sinusitis.
The second type is chronic polypoidal or recurrent sinusitis, which is generally more complex and more common.

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Do the Treatments Differ?

Acute sinusitis usually responds well to antibiotics and decongestants. If pus is present within the sinus cavity, drainage may be required.

In chronic sinusitis, medication may provide temporary relief. However, if symptoms persist or repeatedly recur, a more detailed evaluation is necessary to determine whether surgical treatment is required.

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What Type Do I Have?

To help determine whether your symptoms suggest acute or chronic sinusitis, note which of the following apply:

• Pain confined to one area

• Sudden onset of pain

• Discoloured nasal discharge on one side

• Nasal congestion (stuffiness) on one side

• Frequent, sometimes severe headaches

• Persistent pressure or heaviness in the head

If your symptoms are limited to the first four points, acute sinusitis is more likely.
If your symptoms correspond more closely to those in the second half of the list, chronic sinusitis is more probable.

 

How Can You Be Sure?

If you suspect acute sinusitis, you should consult your family doctor. Diagnosis is often based on what is sometimes referred to as the “rule of one”:

• One area of facial pain

• Discharge from one side of the nose

• Nasal blockage on one side

If chronic sinusitis is suspected, referral to an ENT specialist is recommended. Diagnosis is usually confirmed with the aid of a CT scan of the sinus cavities.

 

How Does Chronic Sinusitis Develop?

Chronic sinusitis typically develops when inflammation of the sinus lining obstructs normal drainage. The body constantly produces mucus to lubricate the nasal passages. In the sinuses, this mucus is transported toward each sinus opening by millions of tiny hair-like structures called cilia.

If a sinus opening is already narrow, inflammation may cause it to swell shut completely, preventing mucus from draining. When this occurs, surgery may be necessary to restore normal drainage.

 

What Will Surgery Do?

Surgery for chronic sinusitis serves two key purposes:

First, it enlarges the natural sinus openings. Since cilia move mucus in only one direction—toward the natural opening—creating additional openings elsewhere would not be effective, as the cilia would not utilise them.

Second, it preserves the function of the cilia. Procedures that damage cilia or create scar tissue can impair mucus transport and are therefore less effective.

Endoscopic sinus surgery is currently the most effective approach. By removing areas of obstruction while preserving normal anatomy, it restores the natural flow of mucus and air through the sinuses.

 

What Can You Expect From Surgery?

In most cases, endoscopic sinus surgery is a relatively straightforward procedure performed under general anaesthesia. Patients usually return to normal activities within a few days, with full recovery taking approximately four weeks.

More complex cases may require longer operating times and a more extended recovery period. Follow-up care will be tailored according to the extent and complexity of the surgery.

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