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Summary

Sinusitis is a common condition in which the hollow air spaces in the bones around the nose, i.e., sinuses, are swollen. The sinuses surrounding the nose include those in the cheeks, forehead, and around the eyes, which are connected to the nose and to each other via narrow channels called as ostia. The sinuses play an essential role in moistening the inhaled air before its entry into the lungs. The cell lining of the sinuses produces mucus and traps the inhaled dirt and dust particles, thereby preventing infections. The primary causes of sinusitis are common cold and allergies. It can also occur due to an infection and usually clears up within two to three weeks. The common symptoms include blocked nose, headache, and swelling on the face. There are several types of sinusitis. Medications are required if it takes a long time to resolve by itself. Plenty of fluids, steam inhalation and rest are recommended along with antibiotics.

  1. Types of sinusitis
  2. Sinusitis symptoms
  3. Sinusitis causes and risk factors
  4. Prevention of sinusitis
  5. Diagnosis of sinusitis
  6. Sinusitis treatment
  7. Sinusitis prognosis & complications
  8. What is sinusitis
  9. Ayurvedic medicine, treatment and remedies for Sinusitis
  10. Homeopathic medicine, treatment and remedies for Sinusitis
  11. Medicines for Sinusitis
  12. Doctors for Sinusitis

Types of sinusitis

There are several types of sinusitis based on the severity of inflammation, history of the individual, and the duration of symptoms. It is classified into the following categories:

  • Acute Rhinosinusitis (ARS)
    It is a condition when you experience sinusitis for a maximum of four weeks and can be classified as severe ARS and non-severe ARS depending on the symptoms. It can also be subdivided on the basis of organism causing the infection as viral rhinosinusitis and acute bacterial rhinosinusitis.
  • Recurrent Acute Rhinosinusitis (RARS)
    Sinusitis is said to be recurrent if there are four or more episodes of acute sinusitis within one year.
  • Subacute Rhinosinusitis (SARS)
    It is a transition phase from ARS to chronic rhinosinusitis (CRS). It lasts for 4 to 12 weeks.
  • Chronic Rhinosinusitis (CRS)
    It is the inflammation of the sinus lasting for more than 12 weeks. It can be further subdivided depending on the inflammatory patterns as CRS in the presence of nasal polyps and CRS in the absence of nasal polyps. Nasal polyps are painless soft outgrowths that cause difficulty in breathing due to a blocked nose.
  • Acute Exacerbation
    It is a condition in which the CRS worsens and shows symptoms and severity similar to that of acute rhinosinusitis.

Sinusitis symptoms

All types of sinusitis show similar signs and symptoms. Individuals with CRS generally have symptoms of lesser severity but have pain in the facial muscles, bad breath, disturbances in the sense of smell, cough, and constant irritation in the throat.

The most frequently observed symptoms in individuals with sinusitis are as follows:

  • Fever.
  • A cough, which worsens at night.
  • Frontal (forehead) headache.
  • Pain in the teeth.
  • Nasal congestion.
  • White, yellow or green discharge from the nose.
  • Decreased sense of taste and smell.
  • Tenderness and swelling on various parts of the eyes, nose, cheeks, and forehead.
  • Bad breath.

Other symptoms of sinusitis include:

Sinusitis is often confused with rhinitis, which is a condition involving only the nasal passages. It causes symptoms, such as nasal irritation and inflammation, runny nose, fatigue, and nasal obstruction. It could also be caused due to allergies or cold.

Sinusitis causes and risk factors

Causes

Sinusitis occurs due to the following reasons:

  • Cold.
  • Infections.
  • Irritation in the nasal cavity and the lining of the sinus, e.g., exposure to an excessively chlorinated water in swimming pools.
  • A sinus infection may block the ostia. Microbial growth occurs in the trapped mucus in the sinuses. Viruses are the most common cause of sinus infections. Bacteria and fungi may also cause sinusitis. Individuals with a weak immune system (body’s defence system) are more prone to this condition and may suffer from viral and bacterial sinusitis.

Risk factors

The individuals with the following conditions and habits are more susceptible to have sinusitis:

  • Active or Passive Cigarette Smoking
    Smoking, as well as exposure to smoke, increases the risk of sinusitis.
  • Structural Abnormalities 
    Polyps, a deviated nasal septum, facial bone deformities like cleft palate, tumours of the nose, narrowed sinus openings and more such conditions also make a person prone to developing sinusitis.
  • Medical Conditions
  • Certain Medications
    Regular and prolonged use of medications, such as nasal decongestants.
  • Gender
    Women are more prone to sinusitis than men.
  • Environmental Factors
    • High altitudes.
    • Air pollution.

Prevention of sinusitis

Sinusitis can be prevented by taking care of a few things, such as:

  • Irrigate nasal passages regularly
    Run water through the nasal passages using a squeeze bottle. This will help in clearing the nasal passage and prevent sinusitis.
  • Avoid dry environments
    A humidifier at your residence or workplace can help in preventing dryness of the air you breathe and help keep your nasal passages moist.
  • Drink plenty of water
    It helps in flushing out toxins from the body and prevents infections.
  • Exercise regularly
    Indulging in any physical activity such as running, jogging, yoga, exercise and others increase blood circulation throughout the body and help in strengthening the immunity.
  • Eat a healthy diet
    Having a balanced diet rich in fruits and vegetables helps in improving the defence mechanism of the body and fighting infections.

