Diagnosis
The diagnosis is made by various measures: In complicated cases, such as the transition to chronic sinusitis, therapy failure and the determination of an alternative diagnosis (med. differential diagnosis), an MRI of the paranasal sinuses can be helpful. However, an MRI in sinusitis is by no means a standard diagnostic tool. As an alternative to MRI, CT (computed tomography) can also be used to establish the diagnosis.
- The physical examination
- The taking of swabs from nasal secretions to identify the bacterial pathogen and
- A rhinoscopy (rhinoscopy)
Therapy
Sinusitis is usually caused by viruses or bacteria. The treatment of sinusitis aims to reduce the inflammation of the nasal mucous membranes and restore the flow of mucus from the paranasal sinuses. First and foremost, measures should be taken to liquefy the mucus, which improves the excretion of the mucus.
This is achieved, for example, by increased fluid intake (e.g. drinking), but high humidity, steam inhalations and nasal rinses or showers with isotonic saline solutions or seawater sprays can also help to alleviate the symptoms of sinusitis. In addition, nasal sprays or drops to reduce swelling of the mucous membranes (e.g. active ingredient: xylometazoline, oxymetazoline) can be used. Mucolytics are also suitable for clearing the sinuses of secretions.
Various preparations are available in pharmacies or drugstores without a prescription, such as capsules containing the active ingredient Cineol, which has an expectorant and anti-inflammatory effect within a short time. The use of nasal sprays containing cortisone can help to reduce inflammation. Over-the-counter painkillers containing active ingredients such as paracetamol or ibuprofen help against headaches and facial pain.
In cases of sinusitis with severe symptoms or if a bacterial infection has been diagnosed, the administration of antibiotics may be appropriate. In some cases with severe progressions, surgery may be necessary to facilitate the drainage of mucus (e.g. polyp removal, straightening of the nasal septum). However, surgery is only necessary if drug treatment does not provide sufficient relief, because according to current knowledge, optimal drug therapy is as effective as surgery.
Even in the case of chronic sinusitis, a surgical intervention is often not expected to completely eliminate the symptoms. The frequency and severity of the symptoms can be alleviated, but most affected patients must continue to receive therapeutic care even after surgery, since in many cases the symptoms return after surgery. For example, removed nasal polyps can grow back after some time.
An operation of the paranasal sinuses always involves risks, for example, important structures for moistening the nose can be damaged during the operation, which is why dry mucous membranes often occur after the operation. In rare cases, structures close to the paranasal sinuses can also be damaged. Since chronic sinusitis can have many different causes, it must be decided individually what kind of surgery can help to alleviate the symptoms in each individual case.
A reduction in the size of the nasal concha is rarely performed nowadays. The typical surgical measure nowadays is a so-called functional endoscopic surgery of the paranasal sinuses (FESS for short). This can remove constrictions or nasal polyps.
This method is very gentle and hardly painful, usually only a one-day stay in hospital is necessary after the operation. The nasal septum can also be operated endoscopically. It is also possible to reduce swollen mucous membranes in the area of the paranasal sinuses with the help of laser technology.
By reducing the swelling of the mucous membranes, it is hoped that the course of the infection will be less severe, as this will prevent blockages in the paranasal sinuses. In rather simple cases of chronic sinusitis, a so-called balloon dilatation can be performed.A balloon is inserted into the nose by means of a catheter and inflated slowly at the entrance of the paranasal sinuses, allowing narrow openings to be widened. This method is relatively simple and involves few complications, but it is questionable whether this surgery has any long-term benefits.
Various drugs can be used to alleviate the symptoms of sinusitis. Sinusitis is often accompanied by headache, facial pain or toothache. These symptoms can be effectively relieved with over-the-counter painkillers containing active ingredients such as paracetamol or ibuprofen.
Decongestant nasal sprays or drops (active ingredients: xylomethazolin, oxymetazolin) are very often used in acute sinusitis to remove the swelling of the mucous membranes, to allow normal secretion drainage and adequate ventilation of the sinuses. If the sinusitis is due to an allergic disease, nasal sprays or drops based on antihistamines and glucocorticoids (cortisone) are used. It should be noted, however, that nasal sprays can cause lasting damage to the nasal mucous membranes and that a kind of dependence can develop if they are used for a long time.
