Help with Sinusitis

Features and Treatment of this Common Cause of Facial Pain

Jan 16, 2008

Sinusitis is frequently an unpleasant sequel to cold and flu. Although there are many treatments only a few have been fully evaluated.

Sinusitis is an inflammation or infection of the sinuses. The sinuses are the air- filled cavities in the bones of the face that give the voice resonance, hence the rather flat quality to the voice of sufferers. Methods of treatment for this painful condition vary considerably in their efficacy.

Symptoms

Symptoms vary according to which sinus cavity is affected. Sinusitis of the frontal cavities produces pain behind the eyes and in the forehead. If the maxillary sinuses are affected there will be pain and tenderness in the cheeks and sometimes toothache. The ethmoid sinus will cause pain either side of the nose and in the forehead. Sphenoid sinusitis can give pain behind the eyes and in the head.

Other symptoms are more generalized such as raised temperature, headache, malaise, nasal discharge or blocked nose, pain and pressure in the face especially on bending forward. The sinuses drain to the back of the nose and throat (post nasal drip) and, if the fluid is infected, can cause sore throat.

Causes of Sinusitis

There are a number of conditions and circumstances that can lead to sinusitis. Infection is the chief culprit, usually a cold or flu virus. The lining of the nose is continuous with the sinus cavities so any infection entering through the nose can track up to the sinuses. Viruses can damage this lining and leave it open to bacterial infection. Some fungi can also infect the sinuses.

Allergy to dust and pollen can cause inflammation of the sinuses as can autoimmune reactions.

People with low immunity: AIDS and those on immuno-suppressant drugs, are particularly at risk. The group most commonly seen to develop sinusitis are asthma sufferers and, to a lesser extent, those with narrow nasal pathways, either congenitally caused or because of nasal polyps. Tooth problems can produce sinus pain even if the sinuses themselves are clear.

Acute and Chronic Sinusitis

Acute sinusitis develops rapidly, usually due to infection and lasts up to a month. Chronic sinusitis is more likely to be allergic and can last months and years.

Treatment

Spans the range from traditional to complementary and orthodox.

Traditional: steam inhalation, nasal washes and hot drinks.
Complementary: acupuncture, herbs and homoeopathy.
Orthodox: pain killers, nasal steroid sprays, oral steroids, antibiotics, decongestants,sinus irrigation and surgery.

Evidence for Effectiveness

With regard to traditional remedies and complementary therapies very few or no good quality trials have been conducted, so it's impossible to comment on effectiveness. These remedies are generally harmless and worth a try; they may actually work for you.

The Cochrane Collaboration has reviewed some orthodox treatments. A review of four randomized placebo-controlled trials on acute sinusitis found that intra-nasal steroids gave modest improvement in symptoms with only minor adverse reactions.

Another Cochrane review found that antibiotics helped some people but not others.

If medication and irrigation fails the usual course of action is surgery. This is now done by functional endoscopic sinus surgery (FESS). The Cochrane reviewers regard this as a safe procedure but found, from the few trials examined, that surgery did not provide any additional benefit to medication in chronic sinusitis.

If you have the symptoms of sinusitis you should consult a doctor in the first instance.