Generality
The stuffy nose is a rather common and annoying symptom but fortunately short-lived. When it lasts for a long time to be dismissed with a simple cold it could be too simplistic. In fact it may happen that the germs responsible for this disorder nest in the nasal and paranasal sinuses, inflaming them.
In recent years, with the advent of modern diagnostic techniques, the concept of sinusitis has been revolutionized. Today we prefer to talk about rhinosinusitis, that is, an inflammatory process that involves both the nose (rhinitis) and one or more of the eight sinuses or paranasal cavities (sinusitis).
The Paranasal Breasts
The paranasal sinuses are four pairs of small cavities full of air that are part of the skull and that communicate with the nose through an orifice called ostio. Their functions are varied: they are essential for the functionality and protection of the respiratory system, increase the perception of odors, lighten the skull and regulate the tone of the voice.
The pressure inside these small cells must be the same as the external one. If this communication between outside and inside is interrupted, for example due to mucus accumulation, breathing becomes difficult and the typical symptoms of rhinosinusitis may appear.
This pathology is often caused by viruses and sometimes by bacteria or fungi. Although most colds resolve within a few days, this banal disorder can sometimes turn into sinusitis (0.5-2% of cases). Germs can inflate the breasts by increasing mucus production and obstructing the air flow. Thus we enter a vicious circle where the overproduction of mucus by the membrane that covers the breasts keeps the occlusion of the orifices.
The paranasal sinuses are in fact carpeted by a mucous membrane which secretes a viscous fluid in the presence of sinusitis which, in addition to hindering the breath, compresses the pain receptors present in the mucosa itself.
Classification and Causes
There are two main types of sinusitis, acute sinusitis and chronic sinusitis. In the first case the classic symptoms of the disease such as rhinorrhea (mucus or pus leakage from the nose), fever and headache arise powerfully but resolve within a few days (from one to three weeks from the onset of symptoms).
Chronic sinusitis, on the other hand, are inflammatory states which, for example linked to environmental conditions or to an allergic problem, give rise to recurrent infectious forms that cause headaches, low-grade fever and nasal obstruction.
Wanting to be picky for chronic sinusitis is meant episodes longer than 4-5 weeks, while recurrent sinusitis is characterized by episodes that recur frequently (at least three times a year).
There are also sinusitis of odontogenic origin characterized by the monolaterality of the symptoms; they are usually caused by problems (abscess) of one of the upper molars, the root of which, being anchored in the maxillary sinus, can cause infection.
Sinusitis can also be caused or favored by many other factors such as: occupational exposure to irritants, chronic use of drugs, bronchial asthma, deviation of the nasal septum, facial trauma, presence of polyps, hormonal alterations and allergies.
Symptoms Sinusitis
To learn more: Sinusitis Symptoms
The typical symptoms of sinusitis are:
- nasal obstruction with yellow or green secretion (due to the presence of pus)
- facial pain
- feeling of facial pressure
- temperature
- headache
- toothache; halitosis
- inability to perceive odors (anosmia)
- fatigue
- cough
Nasal secretions generally tend to exit more towards the throat than towards the nostrils where the leakage is less
When the nose breathes badly, not only the paranasal sinuses but also the Eustachian tube, a conduit that connects the nose with the middle ear, is affected. This explains the symptom of plugged ears that very often arises in conjunction with the sinus attack.
Diagnosis
In recent years the diagnosis of sinusitis has also undergone a major modernization. Today the visit of the nose is performed with endoscopic techniques; the old speculations have now been abandoned after having proved insufficient and unreliable.
A first diagnosis of sinusitis is made by evaluating the common clinical signs that make one suspect the inflammation of the paranasal sinuses. For a diagnosis of certainty, instrumental examinations are also used: from the radiograph, which however is reliable at one hundred percent only in the inflammations of the frontal and maxillary sinuses, to the CT scan in the most doubtful cases. Nasal endoscopy with optical fibers also confirms the diagnosis, as well as highlighting any internal factors predisposing to sinusitis.
A nasal endoscopy is an absolutely quiet exam that can be performed without local anesthesia. The optical fibers are in fact very thin, in the order of 2-2.5 mm, and cause only a slight discomfort. For this reason they are also commonly used in the diagnosis of pediatric sinusitis.
Care and Therapy
For further information: Medications for the treatment of sinusitis
When after several days a stubborn cold does not tend to improve and is accompanied by the symptoms described above, it is advisable to consult a doctor. Neglecting sinusitis could in fact lead to potentially serious complications such as the extension of the infection to the orbits and the internal cavities of the skull (meningitis).
If sinusitis lasts for more than two or three weeks, the therapy involves taking antibiotic drugs associated with decongestants and cortisone drugs. In this way one tries to keep the infection under control and on the other to restore the patency of the nasal and paranasal sinuses.
In fact, antibiotics have the purpose of neutralizing the germs responsible for sinusitis. However, it may happen that the prescribed drug is ineffective against the microorganism that is actually causing the disease. In these cases, an analysis of the mucus taken from the paranasal sinus will help to identify the most suitable pathogenic strain and antibiotic.
In sinusitis of allergic origin very often antihistamine drugs are used.
In chronic sinusitis cycles of thermal treatments are recommended in addition to medical therapy. Hot compresses to be applied to the face instead help relieve facial pain. Smoking should obviously be abolished.
Finally, remember that in the presence of sinusitis the decongested drugs (vasoconstrictors that act on the nasal and paranasal mucosa reducing inflammation and decreasing the leakage of liquid and mucus) should not be used too long (generally no more than 7 days) or at high doses to avoid having adverse effects to those hoped for.
To restore the nasal sinus orifices, correct any anatomical anomalies and favor the resolution of sinusitis in the most serious cases. endoscopic or "minimally invasive" surgery is used. An innovative technique, even less invasive but lacking long-term efficacy studies, provides instead for the opening of the breasts by inserting and inflating small balloons in the obstructed cavities.
Prevention
To prevent sinusitis it is important to reduce the risk of infections of the upper airways by avoiding, for example, contacts with people suffering from colds and applying basic hygiene rules (wash your hands frequently with soap and water, especially in conjunction with meals). It is also important to eliminate smoking and alcohol, ventilate the room frequently, keeping it at the right temperature and humidity.
In the case of chronic sinusitis, at the first signs of a cold it is important to drink plenty of fluids to help dilute nasal secretions and use decongested drugs.
