Sinusitis is a condition that can cause a stuffy nose, pain in the face, and yellow or green discharge (mucus) from the nose. Sinuses are hollow areas in the bones of the skull and normally contain air.

These spaces are lined by tissue which secretes a small amount of mucus that helps to trap any foreign particles such as allergens and pollutants in the nasal passage. Sinuses have openings which drain into the nasal cavity. When this mucus secreting tissue gets infected, it swells and makes extra mucus and this can obstruct air flow and mucus drainage into the nasal passages, and this increases the risks of an infection.

Sinusitis can occur when a person gets sick with a cold. The germs causing the cold can also infect the sinuses. Many times, a person feels like his or her cold is getting better then he or she gets sinusitis and begins to feel sick again.

There are two main types of sinusitis: acute and chronic. Acute sinusitis is inflammation that lasts for less than four weeks while chronic sinusitis lasts for more than 12 weeks. The duration of symptoms between 4-12 weeks is often called sub-acute phase. Acute sinusitis is more common.

The most common cause of acute sinusitis is a viral infection associated with the common cold. Bacterial sinusitis occurs much less commonly, in only 0.5 to 2 percent of cases, usually as a complication of viral sinusitis.

Because antibiotics are effective only against bacterial and not viral infections, most people do not need antibiotics for acute sinusitis.

Unlike acute sinusitis, which is usually caused by infection, chronic sinusitis often has more complicated and elusive causes. Infections can certainly contribute to or worsen chronic sinusitis, but people with the chronic condition usually have longstanding inflammation which can be caused by conditions such as; allergies (e.g. Allergy to fungus), nasal passage structural problems or abnormal growths such as nasal polyps which impair the normal drainage of the sinuses.

Sinusitis affects people of all age groups. An average child is likely to have 6-8 colds per year and approximately 0.5- 2% of upper respiratory tract infections in adults and 6-13% of viral upper respiratory tract infections in children are associated with development of acute bacterial sinusitis.

Women generally have more episodes of infective sinusitis than men because they tend to have more close contact with young children.

Common symptoms of sinusitis include; Stuffy or blocked nose, Thick yellow or green discharge from the nose, Pain in the teeth, Pain or pressure in the face which commonly feels worse when a person bends forward.

People with sinusitis can also have other symptoms such as; Fever, cough, trouble smelling, ear pressure or fullness, headache

Commonly, symptoms of sinusitis are associated with worsening of symptoms about 7-10 days after a period of feeling relief.

The diagnosis of sinusitis is done by taking history from the patient, physical examination and sometimes depending on the severity orpattern of ones symptoms, investigations can be done to confirm the diagnosis and the probable cause.

Imaging tests such as sinus X-ray, sinus CT scan can be done.

A Sinus endoscopy, a procedure in which a physician uses a thin tube attached to a camera to see inside the sinuses and to take a sample of mucus from inside the sinuses to examine under the microscope can be done.

Treatment

Initial treatment of acute sinusitis aims to relieve symptoms since almost everyone will improve within the first 7 to 10 days.

Pain relief medicines are recommended for pain. Nasal irrigation,which is done by flushing the nose and sinuses with a saline solution, use of nasal decongestant sprayscan be used to temporarily treat congestion. However, these sprays should be used as prescribed to avoid risk of rebound congestion (when the nose is congested constantly unless the medication is used repeatedly).

If bothersome symptoms of sinusitis persist for 10 or more days, it is possible that one has bacterial sinusitis hence the need for antibiotics but this depends upon the severity of ones symptoms.

Some people with chronic sinusitis need surgery to reopen the sinus passages and remove trapped mucus or polyps.

People with chronic sinusitis should avoid cigarette smoking.

If one hasidentifiable allergies as a contributing factor to chronic sinusitis, they may change things in their home or work conditions to reduce their exposure to the specific allergens that bother them.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital