Bacteria are the most common direct cause of acute sinusitis. (Other organisms might be the infecting cause in less common cases.) The ability of bacteria or other organisms to infect the sinuses, however, must first be set up by conditions that create a favorable environment in the sinus cavities. Sinusitis is most often an acute condition, which is self-limiting and treatable. In some cases, however, the inflammation in the sinuses is lasting, or is chronic to begin with. The causes for such chronic sinusitis cases are sometimes unclear.
Upper Respiratory Infections
The typical process leading to acute sinusitis starts with a cold virus. Over 85% of people with colds have inflamed sinuses. These inflammations are typically brief and mild, however, and very few people with colds develop true sinusitis. Instead, colds and flu set the stage by causing inflammation and congestion in the nasal passages (called rhinitis), leading to obstruction in the sinuses. This creates a hospitable environment for bacterial growth, which is the direct cause of sinus infection. In fact, rhinitis is the precursor to sinusitis in so many cases that doctors now refer to most cases of sinusitis as rhinosinusitis.
Rhinosinusitis tends to involve the following sinuses:
- The maxillary sinuses (behind the cheekbones) are the most common sites.
- The ethmoid sinuses (between the eyes) are the second most common sites affected by colds.
- The frontal (behind the forehead) and sphenoid (behind the eyes) sinuses are involved in about a third of cold-related cases.
Conditions That Cause Chronic or Recurrent Sinusitis
Chronic or recurrent acute sinusitis typically results from one of the following conditions:
- Untreated acute sinusitis that results in damage to the mucous membranes
- Chronic medical disorders that weaken the immune system or produce inflammation in the airways or persistent thickened stagnant mucus (such as diabetes, AIDS, other disorders of the immune system, hypothyroidism, cystic fibrosis, Kartagener's syndrome, and Wegener's granulomatosis)
- Structural abnormalities
- Allergic reaction to fungi
Chronic or recurrent acute sinusitis can be a lifelong condition.
Inflammatory Response, Allergies, and Asthma
The absence of bacterial organisms as factor in many cases suggests that some instances of chronic sinusitis may be due to a continuing inflammatory condition. Many of the immune factors observed in people with chronic sinusitis resemble those that appear in allergic rhinitis, suggesting that sinusitis in some individuals is due to an allergic response.
Review Date: 05/10/2010
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.