Sinusitis is commonly caused by infections of the upper respiratory tract. They are more common in some individuals like those exposed to smoke, pollutants in air, irritants, those availing day care facilities, diabetics and those with a suppressed immunity.

Persons with genetic conditions that make mucus thick and viscid like in Cystic fibrosis and those with altered functions of cilia or ciliary immotile syndrome or Kartagener’s syndrome are also at a higher risk of sinusitis.

Predisposed individuals commonly get long term symptoms of sinusitis or recurrent bouts of acute or sub-acute sinusitis.

Classification of sinusitis

Broadly, sinusitis may be classified according to the duration of its symptoms into acute, sub-acute and chronic.

Acute sinusitis refers to sudden onset symptoms of sinusitis where the symptoms usually resolve by 4 weeks.

In sub-acute cases the symptoms may last for 4 to 12 weeks while in chronic cases the symptoms may persist for 12 weeks or more (3 months or more). 1-8

Symptoms of sinusitis

Symptoms of sinusitis include:

• Feeling of fullness or pressure over the sinuses. The sinuses are located behind the forehead, behind the eyes, beside the bridge of the nose and under the cheek bones. The ones under the cheekbones are the largest and most commonly affected. There may be fullness or pressure over the cheekbones.

• Severe headache. This may be worse in the mornings and when the person bends his or her head forward or downward. This is due to affliction of the sinuses of the forehead.

• There may be pain and tenderness behind, or below the eyes if the sinuses behind the eyes are affected.

• There is pain in the upper jaws and teeth. This is because the same set of nerves that bring in pain sensation from the sinuses may also carry pain sensation from these areas of the face to the brain. Chewing is usually painful.

• There is usually a blocked or runny nose.

• There is persistent cough that is especially worse at night. Since sinusitis is commonly caused by upper respiratory tract infections, this is a common finding.

• There may be a persistent sore throat indicating an upper respiratory tract infection. This may also cause swelling of the lymph nodes or glands around the neck.

• There may be constant fluid drainage at the back of the throat. This is called postnasal drip or drainage.

• In severe infections, especially bacterial infections, there may be a thick, pus filled discharge from the nostrils that may be worse on one side. The discharge may be yellow or green and may be streaked with blood.

• In addition there may be fatigue and general feeling of unwell. Many patients may also develop fever. Sleep may also be disturbed due to the blocked nose and sinuses and the pain.

• There is loss of sense of taste and smell and often there may be development of bad breath due to pus filled discharge from the sinuses.

• In children there may be irritability, ear discomfort, mouth breathing, difficulty in feeding, nasal intonation of speech and snoring.