Sinusitis

When your sinuses (air chambers in the bone behind your cheeks, eyebrows and jaw) are inflamed or infected, it leads to sinusitis. The different sinus areas are:

Frontal sinus – on the brow area
Maxillary sinuses – inside each cheekbone
Ethmoid sinuses – behind the nose bridge and between the eyes
Sphenoid sinuses – behind the ethmoids in the upper region of the nose

When the sinuses are blocked, the mucus is not sufficiently drained thereby leading to sinusitis. Sinusitis occurs when trapped air lays pressure and causes pain in the sinus regions. Typically, sinusitis follows a cold or respiratory ailment. The increased mucus and fungal production leads to inflammation in the nasal passage. Often a structural defect in the nasal cavity or weakened immune system can be the cause for a sinus attack. Allergic rhinitis can bring on an attack of sinusitis. The symptoms and pain associated with sinusitis depend on the affected sinus. Damp weather, environmental pollutants and asthma often lead to sinus attacks. This inflammation is usually the result of a viral infection, an allergy (pollen, dust, pet dander, molds, and food), or an environmental irritant such as air pollution, perfume or cigarette smoke. Persons suffering from chronic inflammation of the nasal passages have an increased risk of suffering sinusitis. Swimming, diving, nasal polyps, smoking or alcohol consumption can lead to blocked sinuses. Air travel is yet another possible trigger.

Acute sinus infection lasts for about a fortnight whereas chronic sinus infection festers longer, for months or years. Most affected persons tend to suffer from acute sinus infection. Typical symptoms of sinus infection:

• Pain over frontal sinuses
  
• Headache
  
• Swelling of eyelids or tissues around the eyes
  
• Earache
  
• Neck pain
  
• Stuffy nose
  
• Facial tenderness
  
• Bad breath
  
• Ache in the upper teeth
  
• Nasal congestion
  

Blood tests and cultures aid in diagnosing and detecting bacterial or fungal infections. Acute sinusitis is treated with antibiotics to control the bacterial infection. Decongestants and painkillers can provide relief to those suffering from sinus infection. On the other hand, chronic sinusitis may need to be treated with steroid nasal sprays. But prolonged use of such products are not without side-effects. Allergies and infections that contribute to the sinus infection must be appropriately treated. Children suffering from chronic sinus infection are treated with removal of adenoids. Functional endoscopic sinus surgery is performed on severe cases of chronic sinusitis where the natural openings of the sinuses are dilated to allow drainage of accumulated mucus.

Home remedies for treating sinus infections
1. Steam inhalation
2. Gentle warm compress on painful area
3. Use of electrostatic filters attached to heating and air conditioning equipment
4. Saline nasal spray
5. Rest with your head elevated to help drain your sinuses
6. Drink plenty of fluids and warm liquids in order to thin mucus

Orbital Cellulitis

Orbital Cellulitis is an inflammation or infection of the eye socket or orbit. As such, the orbital septum is a fibrous membrane that separates the eyelid skin from the deeper structure of the orbit. Since the orbit has direct connection with the sinuses, infection can spread into the orbit in a patient with a sinus infection. Of the two – preseptal cellulitis and orbital cellulitis – the latter is potentially more serious. Both conditions are common in children and adults.

It is very difficult to distinguish between the two as in both the conditions; the eyelids are red and swollen. However, in preseptal cellulitis the eyes move normally and are positioned normally whereas in orbital cellulitis, there is a restriction of eye movements and the eye might appear protruding more than normal. There could be decrease in vision and pupil reaction also.

Causes for orbital cellulitis include sinusitis, trauma or foreign body, infection from blood and tooth abscess. An imaging study is done to evaluate the spread of the disease beyond the orbit, other than blood tests for infection.

Consultation is done with an ophthalmologist and ENT specialist. Treatment includes admission to the hospital for close observation and intravenous therapy with antibiotics. Immediate treatment with intravenous antibiotics is necessary to prevent optic nerve damage and spread of infection to the cavernous sinuses, meninges and brain. Penicillinase-resistant penicillin, such as nafcillin, is recommended, along with metronidazole or clindamycin to treat anaerobic infections. Surgery to drain the orbital and sinus infection may become necessary if the condition of the patient worsens. Patients are regularly monitored for any evidence for loss of vision and pressure on the optic nerve.

Orbital cellulitis can cause complications if the infection spreads to the surrounding tissue and worsens the illness. If it spreads to the brain, then brain abscess, meningitis or hydrocephalus may result. These require intensive care and emergency surgery. But orbital cellulitis responds to proper treatment and there is generally complete recovery.