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Disclaimer: The details in this section are for general information only. Always check with your own doctor.
What are sinuses?
There are four pairs of sinuses in the head that assist the control of temperature and humidity of the air reaching the lungs.
Sinuses begin as pea-sized pouches in the newborn extending outward from the inside of the nose
to the bones of the face and skull. They expand and grow throughout childhood and into young adulthood.
Eventually they become air pockets or cavities that are lined with the same kind of lining that lines the nose.
They are connected to the inside of the nose through smaller openings called ostia.
Normally the nose and sinuses produce a pint and a half of mucus secretions per day.
These secretions pass normally through the nose picking up dust particles, bacteria and other pollutants along the way.
This mucus is swept into the back of the throat by millions of tiny hair-like structures called cilia, which line the nasal cavity.
The mucus moves into the throat and is swallowed. Most people do not notice this mucus flow because it is a normal bodily function.
Types of sinusitis
Sinus infection occurs in two types:
Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold.
Typically a green-yellow nasal discharge occurs a week or more after the onset of the cold and this is associated with
severe pain around the cheeks, eyes and/or forehead.
This may be associated with swelling and a high fever along with toothache.
Chronic sinusitis
is sinusitis that continues for many weeks. Chronic sinusitis may be caused by an acute sinus
infection which fails to resolve or as a result of an underlying allergy affecting the lining
membranes of the nose and sinuses. Common symptoms include nasal obstruction, headache,
nasal discharge, low grade fever, reduced sense of smell, facial pain and halitosis.
What causes sinusitis?
It is worth noting that pain in the face may well be due to other causes such as tension
headache, migraine, neuralgia and jaw dysfunction. The pain from sinusitis usually occurs as a
result of blockage of the sinus opening. These blockages may be caused by infections, irritants,
allergies or a structural abnormality.
Infections: Most adults will get colds and upper respiratory tract infections up to
three times a year. Children get them more frequently. Bacterial infections often follow the
common cold. When the mucus changes from clear to yellow or green it usually means a bacteria
infection has developed. Both viral and bacterial infections cause swelling of the tissues
inside the nose and thickening of the normal mucus. This slows down or even stops proper sinus
drainage and infection in the sinus may ensue.
Irritants: Air pollution, smoke and chemical irritants, for example some sprays containing
pesticides, disinfectants and household detergents, may cause swelling and blockage of the lining
of the nose causing a narrowing of the drainage opening from the sinuses.
This can once again lead to impairment of sinus drainage and consequent infection.
Allergies:
Allergies can cause inflammation inside the nose.
Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy
watery eyes. Chronic sinusitis is sometimes associated with asthma. Allergies are responsible
for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult
to control.
Structural problems:
Occasionally structural problems within the nasal cavity can cause a narrowing.
Some of these can be caused as a result of trauma while others may develop during the growth
period. Occasionally the structural narrowing can be so severe that mucus builds up behind these
areas of blockage giving rise to sinus infection.
Diagnosis and treatment of sinusitis
Acute sinusitis is usually treated with antibiotics and medication to reduce the swelling of
the nasal lining e.g. decongestants. Chronic sinusitis may need long term treatment.
Medical treatment options include antibiotics, decongestants and other treatments to reduce the
swelling of the lining such as nasal steroid sprays. Antihistamines will have a place in patients
who have an underlying allergy. In the vast majority of cases sinusitis can be managed effectively
with medical treatment.
Occasionally symptoms will persist despite ongoing use of medicines in which case surgery may be
necessary. The diagnosis of sinusitis by a specialist will involve the use of a nasal endoscope
which the doctor can use to examine the nasal lining and the sinus openings.
Sinus surgery
Surgery is normally only considered if medical treatment fails.
When surgery is needed the ENT specialist can choose from a number of different options depending
on the severity of the sinus disease. Most sinus operations are performed without an external
incision. Most surgeons will ask for a scan of the sinuses to assist with the planning of the
operation.
You may change your mind about the operation at any time, and signing a consent form does not
mean that you have to have the operation. If you would like to have a second opinion about the
treatment, you can ask your specialist. He or she will not mind arranging this for you.
You may wish to ask your own GP to arrange a second opinion with another specialist.
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Click on an image to enlarge it
Swollen lining of the nose, with pus coming out under the middle turbinate. This patient has acute infective sinusitis
Thick pus coming out under the middle turbinate of the nose, which has come from the sinus. This patient has chronic sinusitis and can be successfully treated with endoscopic surgery
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