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Sinusitis

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(Sinus Infection; Acute Sinusitis; Chronic Sinusitis)

Definition

Sinusitis is inflammation of the sinus cavities. It is usually associated with infection. The sinus cavities are air-filled spaces in the skull.
Acute sinusitis lasts for less than three weeks. Chronic sinusitis is diagnosed when symptoms last for at least three months. You may have recurrent sinusitis if you have repeated bouts of acute sinusitis.
Sinus Infection
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Causes

Infectious sinusitis is caused by bacterial or fungal infection of the sinus cavities. The most common organisms to cause acute sinusitis include:
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis

Risk Factors

These factors increase your chance of developing sinusitis. Tell your doctor if you have any of these risk factors:

Symptoms

Symptoms of sinusitis may include:
  • Nasal congestion not responding well to either decongestants or antihistamines
  • Runny nose or postnasal drip
  • Thick, yellow, or green mucus
  • Cough, often worse at night
  • Ear pain, pressure, or fullness
  • Headache
  • Fever
  • Dental pain
  • Facial pain or pressure that increases when you bend over or press on the area
  • Facial congestion or fullness
  • Bad breath
  • Fatigue

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Sinusitis is diagnosed based on its symptoms and tenderness of the sinuses when pressed.
Tests may include:
  • Holding a flashlight up to the sinuses to see if they are illuminated
  • CT scan of the sinuses—a type of x-ray that uses a computer to make pictures of structures inside the head
  • Removing sinus fluid through a needle for testing (rare)
  • Endoscopic examination of the sinuses—threading a tiny, lighted tube into the nasal cavities to view the sinus opening
You have acute sinusitis when the following occurs:
  • History of 10 or more days of colored mucus
  • Tenderness over the sinuses
  • Visible mucus in the nose

Treatment

Home Care

  • Moisturizing—Drinking lots of fluids may keep your nasal secretions thin. This will avoid plugging up your nasal passages and sinuses. Salt water nose sprays or irrigation may also loosen nasal secretions.
  • Using steam treatments—Keep a humidifier running in your bedroom. Fill a bowl with steaming water every couple of hours. Make a steam tent with a towel over your head. This will let you breathe in the steam.

Medications

  • Decongestants—Use either decongestant pills or nasal sprays to shrink nasal passages. Do not use nasal sprays for longer than 3-4 days in a row.
  • Intranasal corticosteroids—These are inhaled directly into your nose through a nasal spray. Corticosteroids may help relieve congestion by decreasing swelling in the lining of the nose.
  • Antihistamines—Allergy medicines called antihistamines may help sinusitis symptoms if they are caused by allergies. However, they may also dry out the nose.
  • Guaifenesin—This medicine can help you cough up secretions.
  • Antibiotics—Your doctor may decide to give you antibiotics if the infection seems to be caused by bacteria. Although, studies have shown that antibiotics are not effective in treating acute sinusitis.
  • Over-the-counter medicine—You can use acetaminophen, ibuprofen, or aspirin to treat sinus pain.
    • Note: Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome. Ask your doctor which other medicines are safe for your child.

Surgery

Surgery is a last resort for people with very troublesome, serious chronic sinusitis. It includes:
  • Repair of a deviated septum
  • Removal of nasal polyps
  • Functional endoscopic sinus surgery—a lighted scope is used to enlarge the sinuses to improve drainage
  • Balloon sinuplasty—a tube with a balloon attached is inserted into the sinuses (the balloon is inflated to open the sinus passages)
If you are diagnosed with sinusitis, follow your doctor's instructions .

Prevention

If you have a tendency to get sinusitis following a cold or allergy attack, try these preventive measures:
  • Have allergy testing to find out what things you are allergic to and to learn how to treat your allergies.
  • Avoid substances you know you are allergic to.
  • If you have allergies, consider using cortisone nasal spray or antihistamines to decrease inflammation.
  • If you get a cold, drink lots of fluids and use a decongestant (either pills or nasal spray).
  • Blow your nose gently, while pressing one nostril closed.
  • Try not to fly in an airplane when you are congested. If you must fly, use a nasal spray decongestant to decrease inflammation prior to takeoff and landing.
  • Use a humidifier when you have a cold, allergic symptoms, or sinusitis.
  • Use High-Efficiency Particulate Air (HEPA) filters for your furnace and vacuum cleaner to remove allergens from the air.
  • Avoid cigarette smoke.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org

National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov

CANADIAN RESOURCES

Allergy Asthma Information Association http://aaia.ca

Calgary Allergy Network http://www.calgaryallergy.ca

References

Fact sheet: allergic rhinitis, sinusitis, and rhinosinusitis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/rhinitis.cfm. Accessed June 22, 2008.

Mandell GL, Douglas RG, et al. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone, Inc; 2000.

Medical Center of McKinney. So long, sinusitis. Medical Center of McKinney website. Available at: http://medicalcenterofmckinney.com/CustomPage.asp?guidCustomContentID={0D77FEAB-2FF8-41F8-9C33-3FF80A863515}. Published May 26, 2010. Accessed June 10, 2010.

Medications for sinusitis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. Updated September 2009. Accessed December 11, 2009.

Okuyemi KS, Tsue TT. Radiologic imaging in the management of sinusitis. Am Fam Physician. 2002;66:1882-1886.

Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Scheid DC, Hamm RM. Acute bacterial rhinosinusitis in adults. Am Fam Physician. 2004;70:1685-1692:1697-1704.

Sinus infection (sinusitis). National Institute of Allergy and Infectious Disease, National Institutes of Health (NIH) website. Available at: http://www.niaid.nih.gov/topics/sinusitis/Pages/index.aspx. Accessed June 22, 2008.

Sinusitis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Accessed November 10, 2007.

Stewart AE, Vaughan WC. Balloon sinuplasty versus surgical management of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2010;10(3):181-187.

1/10/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA. 2007;298:2487-2496.

12/11/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2009;(4):CD005149.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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