Sinus infection, otherwise known as sinusitis, is the inflammation of the mucosa or the inner tissue lining of the paranasal air sinuses. Sinuses mean cavities in the skull bones or facial bones.
There are four paired paranasal air sinuses. These are the air-filled spaces which are surrounding the human nose. These four air-filled, paranasal sinuses are as follows.
- Frontal sinus
- Sphenoid sinus
- Ethmoid sinus or Ethmoid air cells
- Maxillary sinus
When the inner tissue lining of these sinuses gets inflamed due to a variety of reasons, the condition is termed sinusitis or sinus infection. When all the paranasal air sinuses get inflamed simultaneously the condition is termed as ‘pansinusitis’.
The sinus infection is most commonly seen in the maxillary sinus. Also, the maxillary sinus is the largest of all the paranasal air sinuses.
Different Types of Sinus Infection, Causes, Symptoms, and Treatments
Following are the most commonly seen types of sinus infection among humans.
Sinusitis of Odontogenic Origins
Sinusitis of odontogenic origins is the sinus infection and inflammation caused due to odontogenic (tooth related) factors. Odontogenic means the one which originates from the tooth or its closely surrounding structures.
Preliminary diagnosis of odontogenic sinusitis is done based on the signs and symptoms presented by the individual. The confirmed diagnosis may be arrived at, using radiographs.
Causes of Sinus Infection In Odontogenic Sinusitis
Odontogenic sinusitis may be caused due to one or more of the following reasons.
- Infections caused due to periapical dental abscesses which may later spread into the maxillary sinus if left untreated.
- Infections that may be caused following a common cold and upper respiratory tract infections.
- A displaced tooth or root
- Trauma due to various causes may also result in sinusitis or sinus infection.
- Any kind of allergy
- Neoplasms of odontogenic origin
- Infected cysts of dental origin
- Oroantral fistula or communication
Clinical Features of Odontogenic Sinusitis
- Severe throbbing pain in the maxillary sinus region, which is the affected sinus in case of odontogenic sinusitis.
- The severity of the pain may reduce once the pus is drained from the area.
- Slight swelling of the affected area, especially cheek, may be present.
- Sometimes the affected person may feel ‘foul pus running down the nostril’.
- The feeling of unpleasant taste
- A foul smell is often present
Treatment of Odontogenic Sinus Infection
The treatment for odontogenic sinus infection depends on the removal of the teeth that are causing the infection. This, however, is a risky approach as there are chances of perforating the floor of the antrum.
So the dentist may opt for the tooth extraction only after antibiotic prophylaxis of the patient, at least for five days prior to the extraction. Use of decongestants in the forms of nasal inhalations and drops may be necessary in these cases.
As the name suggests, acute sinusitis is of sudden onset. This may or may not be associated with pus discharge.
Signs of Acute Sinus Infection
- Tenderness over the affected area
- Numbness may be occasionally felt in the affected area
- Swelling may be observed in severe cases of infection
- Fetor oris or halitosis may be present
- There may be an opening established between the maxillary sinus and the oral cavity.
- Pus may discharge inside the mouth.
Acute Sinusitis Symptoms
- The affected individual may have cold 3 to 4 days prior to the onset of acute sinusitis.
- Rhinitis in these cases is usually accompanied by blockage of the nose.
- Foul smelling discharge from the nose may be occasionally noted in some affected individuals, which is often thick, and discolored.
- Pharyngitis may be present
- Heaviness in the head may be felt
- Constant throbbing kind of pain may be felt over the affected area, especially cheek and the entire side of the face.
- Discharge from one side of the nose may be present, especially on lowering the head.
- One side of the nose may be blocked.
- Difficulty in breathing may be experienced by some.
- Chills and fever may be present in some.
- In rare cases, anorexia may be observed.
Treatment of Acute Sinusitis
Acute sinusitis may be treated in the following ways.
- Bed rest is very important in these cases.
- You need to take plenty of fluids and maintain good oral hygiene.
- 5-7 days of antibiotic/antimicrobial prophylaxis may be required.
- Erythromycin and Amoxicillin are the drugs of choice in these conditions.
- Decongestants in the form of nasal drops or sprays are very useful in cases of sinus infection.
- 0.1% Xylometazoline hydrochloride is the chosen decongestant, which is used for this purpose.
- Taking simple steam inhalation every 8 hours greatly helps.
- Mucolytic agents may be occasionally used to reduce the thickness of mucous discharge and facilitate drainage.
- Pain can be managed with simple NSAIDs.
Chronic sinus infection is caused due to various kinds of persistent infections. These may be one or more of the following.
- Chronic infection in the sinus itself
- Chronic dental infections
- Chronic rhinitis
- Various allergic conditions
Signs and Symptoms of Chronic Sinus Infection
- In many cases, this condition may not show any symptoms
- If there is an acute exaggeration in chronic sinusitis, pain may be felt over the affected area.
- A condition called Cacosmia may be seen in the affected individuals. This is a condition where the person has a bad taste in the mouth along with the bad breath.
Treatment of Chronic Sinusitis
- The success of the treatment is totally dependant on the removal of the cause of the infection.
- The treatment should not be delayed as there are chances of serious complications.
- If a dental infection is causing chronic sinusitis, the offending tooth may be extracted followed by the surgical closure of the socket.
- In cases of people with severe and chronic rhinitis conditions, the sinusitis may become irreversible.
- If a foreign body is causing the chronic sinusitis (mostly maxillary sinusitis), the immediate retrieval of the foreign body from the sinus will be done.
- Surgical drainage of pus will also be required in most of the severe cases.
Sinus Infection Caused By Oro Antral Communications or Fistula
An oroantral communication, otherwise known as a fistula, is an unnatural ‘communication’ or an ‘opening’ between the maxillary sinus and the oral cavity(mouth). This also is one of the important causes of maxillary sinus infection.
This tract, or the opening, usually has epithelial tissue lining and is always classified as a pathological condition.
It may be caused due to the following.
- Following the extraction of teeth.
- Due to a long-standing infection
- Trauma to the face
- Accidental injury caused during the tooth removal
- Following a surgery that is done to remove a large cyst or tumor.
Management of Oro Antral Fistula
If the condition is detected early, immediate surgery is done to close the opening which is then followed by antibiotic prophylaxis to prevent further infection.
A protective acrylic denture may be used to act as a barrier to prevent the entry of food particles into the sinus until the opening is surgically closed.
In cases of long-standing oroantral fistulas drainage of pus and control of the infection is important prior to the surgical closure of the opening.