Sinusitis

Your sinuses are hollow air spaces within the bones surrounding the nose. They produce mucus, which drains into the nose. If your nose is swollen, this can block the sinuses and cause pain.

THERE ARE SEVERAL TYPES OF SINUSITIS, INCLUDING

• Acute, which lasts up to 4 weeks
• Subacute, which lasts 4 to 12 weeks
• Chronic, which lasts more than 12 weeks and can continue for months or even years
• Recurrent, with several attacks within a year

Acute sinusitis often starts as a cold, which then turns into a bacterial infection. Allergies, nasal problems, and certain diseases can also cause acute and chronic sinusitis.

Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip.

Your health care professional diagnoses sinusitis based on your symptoms and an examination of your nose and face. You may also need imaging tests. Treatments include antibiotics, decongestants, and pain relievers. Using heat pads on the inflamed area, saline nasal sprays, and vaporizers can also help.

Prevention

There is little information about the prevention of acute or chronic sinusitis, but the following measures may help:

• Avoid exposure to irritants such as cigarette and cigar smoke or strong chemicals.
• To avoid infections, wash hands frequently during common cold season and try to avoid touching your face.
• If you have allergies, avoid exposure to allergy-inducing substances, or consider asking your healthcare provider for an allergy evaluation or a referral to an allergy specialist.

Risk Factors

THE FOLLOWING MAY INCREASE THE RISK THAT AN ADULT OR CHILD WILL DEVELOP SINUSITIS:

• Allergic rhinitis or hay fever
• Cystic fibrosis
• Going to day care
• Diseases that prevent the cilia from working properly
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Smoking
• Weakened immune system from HIV or chemotherapy

Causes

The sinuses are air-filled spaces in the skull. They are located behind the forehead, nasal bones, cheeks, and eyes. Healthy sinuses contain no bacteria or other germs. Most of the time, mucus is able to drain out and air is able to flow through the sinuses.

When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.

SINUSITIS CAN OCCUR FROM ONE OF THESE CONDITIONS:

• Small hairs (cilia) in the sinuses fail to properly to move mucus out. This may be due to some medical conditions.
• Colds and allergies may cause too much mucus to be made or block the opening of the sinuses.
• A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

THERE ARE TWO TYPES OF SINUSITIS:

• Acute sinusitis is when symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses.
• Chronic sinusitis is when swelling and inflammation of the sinuses are present for longer than 3 months. It may be caused by bacteria or a fungus.

Symptoms

Most people with sinusitis have facial pain or tenderness in several places, and their symptoms usually do not clearly indicate which sinuses are inflamed. The pain of a sinus attack arises because trapped air and mucus put pressure on the membranes of the sinuses and the bony wall behind them. Also, when a swollen membrane at the opening of a paranasal sinus prevents air from entering into the sinuses, it can create a vacuum that causes pain.

People with sinusitis have thick nasal secretions that can be white, yellowish, greenish, or blood-tinged. Sometimes these secretions drain in the back of the throat and are difficult to clear. This is referred to as “post-nasal drainage.” Chronic post-nasal discharge may indicate sinusitis, even in people who do not have facial pain.

However, facial pain without either nasal or post-nasal drainage is rarely caused by inflammation of the sinuses. People who experience pain but no nasal discharge often are diagnosed with a pain disorder—such as migraine, cluster headaches, or tension-type headaches—rather than sinusitis.

LESS COMMON SYMPTOMS OF ACUTE OR CHRONIC SINUSITIS INCLUDE

• Tiredness
• Decreased sense of smell
• Cough that may be worse at night
• Sore throat
• Bad breath
• Fever

On very rare occasions, acute sinusitis can result in brain infection and other serious complications.

Diagnosis

Often, healthcare providers can diagnose acute sinusitis by reviewing a person’s symptoms and examining the nose and face. Doctors may perform a procedure called rhinoscopy, in which they use a thin, flexible tube-like instrument to examine the inside of the nose.

If symptoms do not clearly indicate sinusitis or if they persist for a long time and do not get better with treatment, the doctor may order a computerized tomography (CT) scan—a form of X-ray that shows some soft-tissue and other structures that cannot be seen in conventional X-rays—to confirm the diagnosis of sinusitis and to evaluate how severe it is.

Laboratory tests that a healthcare professional may use to check for possible causes of chronic rhinosinusitis include

• Allergy tests
• Blood tests to rule out conditions that are associated with sinusitis, such as an immune deficiency disorder
• A sweat test or a blood test to rule out cystic fibrosis
• Tests on the material inside the sinuses to detect a bacterial or fungal infection
• An aspirin challenge to test for aspirin-exacerbated respiratory disease. In an aspirin challenge, a person takes small but gradually increasing doses of aspirin under the careful supervision of a healthcare professional.

Treatment

SELF CARE

Try the following steps to reduce congestion in your sinuses:

• Apply a warm, moist washcloth to your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Inhale steam 2 – 4 times per day (for example, while sitting in the bathroom with the shower running).
• Spray with nasal saline several times per day.
• Use a humidifier.
• Use a Neti pot to flush the sinuses.

Be careful with use of over-the-counter spray nasal decongestants. They may help at first, but using them for more than 3 – 5 days can make nasal stuffiness worse.

To help ease sinus pain or pressure:

• Avoid flying when you are congested.
• Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.

MEDICINE AND OTHER TREATMENTS

Most of the time, antibiotics are not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time it takes for the infection to go away. Antibiotics may be prescribed sooner for:

• Children with nasal discharge, possibly with a cough, that is not getting better after 2 – 3 weeks
• Fever higher than 102.2° Fahrenheit (39° Celsius)
• Headache or pain in the face
• Severe swelling around the eyes

Acute sinusitis should be treated for 10 – 14 days. Chronic sinusitis should be treated for 3 – 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

At some point, your doctor will consider:

• Other prescription medicines
• More testing
• Referral to an ear, nose, and throat (ENT) or allergy specialist

Other treatments for sinusitis include:

• Allergy shots (immunotherapy) to help prevent the disease from returning
• Avoiding allergy triggers
• Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be needed.

You may consider this procedure if:

• Your symptoms do not go away after 3 months of treatment.
• You have more than two or three episodes of acute sinusitis each year.

Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

Recovery

Most sinus infections can be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.