Khaberni - The Family Health Care Institute bulletin, on this Sunday, discusses nasal and sinus inflammation, which is an inflammatory disorder affecting the lining of the nasal passages and sinuses. It can be acute, subacute, or chronic depending on the duration of symptoms and is considered one of the common inflammations that affects the quality of life.
The bulletin provides a precise scientific definition and classification of this condition, its nature, causes and common triggers, its level of contagiousness, in addition to diagnostic methods, treatment options, complications, and preventive measures.
** Definition and Classification
Nasal and sinus inflammation is clinically defined as the presence of inflammation in the nasal cavity and sinuses accompanied by symptoms such as nasal blockage/congestion, nasal or post-nasal drip, pain or pressure in the face, and loss of smell. The commonly accepted time-based classification divides the condition into:
- Acute: Less than 4 weeks
- Subacute: (4–12 weeks)
- Chronic: More than 12 weeks
Cases may differ depending on whether they are associated with nasal polyps, which determines the nature of treatment choices later.
What are the sinuses?
The sinuses are four paired cavities in the head, connected to each other via narrow passages. The sinuses produce mucus that drains through the nasal passages. These secretions help keep the nose clean and free from bacteria, allergens, and other pathogens.
** Common Causes and Triggers
The contributing factors include:
- Viral infections (causes of the common cold).
- Bacterial infections.
- Seasonal or perennial allergies.
- Congenital nasal anatomical defects such as (deviated septum, narrowing of sinus openings).
- Exposure to environmental irritants (smoke, pollution, mold).
- Systemic diseases such as asthma and chronic nasal allergies increase susceptibility and resistance to treatment.
Viruses, bacteria, fungi, and allergens can cause sinus inflammation. Specific pathogens causing sinus inflammation include:
- Common colds.
- Influenza virus.
- Streptococcus pneumoniae bacteria
- Haemophilus influenzae bacteria
- Moraxella catarrhalis bacteria
- Seasonal and nasal allergies.
** What are the risk factors for sinus inflammation?
Some people are more susceptible to sinus inflammation than others. Risk factors include:
- Nasal allergies.
- Asthma.
- Nasal polyps (growth of tissue inside the nose).
- Deviated nasal septum: The septum is a tissue that separates the two sides of the nose, and if it is deviated or not straight, it narrows the passage on one side, which may cause obstruction.
- Weakened immune system, whether due to diseases like HIV (AIDS) or cancer, or as a result of certain medications.
- Smoking.
** Is sinus inflammation contagious?
Sinus inflammation itself is not contagious, but the viruses and bacteria that can cause it may be contagious.
Therefore, it is advisable to wash hands well, avoid contact with others when sick, and sneeze or cough into the elbow instead of hands.
** Diagnosis
The initial diagnosis mainly depends on history and clinical symptoms, with an emphasis on persisting symptoms or signs of bacterial infection (such as persistence of symptoms for more than 10 days without improvement, or a deterioration in health after a temporary improvement).
CT imaging or endoscopy should only be used when complications are suspected or the diagnosis is unclear or before surgery, and not as a routine screening for every acute case. Anterior nasal examination and direct nasal endoscopy help in documenting the presence of mucosal inflammation, pus, or polyps.
** Treatment Plan for Acute Cases
Treatment options include:
- Supportive measures: such as rest, drinking fluids, pain relievers (such as paracetamol or ibuprofen), and nasal lavage with saline solution to relieve congestion and remove mucus.
- Topical nasal steroids which may reduce inflammation and speed up the recovery of symptoms in many cases.
- Antibiotic use should be clinically justified (evidence: severe symptoms or persistence for more than 10 days or deterioration after improvement).
** Managing Chronic Sinus Inflammation
Chronic sinus inflammation (CRS) is characterized by the persistence of symptoms for more than 12 weeks with local inflammation.
Treatment methods include:
- Treating allergies if present.
- High-efficacy nasal steroid sprays.
- Nasal lavages.
- Broad-spectrum antibiotics in certain cases.
- Sometimes, oral steroids are used for severe cases for a short duration.
In patients who do not respond to treatment or have complications, endoscopic sinus surgery is used to improve drainage and ventilation.
** Complications
Although most cases recover quickly, complications (such as periorbital abscesses, periorbital inflammation, cheekbone inflammation) or more serious ones (venous clots or brain complications) may occur if not treated or if diagnosis is delayed.
Patients showing visual signs (change in vision, severe pain behind the eye) should be referred to emergency and the treating doctor.
** Prevention
Managing risk factors (controlling allergies and asthma, avoiding smoking, maintaining proper ventilation in enclosed spaces), and adhering to saline nasal washes as a preventive and therapeutic aid are possible. Additionally, reducing unnecessary use of antibiotics and following vaccination recommendations against influenza to limit viral infections that may precede sinus inflammation are advisable.
