La sinusite est une affection fréquente, notamment chez les enfants.
Découvrez ses symptômes, ses causes et ses complications possibles pour en savoir plus sur cette maladie.
La sinusite, qu’est-ce que c’est ?
La sinusite est une inflammation des muqueuses qui recouvrent l’intérieur des sinus. Les sinus sont des cavités osseuses (réparties en 4 paires) situées dans les os du visage. Chaque sinus communique avec les fosses nasales grâce à de petites ouvertures, par lesquelles s’écoule normalement le mucus produit dans les sinus.
L’inflammation de la muqueuse des sinus, aussi appelée rhinosinusite, est habituellement causée par une infection virale ou bactérienne. Lorsqu’un virus ou une bactérie se propage dans les sinus, la muqueuse s’irrite et enfle, ce qui risque d’obstruer les sinus. Le mucus n’est alors plus drainé normalement vers le nez et, dans ce milieu fermé, les microbes se multiplient librement.
La douleur et la sensation de pression au visage, bien connues des gens atteints de sinusite, proviennent de l’accumulation de mucus à l’intérieur du ou des sinus. Les maux de tête liés à la sinusite sont très fréquents, tout comme une sensation de congestion nasale (= nez bouché).
Consulter en détails les symptômes de la sinusite
La sinusite est une affection fréquente, mais dont la prévalence est difficile à estimer. Selon certaines études, elle toucherait de 10 % à 15 % de la population27, adultes comme enfants.
Note : chaque sinus porte un nom différent en fonction de sa position. Ainsi, selon le sinus infecté, on parlera de sinusite frontale, de sinusite maxillaire, de sphénoïdale gauche ou droit (selon si un seul côté est touché), d’ethmoïdal.
Comment reconnaître une sinusite ?
La sinusite aiguë : à quoi est-elle due ?
Elle ne dure pas plus de 4 semaines et ne réapparaît pas plus de 3 fois par an. Dans la plupart des cas, elle suit une infection virale des voies respiratoires supérieures, le plus souvent un rhume. On estime de 0,5 % à 2 % des personnes enrhumées contractent une sinusite.
Autres causes ou facteurs possibles :
_une infection bactérienne ou fongique (par des champignons) ;
des allergies ;
_un abcès dentaire qui se propage aux sinus ;
_la pollution atmosphérique ;
_des polypes nasaux (excroissances bénines faisant suite à une inflammation) ;
une déviation de la paroi nasale.
La sinusite chronique
La sinusite devient chronique lorsqu’elle persiste au-delà de 12 semaines (on parle de sinusite subaiguë entre 4 et 12 semaines). Si la sinusite aiguë ne répond pas aux traitements habituels ou si elle n’est pas soignée, elle risque d’évoluer vers une sinusite chronique. En général, la chronicité s’installe après plusieurs poussées de sinusite aiguë (sinusites récurrentes), mais il arrive parfois qu’une sinusite aiguë évolue tout de suite vers la chronicité.
Le plus souvent, la sinusite chronique est due à des allergies. Il peut s’agir d’allergies aux animaux familiers, aux acariens, au pollen, aux champignons ou à d’autres substances qui provoquent une inflammation des parois du nez et des sinus (voir la fiche Rhinite allergique). Ainsi, de 50 % à 80 % des personnes atteintes de sinusite chronique sont allergiques ou ont une rhinite allergique28.
D’autres facteurs peuvent être en cause :
_le tabagisme actif ou passif ;
_un système immunitaire faible ;
_la fibrose kystique ;
une anomalie anatomique : une forme anormale des petits canaux permettant aux sinus de communiquer avec les fosses nasales ou une déviation de la cloison nasale ;
_des polypes nasaux ;
_la natation (irritation due au chlore) ;
_l’usage de cocaïne par voie nasale ;
_un traumatisme facial provoquant l’obstruction d’un ou de plusieurs sinus ;
_l’exposition à des produits chimiques irritants (comme le formaldéhyde) ;
_le reflux gastro-oesophagien non traité (surtout chez les enfants).
Voir également comment soigner une sinusite.
Quelles sont les complications possibles après une sinusite ?
Dans de très rares cas, l’infection des sinus peut se propager vers les yeux ou le cerveau, ce qui peut notamment causer les problèmes suivants :
_une méningite ;
_un abcès au cerveau ;
_une thrombophlébite des veines des yeux ;
_une ostéomyélite des os frontaux (surtout chez les enfants).
En outre, les sinusites non traitées ou chroniques risquent d’aggraver les troubles respiratoires chez les personnes souffrant d’asthme, en particulier chez les enfants.
