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Congested Sinuses , Sinus Inflammation and Infection (Sinusitis) The paranasal sinuses are hollow air-filled cavities in the skull. There are four pairs of paranasal sinuses known as the frontal, sphenoid, ethmoid and maxillary sinuses. These cavities are lined with a mucous membrane and its secretions usually drain through small openings (ostia) into the nasal cavity. Since the sinuses are essentially continuous with the nasal cavities, it is prone to the same disease that affect the nasal lining. Its narrow openings, however, maintain a sterile environment within the paranasal sinuses and ensures that secretions constantly drain out without any backward flow from the nasal cavity. What is sinusitis? Sinusitis is the term for inflammation of the paranasal sinus. The inflamed sinus becomes congested with mucus as well as with pus in infectious cases of sinusitis. Inflammation of the nasal cavity (rhinitis) often precedes and exists along with sinusitis and it is therefore jointly referred to as rhinosinusitis. How does sinusitis occur? Sinusitis may occur through one of three mechanisms and are most likely due to a combination of factors. - Inflammation of the tissue lining the sinuses, and at its opening, causes it to swell. The drainage of mucus from the paranasal sinuses are therefore hampered and collects within the sinus cavity. This obstruction may also be due to other physical causes like nasal polyp or foreign body in the nose. - The passage of mucus out of the paranasal sinus is aided by the action of cilia – tiny hair-like projections from epithelial cells. The beating of the cilia aids the movement of mucus in one direction (unidirectional) from the sinus to the nasal cavity. Certain causes like genetic disorders, bacterial toxins and viral attachment may disturb the beating action thereby hampering normal sinus drainage. - Inflammation of the paranasal sinus tissue may cause excessive secretion of mucus which may be thicker than normal. The mucus does not drain as fast as it normally would and are more likely to obstruct the sinus openings (ostia) thereby allowing for sinus congestion. Despite the different mechanisms, the underlying pathophysiology indicates a blockage of the paranasal sinus openings (ostia) which allows for mucus to accumulate in the sinuses. Infections, particularly secondary bacterial infections, tend to arise in these settings. Types of Sinusitis Sinusitis can be classified in several ways but the most common is by duration – acute, subacute or chronic. Acute sinusitis is where the inflammation and symptoms completely subside within 30 days. Subacute sinusitis lasts for 30 to 90 days and chronic sinusitis persists for more than 90 days (or 12 weeks). A further sub-classification is recurrent sinusitis which may involve multiple episodes of sinusitis that completely resolves only to recur within 10 days. Furthermore it may be classified by etiology (cause), pathogenic (microorganism) and location (anatomical). - Etiology – infectious, allergic or obstructive (usually leading to infection) - Pathogenic – viral, bacterial or fungal - Location – frontal, ethmoidal, sphenoidal or maxillary Causes of Sinusitis There are a number of causes of sinusitis but infections are the most common. From these cases, viral infections are the most common in acute sinusitis. With the diverse causes and predisposing factors in chronic sinusitis, secondary bacterial infections may then set in. Infections - Viral sinusitis is almost always associated with viral upper respiratory tract infections involving the nasal cavity (rhinitis). This may be due to a number of viruses including rhinovirus, parainfluenza, influenza A and B, enterovirus, respiratory syncytial virus (RSV) and adenovirus. It is most frequently seen with the common cold. Inflammation of the sinuses and sinus congestion predisposes the patient to a secondary