Paranasal Sinus Disease: Causes, Symptoms, Treatment, Prognosis, Prevention

Sinuses are the cavities present inside the bones of the skull, which are filled with air. Paranasal sinuses are cavities, which are connected to the nasal area. The main function of paranasal cavities are to reduce weight of the skull, help in resonating to the voice and produce mucus, which can pass through the nasal cavity. There are four paired paranasal cavities that surround the nasal area as:

• Maxillary sinuses located under the eyes
• The frontal sinuses located above the eyes
• Ethmoidal sinuses between the eyes
• Sphenoid sinuses are present behind the eyes.

The inflammation or swelling of the tissue lining the sinuses is called as Sinusitis. This inflammation takes place due to infections caused by the virus, bacteria, fungus or by any allergens. Generally healthy sinuses are filled with air. When they get blocked, the germs grow in the fluid and cause infection. Sinusitis in any of the paranasal cavities is known as paranasal sinus disease.

Sinusitis is classified as:

• Acute Sinusitis: It gets completely resolved in <30 days (one month).
• Subacute Sinusitis: It gets completely resolved within 30 to 90 days.
• Chronic Sinusitis: It lasts for >90 days (three months).
• Recurrent Sinusitis: It reoccurs within at least 10 days after resolution of symptoms.

All these types of sinusitis have similar symptoms and are difficult to distinguish. Acute sinusitis is very common. Roughly 90% of adults suffer from sinusitis in their life.

The symptoms of paranasal sinus disease include:

• Nasal obstruction and congestion
• Thick nasal mucus
• Pain in the face
• Headache and toothache
• Sometimes malaise with sore throat and cough
• Fever
• Fever and chills suggest an extension of the infection beyond the sinuses.

Paranasal sinus disease is a common condition found globally. It occurs more in women as compared to the men and occurs at any age. It is recurrent in case of patients suffering from asthma, cystic fibrosis and ciliary dyskinesia.

When patient is in the initial stages of paranasal sinus disease, he/she should immediately consult the doctor and get treated with antibiotics and decongestants. If the patient delays the treatment for Paranasal sinus disease, the infection can further spread to cause brain abscess and maybe dangerous.

The causes of paranasal sinus disease include the following:

• The infections caused by bacteria, fungus, virus, which obstruct the normal sinus drainage
• Immunocompromised states such as Diabetes, HIV infection
• Other factors such as prolonged stay in cold areas such as ICU or hill station, severe burns, etc.
• Cystic fibrosis
• Ciliary dyskinesia.

The sinuses are connected to the nose. The skin lining the sinus possesses tiny hair on them called cilia. These cilia beats constantly to move mucus produced in sinuses into the respiratory tract and out through the nasal cavity. The beating action of cilia helps to remove any debris or organism present in the mucus. When the lining of the sinus becomes swollen or the small orifices of nasal cavity get blocked by allergic inflammation, it interferes with the normal flow of mucus. Obstructed mucus fills the sinus and leads to uncomfortable pressure and provides a good environment for the growth of infection causing organisms.

The common risk factors are the same as mentioned in the causative factors. In most cases the paranasal sinus disease is due to infection. Although, allergen maybe a primary cause, yet it allows bacterial infection to set in.

There is no report of its significant association with age, family history, and smoking habits.

The major complication of sinusitis is the local spread of bacterial infection finally leading to brain abscess if not treated on time.

The doctor performs the physical examination mainly by checking the face and nasal cavity. Often diagnosis may be problematic since symptoms often mimic those of the common cold. X-rays are required only in complicated cases. In cases of chronic paranasal sinus disease, confirmatory testing is advised by direct visualization or CT scan.

Treatment for Paranasal sinus disease is directed towards controlling predisposing factors, treating infections, reducing inflammation of the sinus and facilitating the drainage of sinus secretions. This enables to re-establish the sinus ventilation and correct the mucosal obstruction.

• The bacterial infection is treated with antibiotics such as amoxicillin or doxycycline given for 5-7 days for acute sinusitis and for 6 weeks in case of chronic sinusitis.
• The symptoms of Paranasal sinus disease are relieved by using decongestants, corticosteroid nasal sprays and application of heat and humidity which improve sinus drainage.
• Breathing low-temperature steam such as from a hot shower or nasal irrigation or gargling can relieve symptoms of Paranasal sinus disease.
• Surgery is used in case of chronic and recurrent sinusitis to improve sinus drainage. Usually endoscopy is used. The two main types of surgery include:
  • A turbinectomy that shrinks the swollen tissues of the nose and takes only a few minutes to be completed.
  • Balloon sinuplasty which opens up swollen sinuses, and allows draining of mucus more freely.

Some of the ways to prevent paranasal sinus disease are:

• Maintaining a good nasal hygiene can go a long way in preventing Paranasal sinus disease.
• Immunizations.
• Dust contains common allergens; hence, regular cleaning of room is a must so that the dust does not accumulate.
• The bed sheets should be clean.
• Eating diet rich in nutrients and minerals with adequate rests. This will increase immunity and help to fight infection.
• If one is allergic to cold, avoid excessive exposure to cold conditions to prevent Paranasal sinus disease.

Paranasal sinus disease is a common condition and is very irritating for the patient suffering from it. Treatment is available for most of its types. Taking antibiotics in long run can lead to side effects. Hence, research is required to find a biological therapy to treat this disease. Simple prevention techniques and irrigation of the nasal passage along with gargle and steam inhalation can help a lot in preventing and curing Paranasal sinus disease.