Diagnosis of sinusitis

The following tests are performed to detect sinusitis:

  • Allergy Testing
    This is a test conducted to identify the cause of sinusitis. IgE (a type of antibody or protein of the immune system) levels are measured using a blood test and a scratch test in which small amounts of allergens are pricked into the skin, might be done to identify the substance(s) you are allergic to.
  • Nasal Endoscopy
    It is performed by doctors in severe cases to examine your sinuses and nasal passages to look for mechanical obstruction that might be causing the symptoms.
  • Imaging Tests
    Imaging tests such as X-ray of the sinuses, Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) Scan may also be done. These are performed to determine any physical abnormalities, such as polyps, deviated septum, narrowed drainage passages, which lead to the symptoms.

Sinusitis treatment

The appropriate treatment for sinusitis is essential to living a good quality life. The following are the treatment methods for sinusitis:

  • Antihistaminic drugs
    They help in treating the symptoms of allergic reactions. They prevent the inflammation of the sinuses and nasal cavity.
  • Nasal decongestant spray
    They can be useful if used for a short duration of three to four days. They help in draining the accumulated fluid from the sinuses. However, their long-term use may cause dependency in which the nasal passages will get blocked due to swelling and mucus if the decongestant is not used.
  • Nasal saline irrigations
    Wash your nasal passage using distilled or saline water and clear off the thick mucus secretions.
  • Topical nasal corticosteroids
    These are prescribed to treat the inflammation. The normal dose of these drugs can be used for an extended period without any side effects or addiction.
  • Antibiotics
    This is not a commonly used therapy for sinusitis because 98% of the acute sinusitis infections are due to viruses. Antibiotics are the primary mode of treatment for bacterial sinus infections. They do not provide relief from the symptoms necessitating other over the counter medications along with antibiotic treatment. As antibiotic resistance has increased, antibiotics are generally prescribed when the symptoms persist for more than 7 to 10 days.
  • Surgery
    It is the last treatment option when all medications have failed. It is generally needed in the cases of bony defects and is performed by an otolaryngologist. Surgery can help correct errors in the nasal septum, remove nasal polyps, and open the blocked passages. It can be performed under local as well as general anaesthesia depending on the condition.

Lifestyle management

Even if you are undergoing therapy, self-care is essential for completely resolving sinusitis. The following are the steps to be incorporated in your daily routine for a complete cure:

  • Take plenty of rest
    Resting up adequately will help in faster recovery and getting back to your normal daily routine.
  • Keep your body hydrated
    Drink plenty of fluids, which will help in keeping your mucus thin.
  • Avoid smoking
    Staying away from smoking will prevent further irritation and dehydration of the nasal and sinus lining and help in a speedy recovery.
  • Inhale Steam
    Stay in a hot shower for a prolonged period or inhale the steam of steaming hot water from a utensil. Bend on top of the utensil while sitting on a chair or ground and placing the utensil before you. Cover your head with a thick cloth to inhale more steam and prevent the water from cooling.
  • Irrigate nasal passages
    Clean your nasal passage with a saltwater solution.
  • Sleep with head in an elevated position
    This will prevent pooling of mucus, which typically happens when you sleep with your head in low position.
  • Avoid high altitudes
    This includes travelling via flights. This is because pressure changes have a negative impact on sinusitis and may worsen your condition.
  • Diet
    Some of the foods to be consumed and avoided are as follows:

Sr. No.

Foods that reduce and prevent inflammation

Foods that increase the risk of inflammation

1.

Fish that are rich in omega-3-fatty acids. e.g., sardines, wild salmon, cod

Processed sugars that are commonly labelled as sucrose or fructose

2.

Avocados are high in omega-3-fatty acids and strengthen immunity.

Foods with high saturated fat content, such as pizza, and dairy products including cheese

3.

Beans rich in omega-3-fatty acids such as kidney beans, mung, pinto

Monosodium glutamate, which is commonly present in canned and processed foods

4.

Green vegetables and bean sprouts are rich in vitamin C and calcium, which are useful in counteracting histamine. Histamine is responsible for the inflammatory response in your body.

Excess omega-6-fatty acids, which are found in oils, such as corn oil, safflower oil, sunflower oil

5.

Green tea and other fluids can help in reducing headache caused by dehydration.

Gluten and casein proteins found in rye, wheat, barley, and dairy products

6.

Citrus and other fruits with high levels of vitamin C, e.g., tomatoes. Apples and pears are rich in a natural antihistamine called quercetin.

Refined carbohydrates, such as mashed potatoes and cereals

Sinusitis prognosis & complications

Prognosis

Sinusitis can be treated by taking appropriate self-care steps along with the medications to control the symptoms and reduce inflammation. A timely diagnosis and thorough treatment are enough to cure it. Complications are rare.

