SINUSITIS

Sinusitis is inflammation of the sinuses that occurs with an infection from

a virus, bacteria, or fungus.
Here is an overview of the anatomy of the sinuses (also called paranasal
sinuses). The human skull contains four major pairs of hollow air-filled
cavities called sinuses. These are connected to the space between the
nostrils and the nasal passage (behind your nose). Sinuses help
insulate the skull, reduce its weight, and allow the voice to
resonate within it. The four major pairs of sinuses are the:
1.
2.
3.
4.

frontal sinuses (in the forehead),

maxillary sinuses (behind the cheek bones),
ethmoid sinuses (between the eyes), and
sphenoid sinuses (behind the eyes).

The sinuses contain defenses against viruses and bacteria (germs). The
sinuses are covered with a mucous layer and cells that contain tiny hairs
on their surfaces (cilia). These help trap and propel bacteria and
pollutants outward.
Causes, incidence, and risk factors
The sinuses are air-filled spaces in the skull (behind the forehead, nasal
bones, cheeks, and eyes). Healthy sinuses contain no bacteria or other
germs. Usually, mucus is able to drain out and air is able to circulate.
When the sinus openings become blocked or too much mucus builds up,
bacteria and other germs can grow more easily.
Sinusitis can occur from one of these conditions:

Small hairs (cilia) in the sinuses, which help move mucus out, do
not work properly due to some medical conditions.

Colds and allergies may cause too much mucus to be made or

block the opening of the sinuses.

A deviated nasal septum, nasal bone spur, or nasal polyps may

block the opening of the sinuses.

Sinusitis can be called:

Acute, when symptoms are present for 4 weeks or less. It is

caused by bacteria growing in the sinuses.

Chronic, when swelling and inflammation of the sinuses are

present for longer than 3 months. It may be caused by bacteria or a
fungus.

Acute sinusitis usually follows a viral infection in the upper respiratory

tract, but allergy-causing substances (allergens) or pollutants may also
trigger acute sinusitis. Viral infection damages the cells of the sinus
lining leading to inflammation the lining thickens, obstructing the
nasal passage. This passage connects to the sinuses The obstruction
disrupts the process that removes bacteria normally present in the nasal
passages the bacteria begin to multiply and invade the lining of the
sinus. This causes the symptoms of sinus infection. Allergens and
pollutants produce a similar effect.
Bacteria that normally cause acute sinusitis are Streptococcus
pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These
microorganisms,
along
with Staphylococcus
aureus and
some anaerobes (bacteria that live without oxygen), are involved in
chronic sinusitis.
Fungi are also an increasing cause of chronic sinusitis, especially in people
with diseases that weaken the immune system, such asAIDS, leukemia,
and diabetes.

The following may increase your risk or your child's risk of developing
sinusitis:

Allergic rhinitis or hay fever

Cystic fibrosis

Day care

Diseases that prevent the cilia from working properly

Changes in altitude (flying or scuba diving)

Large adenoids

Smoking

Weakened immune system from HIV or chemotherapy

Symptoms
The symptoms of acute sinusitis in adults usually follow a cold that does
not improve, or one that gets worse after 5 - 7 days of symptoms.
Symptoms include:

Bad breath or loss of smell

Cough, often worse at night

Fatigue and generally not feeling well

Fever

Headache -- pressure-like pain, pain

toothache, or tenderness of the face

Nasal stuffiness and discharge

Sore throat and postnasal drip

behind

the

eyes,

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but
tend to be milder and last longer than 12 weeks.
Symptoms of sinusitis in children include:

Cold or respiratory illness that has been improving and then

begins to get worse

High fever, along with a darkened nasal discharge, for at least 3

days

Nasal discharge, with or without a cough, that has been present

for more than 10 days and is not improving

Sinus Infection Symptoms

Signs and symptoms of sinus infections depend upon which sinuses are
affected and whether the sinus infection is acute or chronic.
Acute sinusitis:
Ethmoid sinusitis (behind the eyes)
o Nasal congestion with discharge
o Postnasal drip (mucus drips down the throat behind the nose) often
accompanied by a sore throat
o Pain or pressure around the inner corner of the eye or down one side
of the nose
o Headache in the temple, or surrounding or behind the eye

Pain or pressure symptoms are worse when coughing, straining, or

lying on the back and better when the head is upright
o Fever is common
Maxillary sinusitis (behind the cheek bones)
o Pain across the cheekbone, under or around the eye, or around the
upper teeth
o Pain or pressure on one or both sides of the face
o Tender, red, or swollen cheekbone (maxilla)
o Pain and pressure symptoms are worse with the head upright and
bending forward and better when reclining
o Nasal discharge or postnasal drip
o Fever is common
Frontal sinusitis (behind forehead, one or both sides)
o Severe headaches in the forehead
o Fever is common
o Pain is worse when reclining and better with the head upright
o Nasal discharge or postnasal drip
Sphenoid sinusitis (behind the eyes)
o Deep headache with pain behind and on top of the head, across the
forehead, and behind the eye
o Fever is common
o Pain is worse when lying on the back or bending forward
o Double vision or vision disturbances if pressure extends into the brain
o Nasal discharge or postnasal drip
o

