SINUSITIS AND ITS TREATMENTS

Sinusitis is a disease that occurs when the spaces in the facial bones are filled with inflamed tissue. Nasal congestion is manifested by yellow-green nasal discharge, post-nasal drip, headache and difficulty in smelling. Memorial Health Group Otolaryngology Department experts gave information about sinusitis symptoms, treatment and prevention methods.

What is Sinusitis?
Sinuses; It is defined as the air spaces in the bones around the nose. Humans have five pairs of sinuses. These;

cheek sinuses (maxillary sinuses),

forehead sinuses (frontal sinuses),

Sinuses between the eyes (anterior and posterior ethmoid sinuses)

Sinuses in the nasal region (sphenoid sinuses) .

In infants and children, the sinuses take on the appearance of adults, and their development by airing is largely completed at the age of 12-14. However, they take their final shape at the age of 22-24.

The sinuses are part of the nasal system, which produces normal secretions (mucus). Normally, the nose and sinuses secrete about half a liter of mucus per day. The mucus produced acts on the nasal cover (mucosa) to sweep and wash away dust particles, bacteria, and other airborne particles. This mucus is then filtered back into the throat and swallowed. The particles and bacteria in it are broken down by stomach acid. Many people are not aware of this because it is a normal bodily function.

Sinusitis; It is a general definition that indicates the inflammation of the mucosa lining the sinuses located around the nose. Since there is no situation where only the sinus mucosa is involved and the nasal mucosa is not affected, the term “rhinosinusitis” is used instead of the term sinusitis today. In general, sinusitis occurs as a result of the inability to discharge the mucus (snot) produced by the lining mucosa into the nose. There are three main factors that cause this.

Obstruction of the nasal discharge channels (ostium) of the sinuses,

Disruption of the system (mucociliary activity) that actively carries the mucus to the ostia in the sinuses,

Change in mucus content or consistency.

In the presence of one or more of these factors, the proliferation of bacteria in the mucus accumulated in the sinuses causes sinusitis. Sinusitis is generally classified as:

acute sinusitis

chronic sinusitis

subacute sinusitis

Recurrent acute sinusitis

Acute exacerbation of chronic sinusitis

Sinusitis Symptoms
Symptoms of sinusitis vary from person to person. In general, people think that it is sinusitis when their head or face hurts, whereas sinusitis makes little difference in pain. The pain rate in sinusitis is around 5%. Complaints that are more prominent in sinusitis are known as nasal congestion, distortion in the voice, feeling of fullness on the face and runny nose. In general, the symptoms of sinusitis can be defined in this way;

Persistent cough at night or in the morning

Yellow-green colored thick nasal discharge,

feeling of pressure around the eyes,

Bad breath, bad smell, nausea and/or vomiting,

Colds (colds/flu) lasting more than 10-14 days, sometimes mild fever,

Nasal congestion and snoring

Sometimes burning in the throat with nasal discharge,

behavioral changes,

long lasting headache

Sinusitis Causes
Although there are many different causes of sinusitis, the most common causes are as follows;

Viral upper respiratory tract infections (URTI): It is the most common cause of sinusitis. The edema and inflammation of the nasal mucosa due to viral infection and the obstruction of the sinus discharge channels, as well as the thick consistency of the mucus produced to clog the ostia, cause secretion accumulation and deterioration in oxygenation in the sinuses. Following this stage, sinusitis occurs with secondary bacterial growth.

Mucosal edema, which obstructs the sinus ostia due to allergies, is the second important cause of sinusitis.

Intranasal curvatures (septum deviation),

polyps,

Anatomical pathologies such as nasal concha enlargements (concha hypertrophies) that narrow or obstruct the sinus discharge channels

Enlarged adenoids, especially seen in children

Pressure changes during swimming or air travel cause the ostia to close.

Although it is more common than sinusitis, hypertension and rheumatism, it impairs quality of life more than diabetes and heart diseases. It has negative effects not only physically but also psychologically. Sinusitis; It prepares the ground for problems such as nasal congestion, pain in the forehead, weakness and fatigue, sleeping with the mouth open at night, snoring, as well as stomach, intestine and lung problems. Therefore, the factors causing sinusitis and sinusitis must be treated.

Does Wet Hair Cause Sinusitis?
Whether going out with wet hair or not drying your hair after a shower will cause sinusitis is one of the most frequently asked questions among the public. When people with allergies or polyps in their noses or growing nasal flesh due to allergies go out with wet hair, the risk of sinusitis increases as the nasal mucosa of this person will swell allergicly during the hot-cold change and the sinuses will close easily. This information does not mean that the person will cut his/her hair or eliminate this risk with short hair. This is a problem with the hot-cold exchange and can be seen in anyone, but in general it is more common if there is a predisposition or disease in the nose that can facilitate this.

Sinusitis Headache
One of the most important causes of headache among the people is known as sinusitis. Sinusitis can cause severe pain that affects quality of life. The causes of headache originating from the sinuses, which are the air-filled spaces around the nose, are briefly;

Mucosal contact surfaces and stabbing pains

Lack of oxygen or negative pressure as a result of lack of ventilation

It can be listed as those that occur as a result of the pressure of inflammatory tissues (polyps) on the surrounding tissues.

