Here we discuss two common forms of chronic sinusitis:
- Chronic Sinusitis
- Allergic Fungal Sinusitis
Chronic Sinusitis
A child’s sinuses are small cavities in the nasal passages that are filled with air. Their function is not well understood, but may be involved in aiding humidification, but may also help in reducing the skull’s weight and protection of the brain. Children are born with two pairs of sinuses, the maxillary sinuses (the cheek) and the ethmoid sinuses (near the eyes). The maxillary sinuses enlarge as the child ages, and the number of ethmoid “cells” increase.
The frontal sinuses (over the forehead) typically do not develop until pre teen or early teens. The sinuses are lined with tissue (mucosa) that have cells that produce mucus, and also cells that have small hairs, or cilia, that aid in movement of secretions out of the sinuses. The sinuses drain out of the sinus into the nasal passage on each side through holes called ostia. When the ostia are blocked, this can lead to an infection. Viral infections and allergies are common causes of blockage, producing swelling within the nasal passage. A sinus infection, or sinusitis, involves inflammation of the mucosal lining, reduction in the movement of the cilia, mucus accumulation and ultimately infection due to bacteria either entering in or present within the sinus. Since sinusitis occurs with nasal drainage, it is also termed rhinosinusitis.
Sinusitis is divided into acute sinusitis and chronic sinusitis. Acute sinusitis lasts for up to 4 weeks. Various signs and symptoms associated with acute sinusitis include:
- Facial pressure or pain
- Discolored nasal drainage
- Nasal congestion
- Discolored post nasal drainage
- Cough Bad breath
- Decreased sense of smell
- Dental pain
- Fatigue
- Fevers
Chronic sinusitis is a sinus infection that has persisted for more than 12 weeks. These infections begin as an acute infection that persists. It may be the result of initial failure to treat or undertreat, or reinfection, teamed with other factors such as allergies, anatomic blockage (polyps, adenoids), and immune disorders. Signs and symptoms associated with chronic sinusitis include many of the symptoms of acute sinusitis. Nasal discharge may be clear or colored in chronic sinusitis.
Factors associated with sinusitis include:
- Allergies
- Adenoid enlargement
- Immune disorders
- Cystic Fibrosis
- Ciliary Dyskinesia
- Nasal Polyps
- Nasal Foreign body
Allergic Fungal Sinusitis
Allergic fungal sinusitis is an entity that is the result of the body’s response to fungus/molds as they pass into the nasal passage. The body produces an “allergic reaction” to the fungus as it is inhaled through the nose from the environment. The resulting reaction typically kills the fungus but produces polyps and very thick drainage that fills the affected sinuses. It typically expands within the sinuses, resulting in nasal blockage and an inability to breathe through the nose. At times, it can produce visible facial changes.
People that develop allergic fungal sinusitis have a normal immune system. Signs/symptoms of allergic fungal sinusitis include:
- Nasal obstruction, typically on one side
- Chronic nasal drainage, and can be clear or colored
- Visible polyps in the nasal passage
- Facial changes, particular eye changes such as movement of the eye laterally
Patients who are suspected to have allergic fungal sinusitis will undergo a CT of the sinuses to assess for the extent of the disease. They will undergo allergy testing through an allergist to determine the particular fungus/mold they are allergic to, and will require allergy immunotherapy (shots). They will ultimately require surgery for removal of the disease.