Cause

1. Infection, caused by the same viruses responsible for the common cold.
2. Allergic, allergens such as animal epithelium, pollen, or dust can trigger inflammation of the nasal mucosa.
3. Vasomotor, due to changes in temperature or humidity.
4. Hormonal, thyroid disorders or increased progesterone in pregnancy.
5. Medication, including antidepressants, progesterone or nasal sprays with vasoconstrictors such as oxymetazoline.
6. Mechanical, from foreign bodies (common in young children who introduce foreign bodies into the nostril).
7. Atrophy, this is characterised by the appearance of thick crusts in the nasal cavity, producing a thinning of the mucosa and bone. The cause is unknown.

Symptoms

• Blocked nose
• Facial pain
• Headache
• Feeling of pressure
• Nasal mucus
• Loss of smell
• Fever and general malaise in acute sinusitis

Diagnosis

• Diagnosis is clinical through examination and the patient’s clinical history.
• If an allergic cause is suspected, allergy tests (blood tests or skin tests) are requested to identify it.

Treatment

• Identification and avoidance of the trigger agent.

 

• Maintenance of good nasal hygiene with nasal washouts and mucosal hydration with vitamin A- and vitamin E-based oils.

 

• In the case of allergic origin, antihistamines, oral or nasal corticosteroids and immunotherapy (vaccines) help to control symptoms. If due to medication, stopping the trigger drug may lead to resolution of symptoms. Although, in some cases including the prolonged use of nasal sprays with vasoconstrictors, changes in the nasal mucosa occur, sometimes resulting in chronic, irreversible rhinitis.

Medical consultations for sinusitis are common in both Family Medicine and the ENT Department.

Sinusitis is an inflammation of the mucosa covering the paranasal sinuses (maxillary, ethmoidal, frontal and sphenoid).

Normally there is also inflammation of the nasal passages (rhinitis), we call this rhinosinusitis.
Sinusitis can be classified as acute if it passes in less than three weeks, subacute when it lasts between three weeks and three months, and chronic when it lasts for more than three months.

Cause

The most common cause is infection, particularly by the common cold virus.

• Infectious: viruses, bacteria (Streptococcus pneumoniae and Haemophilus influenzae) and
• Allergic: pollen, pets, dust…
• Mechanical: such as deviation of the nasal septum or nasal polyps that block the sinuses.

Any of these results in excess mucus production and inflammation of the mucosa that prevents drainage of mucus to the nostrils, this leads to symptoms such as nasal obstruction, favouring the growth of microorganisms.

Symptoms

• Oppressive facial pain
• Runny nose
• Fever
• Blocked nose
• Anosmia (los of sense of smell)

Diagnosis

• Diagnosis is essentially clinical by means of the patient’s medical history and physical examination; these may be complemented by radiological imaging such as plain X-ray or CT scan of the paranasal sinuses. The latter is the most reliable test for diagnosis of sinusitis and the one that provides the most information, as in addition to determining whether the sinuses are occupied it provides information on bone abnormalities, polyps or tumours.

 

• It would be particularly indicated in cases of chronic sinusitis or when several courses of antibiotics have been taken without response.

Treatment

• Treatment when the cause is infectious requires oral antibiotics for 10-14 days.
• Oral and topical corticosteroids and oral and topical antihistamines are effective for symptomatic relief.
• If the cause is mechanical, surgery is sometimes needed to prevent sinusitis becoming chronic.