The term sinusitis is also frequently used – but it only describes an inflammation of the sinuses. Normally, however, the mucous membrane of the nose is also inflamed (rhinitis). This is why many experts prefer the term rhinosinusitis.
Sinusitis, inflammation of the paranasal sinuses
In rhinosinusitis, both the paranasal sinuses and the mucous membrane of the nose are inflamed. This inflammation is usually the result of a viral infection, more rarely a bacterial infection. Acute rhinosinusitis heals after one to two weeks. However, if the symptoms of rhinosinusitis persist for longer than twelve weeks, experts speak of chronic rhinosinusitis.
The term sinusitis is also frequently used – but it only describes an inflammation of the sinuses. Normally, however, the mucous membrane of the nose is also inflamed (rhinitis). This is why many experts prefer the term rhinosinusitis.
It usually begins with a typical cold, caused by viruses, sometimes also by bacteria or fungi. Everyone knows the feeling of a runny nose and swollen mucous membranes. However, this swelling and the thickened nasal secretions block access to the sinuses. As a result, the secretions produced in the sinuses can no longer drain through the ostia (accesses). However, pathogens find the ideal breeding ground in this secretion in the poorly ventilated sinuses and the mucous membrane becomes inflamed. Chronic rhinosinusitis usually develops over time from recurring acute sinusitis.
There are various paranasal sinuses in which chronic rhinosinusitis can occur:
The various sinuses can become inflamed individually. Sometimes, however, several infections occur at the same time. Chronic rhinosinusitis usually affects the maxillary sinus or ethmoid bone.
Many people suffer from acute rhinosinusitis: Every adult gets around two to three upper respiratory tract infections a year, a child as many as seven to ten. In most cases, this is a viral infection, less frequently bacteria are the cause of the symptoms. In some people, however, acute sinusitis develops into chronic sinusitis. Around one in 20 people living in Switzerland suffers from chronic rhinosinusitis, with some experts estimating the figure at ten to 15 percent of the population. Those affected often have asthma at the same time. In some cases, chronic rhinosinusitis also occurs in conjunction with hypersensitivity to acetylsalicylic acid.
If the accesses to the paranasal sinuses (ostia) are naturally small, the risk of rhinosinusitis is high. This is because the smaller the passage, the easier it can be closed by secretions and swelling. This can also be the case with a deviated nasal septum or an enlarged turbinate. Another possible cause is nasal polyps or a tumor.
In principle, there is a risk that sinusitis will become chronic if it cannot heal properly. Allergies with constant or prolonged rhinitis can also trigger chronic rhinosinusitis, as can a weakened immune system. An intolerance to acetylsalicylic acid is also a risk factor. In some cases, however, it remains unclear why a person develops chronic rhinosinusitis.
Acute rhinosinusitis begins with a runny nose in which the mucous membranes are no longer able to fight off the pathogens – viruses or bacteria. Sometimes viral rhinosinusitis is followed by bacterial rhinosinusitis. Less common causes are pathogens from the bath water, infections from a tooth infection or pathogens that penetrate during dental surgery. The symptoms can also be triggered by an allergic rhinitis or the pressure fluctuations when diving or flying.
If a cold turns into an acute sinus infection, this usually manifests itself in the following symptoms:
The pain usually occurs at the site where the sinus is located. They become stronger when the person concerned stands up, jumps or bends forward. The sinus is also sensitive to light tapping. Children feel less pressure than adults. In chronic rhinosinusitis, however, the pain is usually significantly less than in acute rhinosinusitis – sometimes it is even completely absent. In the chronic form, the symptoms often only occur on one side.
The nasal secretion is also conspicuous in rhinosinusitis: it contains pus and is therefore yellow-greenish in color and somewhat viscous. At the same time, the entire nose swells up, making it difficult for those affected to breathe through the nose and smell less. Acute rhinosinusitis is often accompanied by fever, earache, cough or general fatigue.
One of the most important questions for us is how long you have had your complaints. This allows us to differentiate between acute and chronic rhinosinusitis. We proceed as follows during the examination:
If chronic rhinosinusitis is suspected, we also use an ultrasound examination or computer tomography (CT). This rules out the possibility that polyps or tumors are the cause of the symptoms. It also allows us to better assess the extent of the inflammation. CT is particularly useful before an operation in order to plan it better.
Only if we suspect that other illnesses are the cause of chronic rhinosinusitis do we recommend a blood test, an allergy test or a check-up at the dentist. An MRI is also sometimes used.
You can prevent rhinosinusitis by taking it easy during an infection of the respiratory tract. Only when the last symptoms of the illness have subsided and you really feel fit again should you take up sport or other strenuous activities. The following measures help the mucous membranes of the nose during a cold:
Basically, a strong immune system helps to ward off colds and thus also sinusitis. You strengthen your immune system primarily through
If you notice that you still have a feeling of pressure in your forehead or cheeks after a cold, even after a long time, you should visit us.
While acute rhinosinusitis usually runs its course without complications, chronic sinusitis is protracted. You will need patience and should strictly follow our instructions over a longer period of time. Even after surgery, relapses can occur, usually in episodes. For the rest of their lives, those affected must take care to keep their nasal mucous membranes moist.
If chronic rhinosinusitis is not treated, there is a risk of dangerous complications: If the inflammation continues to spread, sinusitis can “break through” – the skin of the forehead then reddens and the upper eyelid swells. The meninges can also become inflamed as a result. An inflammation of the maxillary sinus can lead into the eye socket and cause visual disturbances and restricted eye movement. Even seizures and paralysis of individual nerves are possible in severe cases. It is therefore important to have complaints clarified by us in good time.
Acute rhinosinusitis usually subsides on its own within one to two weeks. Nasal showers, decongestant nasal sprays, mucolytics and rest alleviate the symptoms. The treatment of chronic rhinosinusitis depends on the cause. If an allergy is the trigger, treatment with anti-allergic drugs and a nasal spray containing corticosteroids often leads to an improvement in symptoms. Bacterial infections have often also developed in the closed sinuses in the case of chronic sinusitis. These can be treated effectively with antibiotics. Regular nasal irrigation and nasal sprays containing corticosteroids can support healing. We often also give tablets containing corticosteroids. If treatment with antibiotics and cortisone is ineffective, surgery is sometimes necessary. We consider nosebleeds, visual disturbances or persistent severe headaches and facial pain, for example, to be signs that the previous therapy is not sufficient.