bacterial infections. - Bacterial sinusitis may be due to streptococci, staphylococci, Hemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis. Both acute and chronic sinusitis are frequently associated with secondary bacterial infections. Tuberculosis may be the cause of sinusitis in patients with HIV. - Fungal sinusitis is mostly seen in immunocompromised patients – mucormycosis in long term diabetics (diabetes mellitus) and aspergillosis or candidiasis in HIV/AIDS. Fungal infections tend to cause chronic sinusitis. More commonly fungi in the paranasal sinuses trigger an allergic reaction. Allergies Allergic sinusitis is more frequently seen in patients with an allergic constitution (atopy). With allergic rhinitis, it may be throughout the year (perennial) or only exacerbate during certain periods (seasonal). Inhaled allergens such as dust, pollen and animal dander are common triggers. The condition is further exacerbated by secondary bacterial infections that may require acute treatment. The presence of fungi within the paranasal sinus may also cause an allergic reaction. In these instances, the fungi do not invade and infect the sinus as is seen in immunocompromised patients. Other Other causes often create conditions that eventually lead to a sinus infection. Most notable among these other causes is an obstruction caused by a nasal polyp, tumors, a deviated septum or following trauma where a fractured facial bone obstructs the opening of the sinus. In addition, the following causes and risk factors may play a role in both acute and chronic sinusitis : - Non-allergic rhinitis - Hormonal factors – pregnancy, oral contraceptive - Gastroesophageal reflux disease (GERD) - Dental diseases - Cystic fibrosis - Kartagener syndrome - Cigarette smoking - Environmental pollution - Occupational exposure to airborne irritants - Cocaine inhalation (snorting cocaine) Signs and Symptoms of Sinusitis The most prominent featureĀ is congestion of the sinuses which leads to similar symptoms in both acute and chronic cases. This includes : - Nasal discharge – thick, yellow to green and often offensive - Runny nose and nasal congestion - Facial pain and discomfort (feeling of fullness / pressure) - Facial swelling and redness of skin over the affected area - Loss of smell and/or taste - Headache - Fever and chills is seen with an infection - Fatigue Other symptoms may include : - Sore throat - Ear pain - Bad breath - Snoring Symptoms may be more specific for congestion of certain paranasal sinuses. - Maxillary sinusitis - Cheek pain - Toothache - Frontal headache - Frontal sinusitis - Frontal headache - Eye pain - Ethmoidal sinusitis - Pain between and behind the eyes - Swelling around the eye and may involve the eyelid - Excessive tearing - Sphenoidal sinusitis - Vague headache varying from the front, back or even top of the head - Classic symptoms of sinusitis such as a runny nose/nasal congestion may be absent References : Sinusitis. Merck Manuals (www.merckmanuals.com)
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KOJI SU SIMPTOMI? Upala sinusa - SINUSITIS Šta je SINUSITIS? Sinusitis je upala sluznice koja oblaže sinuse, a može biti posljedica prehlade, upale ždrijela, ili alergije. Postoje 4 parna sinusa: - maksilarni (sinusi u gornjoj vilici, iznad zuba i ispod očiju), - etmoidni (sinusi između očiju sa obe strane nosa), - frontalni (čeoni sinusi) i - sfenoidni (sinusi iza očiju, duboko u glavi). Sinusi su povezani sa nosem preko uzanih otvora kroz koje izlazi sluz iz sinusa a ulazi vazduh. Kada gust sekret ili otok sluzokože izazvan infekcijom, alergijom ili iritansima dovedu do suženja ili potpune blokade ovih otvora, dolazi do zapaljenja sinusa. Koji su UZROCI? Akutni sinusitis najčešće nastaje kao posljedica prehlade ili alergije, koje stvaraju preduvjete za nastanak infekcije. Akutni sinusitis najčešće je uzrokovan bakterijama ili virusima, mnogo rjeđe gljivicama. Bakterije koje najčešće