Chronic sinusitis:
Ethmoid sinusitis
o Chronic nasal discharge, obstruction, and low-grade discomfort
across the bridge of the nose
o Pain is worse in the late morning or when wearing glasses
o Chronic sore throat and bad breath
Maxillary sinusitis
o Discomfort or pressure below the eye
o Chronic toothache or increased tooth sensitivity
o Pain possibly worse with colds, flu, or allergies
o Increased discomfort throughout the day with increased cough at
night
Frontal sinusitis
o Persistent, low-grade headache in the forehead
o History of trauma or damage to the sinus area
o Chronic postnasal drip
Sphenoid sinusitis
o Low-grade general headache is common
o Chronic postnasal drip
Signs and tests

The doctor will examine you or your child for sinusitis by:
Looking in the nose for signs of polyps

Shining a light against the sinus (transillumination) for signs of

inflammation

Tapping over a sinus area to find infection

Pemeriksaan Fisik

Vital sign: (demam)

Raba lokasi sinus

Pemeriksaan hidung

Regular x-rays of the sinuses are not very accurate for diagnosing
sinusitis.
Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or
rhinoscopy) may help diagnose sinusitis. This is usually done by doctors
who specialize in ear, nose, and throat problems (ENTs).
Imaging tests that may be used to decide on treatment are:

A CT scan of the sinuses to help diagnose sinusitis or view the

bones and tissues of the sinuses more closely
An MRI of the sinuses if there might be a tumor or fungal infection

If you or your child has sinusitis that does not go away or keeps returning,
other tests may include:

Allergy testing

Blood tests for HIV or other tests for poor immune function

Ciliary function tests

Nasal cultures

Nasal cytology
Sweat chloride tests for cystic fibrosis

Treatment
SELF CARE
Try the following measures to help reduce congestion in your sinuses:

Apply a warm, moist washcloth to your face several times a day.

Drink plenty of fluids to thin the mucus.

Inhale steam 2 - 4 times per day (for example, while sitting in the
bathroom with the shower running).
Spray with nasal saline several times per day.

Use a humidifier.

Use a Neti pot to flush the sinuses.

Be careful with over-the-counter spray nasal decongestants. They may

help at first, but using them for more than 3 - 5 days can make nasal
stuffiness worse.

Other treatments for sinusitis include:

Allergy shots (immunotherapy) to help

prevent the disease from returning
Avoiding allergy triggers

Nasal
corticosteroid
sprays
and
antihistamines to decrease swelling, especially if there are nasal
polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be
needed, especially in patients whose symptoms do not go away after 3
months of treatment, or in patients who have more than two or three
episodes of acute sinusitis each year. An ENT specialist (also known as an
otolaryngologist) can perform this surgery.
Most fungal sinus infections need surgery. Surgery to repair a deviated
septum or nasal polyps may prevent the condition from returning.

Thin the mucus: Expectorants are drugs that help expel mucus from the
lungs and respiratory passages. They help thin mucous secretions,
enhancing
drainage
from
the
sinuses.
The
most
common
is guaifenesin(contained in Robitussin and Mucinex). Over-the-counter
(OTC) sinus medications can also combine decongestants and cough
suppressants to reduce symptoms and eliminate the need for the use of
many prescription medications. Read label ingredients to find the right
combination of ingredients or ask the pharmacist.
Relieve pain: Pain medication such as ibuprofen (Motrin and
Advil), aspirin, and naproxen (Aleve) can reduce pain and inflammation.
These medications help to open the airways by reducing
swelling .Acetaminophen (Tylenol) can be used for pain and fever but does
not help with the inflammation.
Nasal saline irrigation: There are several methods of nasal irrigation,
and a popular remedy is the Neti-pot - a ceramic pot that looks like a cross
between a small teapot and Aladdin's magic lamp.
Expectations (prognosis)

Sinus infections can usually be cured with self-care measures and medical
treatment. If you are having repeated attacks, you should be checked for
causes such as nasal polyps or other problems, such as allergies.
Complications
Although very rare, complications may include:

Abscess
Bone infection (osteomyelitis)
Meningitis
Skin infection around the eye (orbital cellulitis)

Differential Diagnoses

Asthma

Bronchitis

Prevention
The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

Eat plenty of fruits and vegetables, which are rich in antioxidants

and other chemicals that could boost your immune system and help
your body resist infection.

Get an influenza vaccine each year.

Reduce stress.

Wash your hands often, particularly after shaking hands with

others.

Other tips for preventing sinusitis:

Avoid smoke and pollutants.

Drink plenty of fluids to increase moisture in your body.

Take decongestants during an upper respiratory infection.

Treat allergies quickly and appropriately.

Use a humidifier to increase moisture in your nose and sinuses.