Various drugs can be used to liquefy nasal secretions and to facilitate their drainage. Active ingredients such as ambroxol are suitable here. Naturopathy also offers some drugs for the treatment of sinusitis.
For example, Schüssler salts, homeopathic remedies, but also the ingredients of plants (e.g. myrtol, eucalyptus oil, elderflower, chamomile, cineole) can help to alleviate the symptoms of sinusitis. As a herbal preparation, for example, Sinupret®, available as Sinupret® forte or Sinupret® drops, is used. In various types of application, these preparations can have an expectorant effect and provide relief in acute sinusitis.
Antibiotics are only indicated in rare cases of sinusitis. For example, an antibiotic containing the active substance amoxicilin should only be taken if the symptoms of the sinusitis are very severe, last longer than a week or if a bacterial cause of the sinusitis has been identified. The use of antibiotics is extremely rarely necessary in the treatment of sinusitis, as both bacterial and viral inflammation heal within a fortnight without complications in 60 to 80 percent of cases.
Nevertheless, acute sinusitis is one of the most common reasons for prescribing antibiotics. However, antibiotic therapy is only indicated in cases of severe symptoms or threatening complications. Certain symptoms are indicative of bacterial sinusitis, such as high fever, severe unilateral facial pain, swelling around the eyes, sensitivity to light, stiff neck or if the symptoms persist for more than seven days.
In this case the administration of antibiotics is recommended. In cases where antibiotics are indicated, the active substance amoxicillin is recommended. However, sinusitis is most frequently caused by respiratory viruses.
In these cases antibiotics have little or no effect. Treatment without antibiotics, which aims to reduce the swelling of the mucous membranes and to allow normal drainage of secretions and adequate ventilation of the paranasal sinuses, is sufficient in most cases to relieve the symptoms of a sinusitis and to accelerate the healing process. Various home remedies are suitable in the treatment of sinusitis to clear the sinuses of mucus and make breathing easier.
Even at the first signs of symptoms, it is advisable to treat the symptoms with simple household remedies. For example, it is advisable to inhale warm vapors to reduce the swelling of irritated mucous membranes and to clear the nose of mucus. To do this, pour boiling water (possibly with the addition of essential oils, eucalyptus oil or camomile flowers) into a bowl, bend over it with a towel over your head and inhale the rising steam.
Just by inhaling two to three times a day for a few minutes, the symptoms of a cold or sinusitis can be relieved. Babies and children should be careful with essential oils, as they can irritate the respiratory tract and trigger an asthma attack, which can cause an infant or child to experience difficulty breathing.A cold bath at body temperature can also help to clear the sinuses. Not only the warmth of the vapors can have a beneficial effect, but also infrared light directed at the sinuses can accelerate the healing process.
However, the application of heat is only useful if it is perceived as pleasant. In the case of very severe inflammation, heat can also increase the discomfort. Saline solutions are suitable for rinsing the sinuses, which can either be bought ready-made at the pharmacy or prepared by the patient himself.
There are so-called nasal showers that can be used for this purpose, but you can also put the rinsing solution in a small bowl. Then you cover one nostril and suck up water with the free nostril. The solution flows through the nose and comes out through the mouth.
By rinsing the paranasal sinuses, snorting off the secretion is made easier and the salt water also has a disinfecting effect. The sinuses should not be rinsed more than four times a day. However, one should not overdo it with measures to free the sinuses, since the mucous membranes can be irritated quickly and nosebleeds can occur.
Other household remedies for sinus treatment are compresses. A linen cloth or washcloth is soaked in warm water and eucalyptus oil or lemon and then placed on the sinuses. A very important household remedy for sinusitis is a high fluid intake to liquefy the mucus.
Herbal and peppermint teas can also have a decongestant effect. In addition, care should be taken to ensure that there is sufficient humidity in the living rooms and that cigarette smoke in the vicinity is avoided, as it irritates the mucous membranes. If the symptoms of sinusitis do not improve despite the use of home remedies, a doctor should be consulted so that the disease can be fully cured and a chronic course can be prevented.