Qui est susceptible d’attraper une sinusite ?
Les enfants.
Les enfants contractent en moyenne de 6 à 8 rhumes par an, dont 0,5 % à 5 % évoluent vers une sinusite (qui touche principalement les sinus ethmoïdaux, car les autres sinus se forment plus tard dans l’enfance) ;
_les personnes qui ont déjà eu une sinusite sont plus à risque d’en avoir d’autres ;
_les personnes qui souffrent d’allergies respiratoires (rhume des foins) ;
_les personnes asthmatiques ;
_les personnes qui ont une anomalie congénitale qui cause l’obstruction du nez ou des sinus ;
_les personnes qui ont des polypes nasaux ou des abcès dentaires ;
_les personnes dont le système immunitaire est affaibli en raison d’une autre maladie ;
_les personnes atteintes de fibrose kystique.
Facteurs de risque d’une sinusite
Contracter une infection des voies respiratoires supérieures (principal facteur) ;
vivre dans un milieu où l’air est humide ou pollué ;
fumer la cigarette ou être exposé à la fumée ou à d’autres polluants chimiques.
Comment prévenir la sinusite ?
La sinusite, qui dure généralement plus longtemps qu’un rhume, peut être très douloureuse et entraîner des complications graves. Les personnes qui se savent à risque (dont celles qui ont déjà eu une sinusite) peuvent réduire leur risque de récidive. Les mesures préventives aident à prévenir l’évolution vers une sinusite chronique.
Mesures pour prévenir les sinusites
Certaines mesures permettent de réduire le risque de contracter la maladie une première fois, ou de nouveau, ou encore d’avoir une sinusite chronique. Pour l’essentiel, il s’agit de :
prévenir le rhume par les moyens habituels : bien se laver les mains, éviter les contacts étroits avec les personnes enrhumées. Voir la fiche Rhume ;
prévenir les allergies en s’exposant le moins possible aux allergènes (animaux familiers, pollen, acariens, etc.) et aux polluants qui nous affectent habituellement ;
avoir un mode de vie équilibré en ce qui a trait au stress, à l’activité physique, à l’alimentation, etc. Voir la fiche Renforcer son système immunitaire ;
éviter de fumer ou de s’exposer à la fumée de tabac, qui irrite les sinus ;
éviter d’utiliser des décongestionnants sous forme de vaporisateurs nasaux (Dristan®, Otrivin®) durant plus de 3 jours, car ils peuvent entraîner une accoutumance et une congestion nasale de « rebond » (qui réapparaît au moment de l’arrêt).
De plus, chez certaines personnes, ils irritent la muqueuse fragile du nez. Les décongestionnants pris par voie orale occasionnent moins de problèmes à la muqueuse nasale, mais peuvent avoir des effets secondaires gênants (aggravation de l’hypertension artérielle, par exemple). De plus, leur efficacité est contestée.
Mesures pour éviter que la sinusite ne s’aggrave
Tout d’abord, il est conseillé de consulter un médecin pour recevoir un diagnostic précis et prendre les mesures nécessaires pour traiter la sinusite permet généralement de prévenir les complications (méningite, ostéomyélite, etc.).
Surveiller les signes suivants, qui indiquent une complication :
_une vision anormale (parfois, une vision double) ;
_une enflure autour des yeux ;
_un changement dans l’état de conscience.
Ne pas insister auprès de son médecin pour recevoir des antibiotiques si ce n’est pas nécessaire. La plupart des sinusites sont d’origine virale ou allergique et ne peuvent donc pas être traitées par antibiotiques (qui ne combattent que les bactéries).
L’opinion de notre médecin sur la sinusite
Dans le cadre de sa démarche de qualité, Passeportsanté vous propose de découvrir l’opinion d’un professionnel de la santé. Le Dr Dominic Larose, urgentologue, vous donne son avis sur la sinusite :
» Malheureusement, j’ai trop souvent vu des patients attendre des heures pour voir un médecin, en espérant qu’il guérisse leur sinusite qui dure depuis 3 ou 4 jours. Ils sont souvent déçus de ne pas recevoir d’autre recommandation que de continuer à utiliser des irrigations salines.
Je réserve les prescriptions d’antibiotiques, qui sont de toute façon d’utilité douteuse, aux patients qui ont des symptômes depuis plus de 7 jours ou qui ont des symptômes vraiment graves.
Je vous en prie : n’insistez pas pour recevoir des antibiotiques qui ne vous aideront pas et qui pourraient vous rendre au contraire plus malades ! «
passeportsante
20 commentaires
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