What Is Sinusitis?
Sinusitis is an inflammation, usually due to infection, of one or more of the four sets of sinus cavities within each side of the facial skeleton. When irritated, the mucous membrane lining the sinus may swell and block the small drainage channels that permit mucus to flow into the nose. The buildup in pressure often results in headache, nasal congestion, drainage and facial pain. Acute sinusitis is a common disorder that often follows a cold or flu; chronic sinusitis refers to persistent or recurrent episodes that are generally milder than acute cases. Sinusitis often subsides on its own and responds well to home treatment. Rarely, infection may spread to the eyes or brain, possibly leading to vision loss, meningitis, or brain abscess.
Who Gets Sinusitis?
Approximately 15% of people in the United States suffer from sinusitis, and about 30 million seek treatment each year. One-third of people who experience an upper respiratory infection develop acute sinusitis.
- Headache pain and pressure concentrated over one or both eyes (frontal sinusitis).
- Pain in the cheek bones or teeth, usually in the upper jaw (maxillary sinusitis).
- Swelling of upper eyelids (ethmoid sinusitis).
- Tenderness over the affected sinus.
- Pain behind the eyes (sphenoid sinusitis).
- A yellowish green nasal discharge and/or postnasal drip.
- Persistent nasal blockage and forced breathing through the mouth following a cold or flu.
- Fever and chills.
- A viral or bacterial infection that spreads to the sinuses from the nose.
- An upper respiratory infection such as the flu or the common cold are the most frequent causes.
- Acute sinusitis may also occur with allergies and fungal infection that causes inflammation of the mucous membranes.
- Anatomical or congenital irregularities, such as a deviated septum.
- Nasal allergy resulting in swelling and polyps.
- Swimming in contaminated water.
- Infection spread from abscesses in the upper teeth.
- Chronic sinusitis may be caused by irritation from dust, air pollutants, or excessive exposure to tobacco smoke, or result from an untreated acute condition.
What If You Do Nothing?
Without treatment, sinusitis can last for weeks or months, often with pain, congestion, drainage, and fatigue. If bacteria travel from the sinuses to the lungs, bronchitis can result. The ears can also be affected, causing balance problems.
- Patient history of upper respiratory infection and physical examination of symptoms are needed.
- If bacterial infection is suspected, removal of fluid from the maxillary sinus using a needle or endoscope-directed suction may be necessary to determine the type of bacterial infection.
- X-rays or a CT scan (computerized tomography) may be used to locate the infected site(s) and determine the extent of infection. Infected sinuses appear opaque or can have air-fluid levels.
- Steam inhaled from a basin of hot water can thin the mucus and ease symptoms. Inhaling the vapors in a hot shower or bath may have similar effects.
- Avoid bending over with your head down. This movement increases sinus pain.
- For some people vigorous exercise has a powerful decongesting effect—though for others, it can aggravate congestion. Try performing an aerobic exercise, such as jogging or stair climbing, at a light intensity. Stop if you feel the congestion worsen.
- Over-the-counter oral or nasal decongestants may reduce swelling. Nasal decongestants decongestant sprays should not be used for more than three days. People with high blood pressure, heart disease, arrhythmias, or glaucoma should ask their doctor about the safety of using oral decongestants.
- Nonprescription pain relievers, ice packs, or warm compresses may soothe sinus pain. In severe cases codeine narcotic or other prescription pain medication may be prescribed.
- Antihistamines are used to treat allergic sinusitis.
- Steroid nasal sprays may be prescribed to reduce inflammation, though they are more useful over the long term in reducing swelling of nasal membranes, thus prompting normal sinus drainage. Some nasal steroid sprays are now available without a prescription.
- Antibiotics are used for bacterial infections; they may be taken for two to six weeks in difficult cases.
- Endoscopy (use of a lighted instrument) may be used to survey the sinuses and clear blockage.
- Surgery may be occasionally needed to drain sinuses in very rare cases. Early surgical drainage is often recommended for frontal sinusitis.
- Hospitalization and intravenous antibiotics are required for severe bacterial sinusitis.
- If you have allergies, limit exposure to allergens and use antihistamines and/or nasal steroid sprays. Formal allergy testing is sometimes warranted.
- When you have a cold, use a cool-mist humidifier and decongestants to promote drainage.
- Sleeping with your head elevated can also help promote optimal drainage.
- Chronic sinusitis sufferers should drink plenty of liquids, and avoid tobacco smoke and alcohol.
- Minimize your exposure to people with colds or known infections. Wash your hands frequently and avoid sharing towels, napkins, and eating utensils with infected persons.
- Take care when flying. The changing air pressure in a plane can force mucus into the sinuses. Consider using a nasal spray before taking off and shortly before landing to keep your sinuses open.
When To Call Your Doctor
- Call a doctor if symptoms persist longer than two weeks or are accompanied by bloody nasal discharge.
- EMERGENCY See a doctor right away if you develop redness, pain, or bulging of an eye, paralysis of eye movements, or nausea and vomiting in association with other symptoms of sinusitis.
Reviewed by Alan Lipkin, M.D., Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network.