Chronic sinusitis
The chronic form of sinusitis is a disease that lasts longer than two to three months. Inflammatory processes in the maxillary sinus, which occur several times within a short period of time, also belong to the chronic form of this disease. In most cases, a chronic sinusitis results directly from an acute disease.
This can happen when an acute inflammation does not heal or heals insufficiently. Resistance to antibiotics can also lead to the development of chronic maxillary sinusitis. In addition to the maxillary sinuses, the ethmoid cells in particular can be affected by chronic sinusitis.
Other possible causes are allergies, curvature of the nasal septum, nasal polyps or inflammation of the dental root. Symptoms of a chronic course of this infectious disease include a long-lasting loss of smell (anosmia), strong, thin nasal discharge (rhinorrhoea), secretion in the throat, strong sensations of pressure in the area of the head (especially the paranasal sinuses and the orbit) and headaches. The most frequently described symptoms of sinusitis include moderate to severe headaches and a dull throbbing sensation of pressure in the head area (especially on the cheeks and under the eye sockets).
It can be observed that the perceived pain is significantly worsened when trying to bend the head towards the chest. In the case of sinusitis, the pain is usually felt most clearly in the area of the cheeks.In addition, some patients complain of severe toothache, which is due to the fact that in many people the roots of the molars of the upper jaw reach into the maxillary sinus. Usually, an inflammation of the maxillary sinus is accompanied by a severe rhinitis, in which purulent, yellowish-green secretion flows from the nostrils.
This also results in an obstruction of normal nasal breathing. If the inflammatory processes are very severe, the organism reacts with high fever and a general feeling of exhaustion. In addition, temporary visual disturbances may occur due to the pressure in the area of the eye socket.
Severe swelling of the cheeks and/or the development of an inflammation of the molars of the upper jaw are also possible in the course of an inflammation of the maxillary sinus. Many people who suffer from a flu-like infection notice the simultaneous occurrence of toothache. In this context, it is noticeable that cold-associated toothache usually occurs exclusively in the area of the upper jaw.
The teeth of the lower jaw are not affected in the majority of cases. The reason for the simultaneous occurrence of sinusitis and toothache in the upper jaw is the close anatomical neighborhood relationship between the oral cavity and the maxillary sinus. In addition, both the maxillary sinus and the roots of the upper teeth are usually supplied by a common nerve branch.
Inflammatory processes in the area of the paranasal sinuses (for example in the maxillary sinus) thus exert a painful stimulus that continues via these very nerve fibers to the teeth. A second explanation for toothache in connection with flu-like infections is the fact that there are often accumulations of secretions in the paranasal sinuses. As a result, the pressure in the sinus area increases significantly and the person affected suffers from toothache.
In general, it is not necessary to see a dentist if toothache and upper respiratory tract infections occur simultaneously. For most patients, inhalations with table salt or mint help to increase the flow of secretions and thus effectively relieve the toothache. In severe cases, painkillers such as Paracetamol® or Ibuprofen can be taken.
However, if the symptoms do not subside for several days or a fever occurs, a doctor should be consulted so that antibiotic therapy can be initiated if necessary. Otherwise, if suitable treatment is not given, there is a risk that the acute sinusitis with toothache will develop into a chronic form.
- Cough
- Sniffles
- Sore throat and headaches
There can be many different reasons for the occurrence of sinusitis.
For this reason, many patients suffer from sinusitis without simultaneously reporting accompanying symptoms such as a cold or watery eyes. In these cases, bacterial pathogens, which for example have entered the bony maxillary sinus from the oral cavity, can be the cause. A particular risk for the development of sinusitis without a cold is the removal of molars from the upper jaw.
In a large number of adults, it can be observed that the posterior teeth of the upper jaw have a close connection to the maxillary sinus. In some patients, the roots of their teeth even extend directly into the maxillary sinus. If the maxillary sinus is opened due to a necessary tooth extraction (tooth removal), a direct connection to the oral cavity is created.
Bacterial pathogens can, if a suitable closure method is not used, simply migrate into the sinus and provoke an inflammation of the maxillary sinus without a rhinitis. However, this happens relatively seldom in everyday clinical practice, since an opening of the maxillary sinus can now be treated well by closing the gums and the targeted intake of an antibiotic. The most important step in the diagnosis of a sinusitis is a detailed doctor-patient consultation (anamnesis), in which the person affected should describe all symptoms to the dentist as comprehensively as possible.
In this context, recently performed dental treatments (e.g. tooth extractions or root canal treatments) play a decisive role. If the affected patient has undergone such dental treatment shortly before the onset of symptoms, the probability of the presence of sinusitis is particularly high. During the subsequent physical examination, both halves of the jaw are tapped.In this way, the diagnosis can usually be confirmed by the occurrence of pain stimuli on the affected half of the jaw.
Since specific inflammatory mediators can be detected in the course of the inflammatory processes in the sinus area, a blood test can also be used to diagnose sinusitis. For example, in the presence of a sinusitis, the number of white blood cells and the so-called C-reactive protein (CRP) increases significantly. If no reliable diagnosis can be made even after these steps, a rhinoscopy is recommended.
In this examination method, the nasal passage is widened by using a nasal spreader or a flexible tube. A device with a built-in light source and camera (nasal endoscope) can then be inserted into the inside of the nose. During this procedure, the physician evaluates especially the condition of the mucous membranes lining the nose.
In addition, existing nasal secretions can be assessed and checked for purulent residues. However, it is much easier to perform an ultrasound or X-ray examination. (In everyday clinical practice, diagnosis by means of ultrasound is preferable to the preparation of an X-ray, as it does not expose the patient to radiation).
In this way, it is quite easy to visualize accumulations of secretions and inflammation in the maxillary sinus. In the case of chronic forms of maxillary sinusitis, computer tomography (or CT for short) may also be useful despite the comparatively high radiation exposure. Inflammations of the maxillary sinus can be detected quite easily by thickening of the wall structures and accumulation of fluid.
Basically, the treatment of sinusitis does not differ from that of a common cold. The affected patients should stay in bed for a few days and drink plenty of fluids, especially water and tea. In addition, warm baths and/or hot-water bottles will help during the first days of illness.
In addition, saline nasal sprays or nasal drops can help to reduce the swelling. The advantage of salt solutions in contrast to commercial nasal sprays is the gentler effect on the nasal mucous membranes. Nevertheless, salt sprays should not be used for longer than one week.
Affected patients should avoid cooling the paranasal sinus area during the illness, because in some studies it was found that cooling has a rather obstructive and unfavorable influence on the healing process. Heat, on the other hand, helps to positively influence the course of the disease and accelerate the healing of the inflammatory processes. In addition, painkillers should be taken to relieve the pain.
In most cases, the treating physician will prescribe an antibiotic for a bacterially triggered sinusitis. This antibiotic should also be taken completely after the symptoms and complaints have subsided, according to the doctor’s instructions. Surgical treatment may be necessary for inflammations that are promoted by anatomical reasons (curvature of the nasal septum) or polyps. Straightening of the nasal septum or removal of polyps may be sufficient to minimize the risk of recurrence. This is because the best possible drainage of the secretion minimizes the probability of inflammatory processes developing within the paranasal sinuses.
