Effective Inhalation Therapy for Managing Acute and Chronic Sinusitis

Even though many experts prefer the term rhinosinusitis, we use the term sinusitis here, as this term is more commonly used. The sinuses are hollow cavities in the skull. They are divided into the frontal, maxillary, ethmoid and sphenoid sinuses. All sinuses are filled with air and are lined with a mucous membrane where a fine film of mucus is constantly formed. Their job is to stop dust, dirt particles or undesirable germs. The sinuses are connected to the nasal cavity by small openings/channels – so called ostia. These passages allow mucus and air to flow between the sinuses and the nasal cavity, helping to keep the sinuses ventilated, clear and healthy.

Sinusitis, also known as a sinus infection, is an inflammation of the mucous membrane of the nose and the paranasal sinuses. The inflammation causes mucus to build up, resulting in the ostia being blocked so there is almost no ventilation.

Common causes include allergies, colds, viral and bacterial infections. Having a cold for example can lead to the mucous membrane producing more mucus and swelling. The built-up mucus can´t get out of the sinus as the ostia are blocked by the swelling.

The mechanism for allergies and viral/bacterial infections is similar: The inflammation results in more mucus being produced and a swelling of the mucous membrane.

Typical symptoms include:

• Pain in the forehead and eyes
• Painful cheek bones and upper jaw
• Nasal congestion
• Headache radiating into the back of the head
• Cough and sore throat
• Lassitude
• General feeling of illness

Pressure over the forehead and cheekbones are typical signs of a sinusitis that get worse when you cough, sneeze and bend down. The symptoms can often be limited to one side of the head. Some patients find their sense of smell being impaired and they complain of mucus flowing from the nose down the back of the throat. The symptoms can also lead to impaired sleep and thus fatigue during the day.

Acute and Chronic Sinusitis – what is the difference?

Acute sinusitis lasts less than 3 months and may come with more severe symptoms, while chronic sinusitis lasts 3 month or longer and may involve less obvious symptoms such as difficulty breathing through the nose and an uncomfortable sense of pressure.

An acute sinusitis can come in two waves:  First, patients get a cold with exhaustion and fever. Then there is a brief period where symptoms improve but afterwards it is entirely possible that they can get worse. Usually, the disease is more or less resolved after two weeks. Within six weeks it has resolved in about 90% of patients. However, up to 10 percent are affected by a chronic form of sinusitis, lasting for 3 months or longer.

If you have a chronic sinusitis, you may experience periods with less energy, a dull sense of pressure around the affected sinuses, recurring headaches or infections, difficulty breathing through your nose and a constant flow of mucus down the back of your throat.

Rare complications

When the sinuses are infected, the connection between the sinuses to the middle ear can sometimes mean that a sinus infection spreads to the ears. This can lead to a middle ear infection, especially in small children.

Consult a GP or an ENT specialist if you suspect sinusitis, especially if symptoms persist or worsen.

Clearing the sinuses – this is what patients are aiming for first and foremost. This is understandable, since unimpaired breathing through the nose is a basic human need. Comprehensive treatment, however, involves many very different therapy options. The most important thing to clarify first is whether it is an acute or a chronic rhinosinusitis. Your doctor will design the treatment plan accordingly.

Over-the-Counter Medications

Over-the-counter painkillers from the pharmacy can help alleviate headaches and facial pain associated with sinusitis. However, they will not help with the underlying problem: the built-up mucus and will only relieve the pain for a short time.

Decongestant nasal sprays

Decongestant nasal drops or sprays can help you breathe through your nose more easily. It is essential to restrict their use to short periods of no more than seven days¹ because otherwise your body can get used to them and once the effect of the product has subsided, the mucous membranes swell up again – usually even worse than before. Those affected then must keep reaching for “the bottle”. This makes the mucous membranes dry out.

Nasal rinse

A nasal rinse with natural saline solutions is an often-used home remedy. Nasal rinses can reduce swelling of the mucous membranes and encourage the discharge of the mucus. Also, pollen and germs are flushed out through the nose.

Nebuliser therapy can ease symptoms and improve quality of life by delivering medications directly to the sinuses. However, the sinuses are not an easy target for nebulisers as the fine mist must get through the ostia and into the sinuses that are hardly ventilated.

The key to this is a pulsating nebuliser device that creates an alternating pressure which can get the fine mist into the sinuses² . The PARI SINUS2 is the only nebuliser device that can do this.  Nasal rinses, nasal sprays and conventional nebuliser devices are mostly reaching the nasal cavity but not the sinuses.