Adult Sinus Disorders
Adult Sinusitis and Sinus Infections
Sinusitis, or rhinosinusitis, results from inflammation of the lining of the nasal passages and paranasal sinuses. Symptoms of sinusitis include nasal obstruction or congestion, thick and discolored drainage, decreased smell or taste, facial pressure or discomfort or fullness. If your symptoms do not improve as you reach 10 to 14 days, you may be suffering from acute bacterial sinusitis.
Fungus is present in all our surroundings and the air we inhale. Most healthy people do not react to the presence of fungus due to a functioning immune system. However, in rare instances, fungus may cause inflammation in the nose and the sinuses. Fungal sinusitis can come in many forms, differing in pathology, symptoms, course, severity, and the treatment required. Treatment involves surgery in combination with medical therapy using anti-fungal agents.
Sinusitis and Asthma
Allergic rhinitis and asthma are both conditions in which there is inflammation of the affected airway. The symptoms of rhinitis are runny nose, stuffy nose, nose itching, sneezing and mucus dripping down the back of the nose. Asthma usually causes episodes of breathlessness, chest tightness and wheezing. The severity of both conditions can vary by season. Adding medications for allergic rhinitis to the treatment for asthmatic patients can improve control of asthma. Endoscopic sinus surgery for the treatment of rhinosinusitis and nasal polyps in patients with asthma also appears to improve asthma control.
Headaches and Sinus Disease
Sinusitis and headache are each extremely common diseases, and although sometimes they can be related, often they are separate issues. With millions of Americans suffering from each of these problems, there is bound to be some overlap and confusion on the part of the patient as to their true diagnosis. “Sinus headache” is a common complaint that patients present with, but evidence suggests that this phrase may not be a real clinical diagnosis. Evidence of a sinus-related headache may include drainage in the nasal cavity, nasal obstruction, decreased or absent sense of smell and/or fever. These headaches are caused by the pressure of mucus against the lining of the sinus cavities when that mucus becomes trapped and unable to drain into the nasal cavity due to inflammation and swelling of the openings. Treatment for these true “sinus headaches” may be medical, including antibiotics and/or steroids, or surgery, depending on the individual’s conditions.
Cystic Fibrosis (CF) is a disease that affects multiple systems in the body including the lungs, the digestive tract, and the sinuses. CF is the most common lethal inherited disease in the Caucasian population, with an incidence of 1 in 20 newborns. The earliest sign of CF is meconium ileus and is seen at birth in approximately 20% of infants with CF. Pancreatic insufficiency is also very common and causes stunted growth and development. The most common presenting symptom is respiratory manifestations including a chronic cough, wheezing, and recurrent upper or lower airway infections. Patients with upper respiratory manifestations commonly have severe nasal polyposis and thick tenacious mucus. Undiagnosed children may have nasal polyposis as their presenting finding. Other symptoms of sinus disease include post nasal drip, headaches, constant need to clear one’s throat, nasal obstruction, loss of taste or smell and severe bad breath.
Currently there is no cure for CF. However, patients benefit from a CF team consisting of multiple medical specialists, including pulmonologists and otolaryngologists. Medical therapies like hypertonic saline, intravenous and topical/nebulized antibiotics and pancreatic enzymes have somewhat alleviated the symptoms of this disease and have helped extend expected life spans of CF patients. Nasal irrigations are particularly helpful in the sinuses to help clear thick sticky mucus.
Medical treatment of the sinuses, although individually assigned to each patient, commonly consists of saline irrigations, oral or topical antibiotics, and nasal steroids. Surgical treatment of sinus disease could be considered for frequent recurring pulmonary exacerbations, pre- or post-lung transplant, and/or persistent symptoms such as headaches or nasal obstruction. Endoscopic sinus surgery removes the obstructing nasal polyps and opens the sinuses, which facilitates mucus clearance and allows access for mechanical irrigations.