Acute maxillary sinusitis

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What is it about ?

Sinuses are spaces filled with air, located in the bones of the skull. They are connected to the nose and throat (nasopharynx) by small openings.

There are different sinuses:

  • The sinuses of the forehead bone (the frontal sinuses),
  • The sinuses on either side of the nose, in the jaws (the maxillary sinuses),
  • The sinuses above and behind the bone of the nose (the ethmoid sinuses),
  • The sinus at the height of the temples, in the center of the skull (the sphenoidal sinus).

Sinusitis is a inflammation of the sinus lining.

Sinusitis usually begins with a simple common cold. The lining of the nose swells and produces a lot of mucus. This can “block” the opening between the sinuses and the nasopharynx. The mucus becomes thicker and can (almost) no longer drain. The sinus is too full and you may feel pressure or pain.

Maxillary sinusitis

Maxillary sinusitis is an inflammation of the lining of the maxillary sinus.

  • If it lasts less than 3 months, we are talking about acute maxillary sinusitis ;
  • If it lasts more than 3 months, we talk about chronic maxillary sinusitis.

The cause is almost always a upper respiratory tract infection (nose, throat, middle ear, windpipe), which is caused by a virus. Sometimes bacterial superinfection is added.

It is more common in people with respiratory allergy and chronic rhinitis, in the presence of nasal polyps, in the event of anomalies of the nasal septum, in an infection of the tooth root and, more rarely, in the presence of a foreign body in the nose (especially in children).

What is its frequency?

Out of 1,000 upper respiratory tract infections, between 5 and 50 end in acute maxillary sinusitis.

How to recognize it?

After a banal common cold, you develop pain around the eyes and in the cheeks. The pain increases when you lean forward. Sometimes it radiates to the upper teeth.

In addition to pain in the face, you may also suffer from:

In case of bacterial infection, the fever is common.

How is the diagnosis made?

The doctor usually makes the diagnosis on the basis of symptoms. Facing a common cold that lasts more than 10 days or comes back again and again with a purulent nasal discharge and fever, the doctor will always think of sinusitis.

No routine technical examination is normally performed. In some cases, however, the doctor may order an X-ray or a CT scan:

  • If in doubt about the diagnosis, a strong fever and if you have a serious feeling of ill-being, the doctor may prescribe some technical examinations. A x-ray can thus rule out the presence of fluid / mucus in the sinuses. The presence of fluid / mucus in the sinuses, however, does not always mean that you have sinusitis.
  • If the doctor still wants an imaging test to determine the extent of the condition, and therefore the continuation of treatment, the CT scan is the best choice. This examination may be necessary in the event of suspected complications or development in chronic sinusitis. However, the radiation dose required for this examination is considerably higher than for a normal x-ray.

What can you do ?

Most of upper respiratory tract infections being caused by viruses, you can wait calmly and see how things go.

This is because sinusitis is usually caused by the same virus and spontaneously heals.

What can your pharmacist do?

The pharmacist can advise you on saline solution (physiological serum), pain reliever, and nasal drops or spray to relieve your symptoms.

Saline solution

The symptoms in the nose can be mitigated by a rinse with saline solution.

Painkillers

The painkillers can relieve pain in the head, from muscles and joints. the paracetamol must be privileged. You will find here different brands of paracetamol.

Nasal drops or sprays

The pharmacist will advise you which nasal spray to use. He will explain to you how to use it correctly.

Decongestant nasal drops or sprays (vasoconstrictors)

These drugs to put in the nose deflate the lining of your nose. They do not change the duration of the illness, nor the healing process. They just decrease your symptoms temporarily.

If you are using these medicines, use them as short a time as possible : maximum 5 days and, preferably, only at night. If you use them for longer, they often result in what is called a rebound effect. This means that when the medicine stops working, the lining swells even more than before. You therefore continue to use the nasal drops or spray and find it even more difficult to do without them.

Nasal spray with cortisone

A cortisone nasal spray can also be helpful in reducing inflammation and in allergy or nasal polyposis. He relieves the stuffy nose and improves your sense of smell. You can use it longer. Ask the doctor for advice first. If you have a doctor’s prescription, your cortisone nasal spray will also be reimbursed.

This product only works after a maximum of 3 to 10 days. We must therefore hold on and continue the treatment.

The Side effects Possible options of a cortisone nasal spray are:

  • Irritation of the nose;
  • Sneezing attacks after administration;
  • Occasionally, nose bleeds (some time after the start of treatment).

If you are suffering from the above side effects, it is recommended to stop the spray for a few days. Side effects are often due to improper use of the nasal spray. Make sure to spray the product without touching the nasal septum.

What can your doctor do?

Medications

As a first step, your doctor may prescribe painkillers to relieve symptoms. a nasal medication containing a decongestant or cortisone (see above) may also be helpful.

If you have acute sinusitis, the antibiotics are generally not indicated.

In the case of a severe rhinosinusitis associated with severe pain, fever and a severe feeling of discomfort, the doctor may still consider antibiotic therapy, certainly if the symptoms last more than 10 days. However, it is still preferable, also in this situation, to wait for spontaneous improvement since antibiotics have not been shown to reduce the risk of chronic sinusitis or other complications.

If symptoms persist for more than 10 days, a seven-day course of antibiotics may be indicated in patients with severe symptoms. When choosing a treatment, remember that acute maxillary sinusitis often resolves on its own.

Specialist orientation

If the doctor sees signs of complicationssuch as redness and swelling in the face, abnormalities in the eyes or stimulation of the nerves in the brain, he will refer you to a specialist immediately.

Want to know more?

Sources

    • Zelfzorgadvies in de apotheek, Praktijkgids 2. S. Cornwell, V. Foulon. Publisher Acco. 2018 edition.