• Sinusitis

    (Sinus Infection; Acute Sinusitis; Chronic Sinusitis; Rhinosinusitis)

    Definition

    Sinusitis is inflammation of the sinus cavities. The sinus cavities are air-filled spaces in the skull. It is usually associated with infection.
    Sinusitis is called acute if it lasts for less than 4 weeks, subacute if it lasts 4-12 weeks, and chronic if symptoms last for more than 3 months. You may have recurrent sinusitis if you have repeated bouts of acute sinusitis.
    Sinus Infection
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Infectious sinusitis is caused by a viral, bacterial, or (rarely) fungal infection of fluid in the sinus cavities. Infections are usually associated with acute sinusitis more than chronic.

    Risk Factors

    Factors that may increase your chance of sinusitis include:
    • Recent viral infection
    • Smoking or exposure to second-hand smoke
    • Other sources of indoor or outdoor air pollution
    • Allergies or asthma
    • Abnormalities of the facial bones, sinuses, or nasal passages, such as: Certain chronic illnesses, including:
    • HIV infection and other disorders of the immune system
    • Diabetes
    • Head injury or a medical condition requiring a tube to be inserted into the nose
    • Cocaine and other drugs inhaled through the nose

    Symptoms

    Sinusitis may cause:
    • Facial congestion or fullness
    • Facial pain or pressure that increases when you bend over or press on the area
    • Headache
    • Cough, which is often worse at night
    • Nasal congestion not responding well to either decongestants or antihistamines
    • Runny nose or postnasal drip
    • Thick, yellow, or green mucus
    • Bad breath
    • Ear pain, pressure, or fullness
    • Fever
    • Fatigue
    • Dental pain
    • Initial improvement with sudden worsening of symptoms over the course of a few weeks

    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 light up
    • CT scan or x-ray of the sinuses to look for fluid in the sinus
    • Endoscopic examination of the sinuses—threading a tiny, lighted tube into the nasal cavities to view the sinus opening
    • Removing sinus fluid through a needle for testing (rare)
    You have may acute sinusitis when the following occurs:
    • History of 10 or more days of colored mucous, or visibly infected mucus
    • Tenderness over the sinuses
    • Fever
    • Difficulty smelling

    Treatment

    Most sinus infections are caused by a virus and will pass on their own in 7-10 days. Home care and medications can help manage symptoms.
    Infections that last longer or keep coming back may need more care.

    Home Care

    Secretions can build up in the nasal and sinus passages. This can add to pressure and pain. Secretions can be loosened with:
    • Drinking throughout the day
    • Nasal and sinus washes
    • Steam treatments—may include humidifier running in your bedroom or inhaling steam from bowl of hot water

    Medications

    Medication may help manage symptoms until the sinusitis passes. Options may inlcude:
      Over-the-counter pain relievers.
      • Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
    • Antihistamines—to manage related allergies
    • Intranasal corticosteroids—may decreasing swelling in the lining of the nose in people with allergies
    • Decongestants—to shrink nasal passages. Do not use nasal sprays for longer than 3-4 days in a row.
    Antibiotics are only effective for specific sinus infections. If a sinus infection lasts longer than expected or keeps coming back the doctor may suspect a bacterial infection and recommend antibiotics.

    Surgery

    Surgery may be recommended if above treatments have not provided relief for very troublesome, serious chronic sinusitis. Options may include one or more of the following:
    • Repair of a deviated septum
    • Removal of nasal polyps
    • Functional endoscopic sinus surgery—enlarge the sinuses to improve drainage
    • Balloon sinuplasty—to open the sinus passages

    Prevention

    To help reduce your chance of sinusitis:
      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
      • Stick with your allergy treatment plan
    • If you get a cold, drink lots of fluids and use a decongestant.
    • Use sinus washes as directed.
    • Blow your nose gently, while pressing one nostril closed.
    • If you must travel by air, 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 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 https://www.niaid.nih.gov

    CANADIAN RESOURCES

    Allergy Asthma Information Association http://aaia.ca

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

    References

    Acute sinusitis in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T902952/Acute-sinusitis-in-adults. Updated September 12, 2016. Accessed September 26, 2017.

    Acute sinusitis in children. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T902949/Acute-rhinosinusitis-in-children. Updated September 7, 2017. Accessed September 26, 2017.

    Allergic rhinitis, sinusitis, and rhinosinusitis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/allergic-rhinitis-sinusitis-and-rhinosinusitis. Accessed September 29, 2014.

    Aring AM, Chan MM. Acute rhinosinusitis in adults. Am Fam Physician. 2011;83(9):1057-1063.

    Chronic rhinosinusitis. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T115673/Chronic-rhinosinusitis. Updated August 7, 2017. Accessed September 26, 2017.

    Okuyemi KS, Tsue TT. Radiologic imaging in the management of sinusitis. Am Fam Physician. 2002;66(10):1882-1886.

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

    12/11/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T902952/Acute-sinusitis-in-adults: Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2009;(4):CD005149.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
    • Review Date: 09/2017
    • Update Date: 09/26/2017
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