We discussed the causes, types, symptoms, and risk factors of sinusitis in the previous posts. In this, we shall see the diagnosis and treatment of sinus infection. Most of the cases present to an Ear, Nose, and Throat specialist and a few may go to an infectious disease specialist or the local physician. The diagnosis involves a clinical examination and certain tests. The treatment of a sinus infection can be medical, surgical, or both. Lastly, the steps to prevent sinusitis are as important as treating one.
HOW IS SINUSITIS DIAGNOSED?
CLINICAL EXAMINATION
After listening to your symptoms, the first thing an ENT does is to check the nose with his head-light. Thereafter, he checks the ears and throat as well. There may be fluids inside the eardrum because of obstructed tubes due to long-standing sinusitis. The back wall of the throat may show post nasal drip and pharyngitis.
The doctor also presses the brows or the cheeks to check for tenderness. Pressing the brow on one side elicits tenderness in the frontal sinus of that side. Similarly, pain in the maxillary sinus is checked by pressing the cheek. He will also check your vitals including the temperature. Fever may be present in acute sinusitis.
The nasal cavities show swelling and redness in a case of acute sinusitis. However, a case of chronic sinusitis shows whitish thick nasal discharge, bulged structures and polyps inside. The discharge gives a fair idea about the causative organism, thick yellow discharge being bacterial in origin, whereas a brown colored one is fungal.
NASAL ENDOSCOPY
Clinical examination of the nose may not reveal all the details needed for a complete diagnosis. To acquire more details, we perform an endoscopy under local anesthesia. An endoscope is a long telescope that goes till the throat through the nose showing magnified images of its path. It has a camera with light at the end and the images are displayed on a screen. Although uncomfortable, with adequate decongestion and anesthesia, the procedure is not painful. It reveals deviations of the nasal septum, polyps, obstruction to sinus outflow, and the color and characteristics of the lining of the nose. With this the nature of the infection is somewhat clear and the specialist doctor initiates your treatment.
Computed Tomography of Nose or the Sinus CT
A CT scan is like a combination of a thousand x-rays, each filming a layer of a few millimeters thickness. This way, we obtain minute details of the anatomy. In a CT film, the bone appears white, tissues grey, and air black. Normally, air-filled sinuses appear black. Polyps and mucus membrane thickening inside the sinuses appear grey. Deviations of the septum, extra sinus cavities, abnormal turbinates, and other structural abnormalities are picked up easily by the CT.
A sinus CT is always done before proceeding for endoscopic sinus surgery. This helps us understand-
- The extent of sinus infection and disease
- Status of bony wall between the eyes and nose
- Status of bony wall between the brain and the nose
- The thickness of the bony walls
- Septal deviations
- Anatomical variations
The above details are vital from a surgical point of view. They help decide the extent of surgery and how much relief it will afford. In advanced sinus centers, we use artificial intelligence to superimpose preoperative CT images onto the live images on the screen while operating. This helps us to locate the exact point of pathology and thus prevent inadvertent injury to normal structures.
EVALUATION OF NASAL DISCHARGE OR PUS
The pus from the sinus cavities is checked for the presence of bacteria or fungi. The same test reveals the antibiotics the bacteria may be sensitive to. Additionally, it yields details on whether the sinusitis is allergic or infective.
Other Tests
Blood tests directed at checking the sugar levels, allergy levels and cell counts are useful to understand the cause of sinusitis. They help decide the mode of treatment as well as monitor the progress. We frequently find increased levels of IgE in serum and Eosinophils in blood count. An allergy test like the skin prick test helps to identify the allergen that may be causing frequent exacerbations.
Lastly, additional tests like contrast CT or MRI (magnetic resonance imagine) are ordered when we suspect the extension of disease extra nasally. Talk to one of our experts to find out what is the role of the investigations suggested by your ENT. When your ENT suggests surgery he will ask for some additional tests from an anesthetic point of view. These include chest x-ray, ECG, pre-op serology, and tests to check for normal clotting of the blood.
SINUS INFECTION treatment
After making a diagnosis, the ENT discusses with you the best treatment option for you. Although we have medical and surgical ways of managing sinusitis, a variety of factors help decide what is best for you. Hereby, we provide you a concise note on the various modes of treatment.
MEDICAL MANAGEMENT OF SINUSITIS
An acute bacterial sinus infection needs appropriate antibiotics. Initially we start on a broad-spectrum antibiotic that covers most of the common bacteria known to cause the infection. Subsequently, we switch to the most sensitive one as shown by the pus test.
Chronic sinusitis needs medicines directed at removing tissue edema and inflammation. We commonly use locally acting steroid sprays to achieve this. In a few cases, we may have to give oral steroids.
The sprays are used for long-duration unlike oral steroids. Additionally, we also use anti-allergic medicines like anti-histaminics routinely.
LOCAL DECONGESTION AND DOUCHES
Saline rinses remove secretions and crusts from the nose. Nasal decongestion helps decrease the swelling inside the nose promoting ventilation of sinuses. But, remember that, the decongestant drops should not be used continuously. Many patients find good relief by douching with a neti-pot. Douching with sodium bicarbonate, saline, steroid, and antibiotic rinses are useful in certain patients.
FUNCTIONAL ENDOSCOPIC SINUS SURGERY
The endoscopic sinus surgery aims to improve ventilation and drainage of sinuses. It removes the bony and tissue blockage to the free flow of mucus. The main steps of the surgery include opening the sinus ostium, removal of bony deviations of the nasal septum, removal of polyps, widening the drainage pathways of sinuses, clearing pent up secretions inside sinuses and giving the cavities a thorough wash. We send the material drained out for lab studies to check for bacteria, fungi, and other characteristics. If we feel there is any suspicious tissue we biopsy that as well. Above all, FESS has become the mainstay of the surgical treatment of sinus infection.
We wish to tell our readers that sinus surgery is not a one-stop solution to sinusitis. The procedure helps to improve the functions of the sinuses by removing obstructions, disease, and impediments to mucus flow. After the surgery you may still need medicines and precautions. We request you to discuss everything with your primary surgeon. If you wish to talk to any of our experts regarding your problem, we are available 24×7. It is alright to get a second opinion if you are worried about your treatment.
IMMUNOTHERAPY
We discussed immunotherapy and allergy testing in our post named Allergic Rhinitis. After all, allergies and sinusitis are inter-related. The former is a risk factor for the development of the latter. Measures to prevent allergies help in preventing sinus infections as well. Immunotherapy is a novel solution to treating allergies.
WHAT IF I DON’T TREAT SINUS INFECTIONS
Sinus infections can lead to severe complications. Because the sinuses and nose share borders with eyes and the brain, untreated sinus infections can spread to these structures. Inadequate treatment has cost many diabetic patients their vision. Similarly, the spread of infection through the skull into the brain is life-threatening. The most vulnerable groups are those with uncontrolled diabetes, immune deficiencies, and cancer patients. Bad breath, snoring, sleep apnea, reduced work performance, ear infections and chest infections are the sequelae of untreated sinus infections.
This post gives you an idea about how your visit to an ENT will be and what all he might do. We have tried to provide all must know details on the diagnosis and treatment of the sinus infection. However, our readers must understand that the treatment varies in different people. Medical management may suit some but fail in others. We shall see how to prevent sinus infections and simple home remedies in our next post.
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