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Sinusitis

Sinusitis is inflammation of the sinuses. If the mucous membranes lining the nose become congested and swollen, the tiny openings into the sinuses become blocked, and no air can get in or out. These are ideal conditions for germs to multiply within the sinuses, resulting in sinusitis. Sinusitis may follow a cold or hay fever, or even be provoked by rapid changes in air pressure (as occurs in air travel and underwater diving). Infection of the maxillary sinuses may be caused by sepsis of the upper teeth, which lie just under the floor of these sinuses, or by fractures of the upper jaw. After frequent attacks of acute sinusitis, the lining membrane can become thickened and hypersensitive to quite minor irritants such as cigarette smoke, spicy foods or thick fog. Attacks then become more frequent and difficult to control.

Symptoms

The symptoms of sinusitis depend both on the severity of the infection and the sinuses involved. In acute sinusitis there is almost always intense pain, due to the accumulation of pus in the affected sinus, and the sufferer feels very ill with a high temperature. In chronic sinusitis the pain is often more of a dull ache, but is far more persistent. Maxillary sinusitis causes pain in the upper region of the cheek bones, the forehead and the upper teeth. Ethmoid sinusitis may cause pain whenever the eyes are moved. Frontal sinusitis can cause a vague morning headache, which may be mistakenly attributed to migraine, eyestrain, or some other cause. Sphenoid sinusitis is liable to cause a persistent discharge of pus down the back of the throat (a 'post-nasal drip') with a cough and possibly chest complications. Of the various forms of sinusitis, maxillary sinusitis is the most common.

Treatment

Treatment involves pain-killers and antibiotics such as penicillin or tetracycline. Nose drops are used to shrink the congested and inflamed membranes, and so allow the sinuses to drain. Examination by an ear, nose and throat specialist may be necessary, and the inflamed sinuses may be washed out. Very occasionally, surgery is required. An operation for chronic maxillary sinusitis, the Caldwell-Luc procedure, involves cutting bone away under the upper lip, to allow the maxillary sinuses to drain.

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