It can bring us down at once, with a feeling of vice before the eyes. But, behind this banal ENT infection, there are different forms that are not treated in the same way.
The sinuses lead us a hard life, but we often do not know where exactly these small bone cavities are located. What is certain is that there are four pairs! The maxillary (under the eyes), frontal (above), ethmoid (between the eyes), and sphenoid (deepest, at the back of the eyes) sinuses.
What are we used for? “Many hypotheses are formulated, but none is really proven,” says Professor Jean-François Papon, head of the ENT department at Bicêtre Hospital and vice-president of the French Association of Rhinology. They are thus credited with the ability to humidify and filter the air (as nasal cavities also do), to protect against trauma, to reduce the weight of the skull, or to serve as a sounding board for the voice… Each sinus communicates with the nasal cavity through a narrow orifice, called ostium, which allows mucus to flow and, with it, impurities and potential pathogenic germs. The catch? The opposite path is possible: viruses and other bacteria can therefore easily reach the sinuses from the nasal cavity.
It usually all starts with a virus
Stuffy nose, runny, headaches… nothing is banaler than a cold. But when viruses make their way to the sinuses and multiply there, the symptoms get worse! This is called acute rhinosinusitis, most often localized in the maxillary sinuses. Inflammation and the resulting edema interfere with the drainage of secretions, which increases nasal obstruction and causes diffuse pain around the nose and eyes, headache, and sometimes fever. No need to consult at this stage if you are in good health, do not suffer from diabetes or an immune deficiency. As with any viral infection, antibiotics are not indicated. In addition to not accelerating healing, which can take a good ten days, they may promote the selection of resistant bacteria that will only need to proliferate.
What to do? Nose washes essentially. This is the number one therapeutic reflex. Objective: to clear the nose and facilitate the elimination of secretions and microbes. It can be used several times per day using seawater sprays of the Stemar or Humer type. Choose hypertonic formulas if the obstruction is very troublesome. Inhalations, by moistening the nasal cavities, can also relieve (Calyptol Inhalant, Naturactive Aromasol, Pranarôm Capsules Inhalation …). Based on essential oils, they are reserved for adults or over 12 years. Another tip: sleep in a cool room and with your head slightly raised to help remove the obstruction. In case of fever or headache, we bet on paracetamol but, above all, we forget about anti-inflammatories such as ibuprofen, “which can complicate an ENT infection”, recalls Professor Papon.
If the infection drags on or the pain increases, a bacterium is involved
Sometimes the infection is immediately due to bacteria or that they take advantage of a drop in local defenses caused by viruses to swarm in turn. This is called acute purulent rhinosinusitis. The risk? Poorly treated, it can tend to recur or lead to more serious infections, especially in the case of frontal, ethmoid, or sphenoid sinusitis. “The latter is rarer than maxillary sinusitis, but can lead to serious complications due to the proximity of these sinuses to the tissues of the eye, brain, or meninges,” explains the Pr Papon. What signs should alert? Mainly pain that, instead of being diffuse, is localized next to the affected sinus. It is therefore often unilateral and frequently strong and pulsating, increasing in the lying position. No hesitation either in case of fever persisting more than two days or symptoms of viral sinusitis dragging more than ten days: it is necessary to consult.
What to do? Effective treatment of a bacterial infection involves taking antibiotics (usually seven days), although the effect is not instantaneous. “Due to the importance of edema and inflammation, it takes two to three days to see an improvement,” warns the expert. But, in the absence of effectiveness after this period, it is better to warn your doctor. If nose washes remain indicated, a nasal vasoconstrictor, on prescription only, can also be prescribed in case of significant congestion (Aturgyl, Deturgylone, Derinox …). Its use should be limited to three days, or even five at most, as it can induce dependence, as well as cardiovascular and neurological adverse effects. For these same reasons, it should not be associated with oral decongestants present in some antirhumes (Actifed Day & Night, Dolirhume …), often not very effective in relieving sinusitis.
In case of a dedication, we push the investigation
Poorly treated bacterial sinusitis – due to unsuitable antibiotic treatment or interrupted too early, for example – can recur several times a year or take a dragging form related to poor drainage of the affected sinus. In these situations, we are always looking for a dental origin (see box). A sinus scan can also be performed to clarify the location and origin of the damage and eliminate a cause related to an obstacle, such as a foreign body, or chronic inflammation (nasal polyposis).
What to do? If the infectious origin of sinusitis is well established, we change the antibiotic (always in a seven-day cure), until we find the one that works on the germ in question. This allows, most of the time, to overcome the problem. Otherwise, surgery may be proposed to widen the sinus drainage hole and make it functional again. “This gesture is most often performed endonasal under general anesthesia,” says Professor Papon. And, of course, when the presence of a polyp or foreign body is found, surgery is scheduled.
What if it came from the teeth?
The roots of the upper molars are located nearby, or even in contact with, the wall of the maxillary sinuses. This explains why an infection of one of these teeth or their supporting tissue (periodontitis) can spread to the sinus cavity. In this context, the pain is unilateral, under the eye, and radiates to the jaw. More or less strong, it is not associated with the classic symptoms of the common cold and the tooth concerned does not always hurt. Is this your case? A dental check-up is then recommended urgently!
Be careful if you fly
The sinuses involved in the regulation of pressure in the inner ear, will poorly fulfill this role if they are congested. Medical advice is therefore necessary before flying during acute sinusitis.
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