It is natural for more than one sinus to be sick in many sinus diseases. Therefore, the resulting complaints will be a whole formed by one or more sinuses. In addition, the phenomenon of reflected pain is also involved.

Pain in the sinuses of the cheek region progresses from the sinus region to the upper teeth. The pain is sometimes felt in the cheekbone, nasal and forehead area. Contrary to popular belief, pain in chronic sinusitis is a less common symptom. In malignant tumors of the buccal sinus, pain may only be an advanced complaint. Cysts of the cheek sinuses are also a cause of pain. When the cysts enlarge and cover the inside of the sinus, they cause pain especially with the pressure they put on the sinus openings. The pain is usually severe and extends from the cheek area to the forehead. There is an increase in tear secretion and nasal congestion.

In acute infections of the nasal root sinuses, there is pain on the ipsilateral nasal root and behind the eyes. It is rarely found alone. It is usually present in the form of cheek and forehead sinusitis together with pansinusitis. Benign tumors called osteomas are also known to cause pain from the beginning.

Forehead sinusitis is generally blamed for forehead pain. However, due to the anatomical feature of the forehead sinus mouth, it is easy to empty, which ensures that there is not much pain in forehead sinusitis.

Although there is the least discussion among the nasal sinuses in terms of their characteristics, the final word about the clinical findings is still the skull base sinuses. Many complaints and diseases still take refuge in the responsibility of skull base sinusitis. In acute infection, headache in the back of the head, pain in the forehead and bilateral temples, pain spreading to the shoulder, teeth, palate and nose, neck stiffness, pain in the back of the nose, forgetfulness and distraction can be seen.

The air inside the sinus is theoretically at the same atmospheric pressure as the air outside, and the balancing of the pressure is related to the normal permeability of the sinus openings. The deterioration of this relationship causes a formation such as the air pressure in the sinus being more or less than the external environment. The practical consequence of this is the appearance of a pain. In particular, a formation called “vacuum sinusitis” and “vacuum headache”, which is associated with the decrease in air pressure in the sinus, is mentioned. This situation; It may be either as a result of obstruction of the sinus opening for any reason and absorption of the gases inside by the mucosa, or as a result of its inability to adapt to external atmospheric pressure changes. It is explained by the obstruction of the sinus opening as a result of inflammatory, allergic and tumoral formations and preventing air permeability. Opening the sinus mouth eliminates pain.

Sinusitis Treatment
When sinusitis is not treated correctly, it can cause very serious diseases such as chronic pharyngitis, chronic gastritis, reflux, infections and abscesses around the eyes, meningitis, and brain abscess. The diagnosis of sinusitis is made by ear, nose and throat examination and endoscopic examination, direct radiography and sinus tomography methods. In the disease classified as “Acute”, “Subacute” and “Chronic”; acute sinusitis lasts about 4 weeks. It resolves spontaneously or with medication. Subacute sinusitis is a transitional stage. Acute sinusitis is not healed at this stage; chronic sinusitis is not fully formed. Chronic sinusitis lasts longer than about 3 months. First, antibiotic therapy is administered. If sinusitis is chronic, that is, it cannot be treated with medication, sinusitis surgery may be considered.

“Endoscopic Sinus Surgery” can be applied to chronic sinusitis patients or “Balloon Sinoplasty Surgery” method can be applied to patients who are deemed suitable. In endoscopic sinus surgery, the channels of the sinuses are opened by correcting the polyps or other anatomical disorders that block the natural channels of the sinuses.

Sinusitis Treatment in Children
Situations that require surgery for the sinuses in pediatric sinusitis are cases that are resistant to drug therapy. Surgery is also an important option in the treatment of inflammation around the eyes due to sinusitis. In children with chronic sinusitis and adenoids or who have frequent tonsil infections, removal of the adenoids and, if necessary, tonsils is not a method to treat chronic sinusitis alone, an auxiliary treatment should also be applied. Endoscopic sinus surgery is preferred in chronic sinusitis that does not heal despite the adenoid and tonsil surgeries performed when necessary with drug therapy given at the appropriate time. The most important purpose of this surgery should be to ensure the opening of the sinus openings and to clean the inside of the sinuses. If the most important treatment option suitable for the child is surgery, this should be done without losing time.

Ways to Prevent Sinusitis
It is of great importance to know how to prevent the formation of sinusitis, a disease that can recur even if it is treated. It is recommended to follow these recommendations to prevent sinusitis;

Influenza infection must be treated under the supervision of a doctor.

The nose should always be kept open during the infection. For this, using the ocean waters or swimming in the sea is beneficial in terms of emptying the sinuses. The inside of the nose can be washed with a liquid prepared by mixing a teaspoon of salt and half a teaspoon of baking soda into a glass of water at home. These will prevent the sinuses from filling in flu infections. Menthol, eucalyptus steam can also be used to keep the nose open.

Care should be taken not to go out with wet hair.

It should not be exposed to direct wind.

Allergy treatment should not be neglected.

Nasal bone curvatures should be eliminated by treating the size and swelling of the nasal concha.