Infectious inflammation of the paranasal sinuses (sinusitis) is annoying infectious disease, which is usually treated by otolaryngologists. Before we proceed, we must know some basic facts about the paranasal sinuses. Paranasal sinuses are hollow spaces within the bones of the skull. These spaces are connected by small holes with the main nasal cavity. There are two maxillary sinuses behind the cheeks, ethmoidal sinuses near the bridge of the nose and frontal sinuses above the orbits.


The sinusitis is usually caused by a bacterial infection. Upper respiratory tract infections (viral or bacterial) may reduce local mucosal immunity and the bacteria may penetrate into the sinuses. The infection leads to pus production and local swelling of mucosa, which closes the connections with the main nasal cavity. This forms a vicious circle – the infection persists, the pus accumulates and the symptoms worsen.


The disease initially manifests as classic rhinitis with loss of smell, which is followed by pain in the area of the affected sinus cavity (usually pain in the face or forehead). The pain is worse when you change the position of your head, for example when bending forward. The affected blow out mucus or greenish pus, suffer from elevated body temperature, cough, fatigue and other flu-like symptoms. Many people complain about losing the sense of smell.


When the disease is suspected, it is advisable to do X-ray of the sinuses, which can show us thickening of mucosa and presence of pus. A swab of the nasal mucosa can help to identify the causative microorganism.


The treatment may be either conservative or invasive. Conservative treatment includes bed rest, adequate intake of hot fluid, antibiotics and drugs causing decongestion of the mucous membranes. However, antibiotics may not be efficient as their penetration into the paranasal cavity is decreased and the pus accumulation forms an excellent environment for bacterial growth.


Invasive approach is performed by otolaryngologists. They may perform a puncture of the affected sinus cavity followed by pus evacuation. It is a relatively unpleasant procedure, but it brings a quick and significant relief and the gained pus can be sent for microbiological examination. The puncture is frequently repeated once or twice.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources