Sinusitis; cause, signs and symptoms, diagnosis and management

Sinusitis

Sinusitis is an inflammation or infection of the paranasal sinuses. It can affect one or more of the sinus groups, including the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The condition may be acute (short-term) or chronic (long-term), depending on the duration and severity of symptoms.

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Causes

Sinusitis may result from viral, bacterial, or less commonly fungal infections. It is often preceded by upper respiratory tract infections such as the common cold, which causes inflammation and blockage of sinus drainage pathways.

Other contributing factors include allergies, nasal polyps, deviated nasal septum, and environmental irritants such as smoke and dust.

Signs and Symptoms

Both acute and chronic sinusitis may present with similar clinical features, including:

• Facial pain or tenderness over affected sinuses
• Headache, often worse when bending forward
• Toothache (especially in maxillary sinusitis)
• Malaise and general body weakness
• Nasal congestion due to swollen mucous membranes
• Purulent (pus-like) nasal discharge
• Reduced or loss of smell (anosmia)
• Post-nasal drip causing throat irritation or cough

Diagnosis

Diagnosis is mainly clinical but may be supported by imaging and laboratory investigations:

• Clinical examination: assessment of symptoms and nasal cavity inspection
• X-ray of sinuses: may show opacity indicating fluid or infection
• CT scan: the most accurate imaging method to assess severity and extent of disease
• Nasal endoscopy: allows direct visualization of sinus drainage pathways

Management

The main goals of treatment are to improve sinus drainage, relieve pain, reduce inflammation, and eliminate infection.

Medical Management

• Steam inhalation to loosen secretions and improve drainage
• Decongestants such as ephedrine nasal spray to reduce mucosal swelling
• Analgesics (e.g., paracetamol or ibuprofen) for pain and fever
• Antibiotics such as amoxicillin or co-amoxiclav for bacterial infections, especially in chronic cases

Surgical Management

• Sinus irrigation or antral washout in persistent cases
• Functional endoscopic sinus surgery (FESS) when medical treatment fails

Complications

• Chronic sinusitis
• Orbital infections (cellulitis or abscess)
• Meningitis (rare but serious)
• Brain abscess
• Loss of smell (permanent in severe cases)

Prevention

• Prompt treatment of upper respiratory tract infections
• Avoidance of allergens and irritants (dust, smoke)
• Good nasal hygiene (saline irrigation)
• Management of underlying conditions such as allergies
• Adequate hydration to keep mucus thin and flowing