Complications

The complications in sinusitis are infrequent, and include:

  • Abscess formation or collection of pus in the sinus tissues.
  • Infection of the surrounding structures of the sinuses e.g., around the eyes.
  • Meningitis, a condition that occurs when infections spread up to the skull and affect the brain.

Although these complications are extremely rare, they require immediate steps, such as hospitalisation, surgery, and intravenous (direct administration into the veins) medications, for complete management.

What is sinusitis

Sinusitis is also known as rhinosinusitis because of the inflammation of the nasal cavity as well as the sinuses. It is one of the very frequently detected diseases worldwide, with about 12.83% of the Indian population reported with chronic sinusitis. Sinusitis can be classified into acute, recurrent acute, subacute, and chronic types.

Dr. K. K. Handa

Dr. K. K. Handa

कान, नाक और गले सम्बन्धी विकारों का विज्ञान

Dr. Aru Chhabra Handa

Dr. Aru Chhabra Handa

कान, नाक और गले सम्बन्धी विकारों का विज्ञान

Dr. Yogesh Parmar

Dr. Yogesh Parmar

कान, नाक और गले सम्बन्धी विकारों का विज्ञान

Medicines for Sinusitis

Medicines listed below are available for Sinusitis. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
Blumox CaBLUMOX CA 1.2GM INJECTION 20ML103
BactoclavBACTOCLAV 1.2MG INJECTION99
Mega CvMEGA CV 1.2GM INJECTION98
AzibactAzibact 100 Mg/5 Ml Redimix Suspension21
AtmAtm 100 Mg Tablet Xl20
Erox CvEROX CV DRY SYRUP84
MoxclavMoxclav 1.2 Gm Injection95
NovamoxNOVAMOX 500MG CAPSULE 10S0
Moxikind CvMoxikind Cv 1000 Mg/200 Mg Injection92
PulmoxylPulmoxyl 250 Mg Tablet Dt50
AzilideAzilide 100 Mg Redimix22
ZithroxZithrox 100 Mg Suspension20
AzeeAZEE 100MG DRY 15ML SYRUP27
ClavamClavam 1000 Mg/62.5 Mg Tablet XR352
AdventAdvent 200 Mg/28.5 Mg Dry Syrup47
AugmentinAUGMENTIN 1.2GM INJECTION 1S105
ClampCLAMP 30ML SYRUP45
AzithralAzithral XL 200 Liquid 60ml152
MoxMox 250 mg Capsule27
Zemox ClZemox Cl 1000 Mg/200 Mg Injection135
P Mox KidP Mox Kid 125 Mg/125 Mg Tablet12
AceclaveAceclave 250 Mg/125 Mg Tablet85
Amox ClAmox Cl 200 Mg/28.5 Mg Syrup39
ZoclavZoclav 500 Mg/125 Mg Tablet159

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References

  1. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Sinusitis
  2. Better health channel. Department of Health and Human Services [internet]. State government of Victoria; Sinusitis
  3. National Health Service [Internet]. UK; Sinusitis (sinus infection).
  4. Mustafa M, Patawari P, Iftikhar HM, Shimmi SC, Hussain SS, Sien MM. Acute and chronic rhinosinusitis, pathophysiology and treatment. Int J Pharm Sci Invent. 2015 Feb;4(2):30-36.
  5. World Allergy Organization. Rhinosinusitis: Synopsis. A World Federation of Allergy, Asthma and Clinical Immunology Societies [Internet]
  6. OMICS International [Internet]; Chronic Sinusitis
  7. Am Fam Physician. 2001 Jan 1;63(1):69-77. [Internet] American Academy of Family Physicians; Adult Rhinosinusitis: Diagnosis and Management.
  8. Bachert C, Pawankar R, Zhang L, Bunnag C, Fokkens WJ, Hamilos DL, et al. ICON: chronic rhinosinusitis. World Allergy Organ J. 2014;7:25. PMID: 25379119
  9. National Health Service [Internet]. UK; Nasal polyps.
  10. American College of Allergy, Asthma & Immunology, Illinois, United States. Sinus Infection
  11. National Institute of Health and Family Welfare. Sinusitis. Ministry of Health and Family Welfare [Internet]
  12. American College of Allergy, Asthma & Immunology, Illinois, United States. Allergic Rhinitis
  13. Center for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services; Sinusitis (sinus infection)
  14. American Academy of Allergy, Asthma & Immunology. Sinusitis. Milwaukee, WI [Internet]
  15. Health Harvard Publishing, Published: March, 2009. Harvard Medical School [Internet]. 5 easy steps to prevent sinusitis, from Harvard Women's Health Watch. Harvard University, Cambridge, Massachusetts.
  16. Baylor College of Medicine. Make your own saline rinse: Combat sinus infections. The Sinus Center at Baylor College of Medicine; August 20, 2014 [Internet]
  17. Pacific College of Oriental Medicine. IMPROVE YOUR SINUSES TODAY: WHAT TO EAT TO AVOID INFLAMMATION. Updated:09/10/17 [Internet]
  18. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Sinusitis
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