uzrokuju akutni sinusitis su pneumokoki, streptokoki, Moraxalla catarrhalis i Haemophilus influenzae. Mnogo je zdravih ljudi kod kojih su ove bakterije i inače prisutne na sluznici gornjih dišnih putova, međutim u uvjetima upaljene, otečene sluznice te otežane ventilacije sinusa stvaraju se pogodnosti za povećanje broja bakterija i razvoju infekcije. Hronični sinusitis može se razviti kao posljedica često ponavljanih akutnih upala sinusa, pogotovo ako nisu propisno liječene. Bakterijski uzročnici ipak se često razlikuju od onih koji uzrokuju akutni sinusitis. Tako kao uzročnike hroničnog sinusitisa često nalazimo gram-negativne i anaerobne bakterije te gljivice. Mnoštvo je općih i lokalnih čimbenika koji isto tako pogoduju obolijevanju od hroničnog sinusitisa. Osobe koje su sklone alergijama ili boluju od alergija koje se manifestiraju sa simptomima dišnih puteva (astma, peludna hunjavica i sl.) zbog sklonosti nerijetkim akutnim upalama sinusa vrlo često obolijevaju od hroničnoga sinusitisa. Lokalni faktori koji pogoduju razvoju hroničnog sinusitisa mogu biti devijacija nosnog septuma, nosni polipi, deformiteti nosa i nosnih kostiju, upala zuba gornje čeljusti i dr. Opći faktori koji stvaraju sklonost ovoj bolesti su neke hronične bolesti koje smanjuju otpornost organizma prema infekcijama (HIV infekcija, cistična fibroza te neke druge teže bolesti). Koji su SIMPTOMI? Najčešći simptomi kod sinusitisa su začepljen nos, pojačana sekrecija, osjećaj pritiska i bol u području zahvaćenog sinusa. Takođe, može biti prisutna i glavobolja, te povišena temperatura.mjesto pritiska i boli varira u ovisnosti o tome koji je sinus upaljen. Moguće je da pacijent osjeti bol u uhu i vratu, zubobolju, gubitak njuha, suzenje iz očiju, umor i iscrpljenost. LIJEČENJE Nakon dijagnosticiranja sinusitisa i utvrđivanja uzroka simptoma i možda identifikacije uzročnika infekcije, liječnik će predložiti način liječenja. Akutni sinusitis uglavnom se liječi lijekovima koji olakšavaju simptome, smanjuju upalu i liječe infekciju. Akutni sinusitis • Kapi za nos; smanjuju otečenost sluznice i osjećaj začepljenosti, olakšavaju disanje na nos; • Antibiotici za liječenje bakterijske infekcije; • Sredstva za smanjenje bolova. Pomoć navedenoj terapiji može biti uzimanje veće količine tekućine i inhalacije koje bolesnici mogu primijeniti sami kod kuće. Katkada, kada je riječ o tek blagom sinusitisu, te metode, uz korištenje kapi za nos, mogu biti dovoljne. Važno je napomenuti da se kapi za nos ne koriste više od nekoliko dana jer njihova duža primjena može imati suprotan učinak. Hronični sinusitis Hronični sinusitis obično je rezultat oštećenja sluznice koje je posljedica neliječenoga ili nepropisno liječenoga akutnog sinusitisa. Aerobne i anaerobne bakterije prisutne u kroničnom sinusitisu često se razlikuju od onih koje uzrokuju akutni sinusitis, u skladi s tim i propisivani antibiotici se razlikuju. Simptomatska terapija ista je kao i u liječenju akutnog sinusitisa (kapi, lijekovi protiv boli, inhalacije, ovlaživači sluznice u spreju i dr.). Katkada se propisuju kortikosteroidni sprejevi za nos da bi se smanjila upala i otečenost sluznice. Kortikosteroidi se vrlo rijetko koriste kod akutnog sinusitisa jer osim što ne liječe infekciju, koja je glavni razlog akutnog sinusitisa, mogu je produžiti i otežati liječenje. Operativno liječenje primjenjuje se kada lijekovi nemaju učinka, odnosno kada postoje komplikacije ili strukturni deformiteti (devijacija nosnog septuma, polipi) koji onemogućavaju ili otežavaju liječenje. Čest uzrok ponavljanja akutnih sinusitisa kod djece su adenoidi, odnosno mandule što često zahtijeva operativno liječenje. Najuobičajenija operacija koja se danas izvodi je funkcionalna endoskopska operacija sinusa, u kojoj se prirodni otvori sinusa povećavaju da bi se omogućilo bolje cijeđenje sadržaja sinusa. Ovaj tip operacije je manje invazivan nego tradicionalna operacija sinusa, pa su ozbiljne komplikacije rijetke.