SINUSITIS - Full extract 

Kevin has been teaching at the local high school for several years. With a run of parent teacher nights and a stack of VCE corrections he was feeling run down; a heavy cold was the last thing he needed. 

He had been congested in the head for several days. One afternoon he became aware of an aching pain in the right side of his face, just below his eye. When he leaned forward the pain was more severe. By the time he got home the whole side of his face was aching, even his upper teeth. He also had a fever and felt pretty awful. 

He was at the surgery door when the staff arrived the following morning. "I've had a rotten night," he said. " I didn't know whether to see you or the dentist." Kevin normally keeps very well and is a non-smoker. 

When I examined him I noticed that he was quite flushed and had a fever of 38 C. His ears, throat and chest were all clear. However, he was very tender over the right side of his face. Looking inside his nose I could see that the lining was very swollen and congested. There was also a thick discharge from the right nostril. 

Kevin had quite severe sinusitis. He was given a course of antibiotics, oral decongestants and a special nasal spray. Although the infection improved initially, it recurred with a further cold some weeks later. After preliminary X-rays he was referred to a specialist for further assessment. 

The sinuses are air-filled spaces that are continuous with the main nasal passages. We have several pairs of sinuses: the ethmoids at the root of the nose, frontal sinuses above the eyes, maxillary sinuses below the eyes, and the sphenoid sinuses further back. They have the same lining as the nose itself and can be regarded as being like side-rooms off the main nasal passage. The function of the sinuses is still not clear. However, we do know that they lighten the weight of the skull and may have some effect in improving its resonance. 

Sinusitis means an infection of the sinuses and it may occur as a secondary complication of hayfever or upper respiratory infections. It can be an acute, chronic or recurrent condition. 

The distinction between sinusitis and hayfever is not always clear and people often get the conditions confused. Hayfever is an allergic condition characterized by sneezing, runny nose and itchy eyes. However, the associated nasal congestion may predispose to sinusitis. Hayfever and allergy sit at one end of the spectrum; sinusitis and infection are at the other. There is also a rather large grey area in between, where people may have features of both. 

Symptoms of sinusitis include facial pain, which may be quite severe and extend up around the eyes or down into the teeth area. Other symptoms include headaches, nasal blockage and discharge. There may also be a loss of the sense of smell. 

On examination the person is often very distressed and may have a fever. There may also be tenderness of the facial bones. On inspection of the nasal passages with a special speculum the lining of the nose often appears very boggy and congested. A thick discharge may also be seen coming from the sinus openings. 

Once sinusitis is diagnosed, treatment is commenced with antibiotics, decongestants and analgesics. The symptoms usually resolve well with treatment and there may be no need for further investigation. However, if the symptoms persist or recur it may be necessary to arrange an X-ray of the sinuses; these days CT scans of the sinuses are preferred because of the better detail they provide. The CT scan may demonstrate a collection of fluid inside the sinuses or simply swelling of the tissues that line them. 

If the sinus infection becomes chronic despite adequate treatment, referral to an ENT ( Ear Nose and Throat) specialist may be required. The specialist may suggest widening the opening from the infected sinus into the nasal passage to allow proper drainage to occur. These operations can now be performed endoscopically, using an operating telescope. 

Nowadays there are far fewer complications from sinusitis. In pre-antibiotic days it was not unusual for infection to spread from the sinuses backwards to the brain, or elsewhere in the body. With early diagnosis and modern antibiotic therapy these complications are now exceedingly rare. However, they still occasionally occur. For this reason, people with sinusitis should always complete their full course of treatment and be reviewed by the doctor when necessary. 

Health Tip:
* Persistent facial pain with a cold should always raise the possibility of a sinus infection.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001