Each of us has four paired cavities (spaces) in our head that are connected to the nose by narrow channels. These cavities, known as sinuses, produce a thin mucus that drains out of the channels of the nose.
Normally, sinuses are filled with air. But when sinuses become blocked and filled with fluid, bacteria can grow and cause an infection (bacterial sinusitis).
Conditions that cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose due to allergies), nasal polyps (small growths in the lining of the nose), or deviated septum (a shift in the nasal cavity). Allergies such as hay fever can also cause swelling and poor drainage of the sinuses.
If you have symptoms that involve the sinuses, it may be difficult to tell if you have sinusitis, a cold, or a nasal allergy. This article will describe the symptoms, diagnosis, and treatment of sinusitis, and how to distinguish sinusitis from a cold or nasal allergy.
What is sinusitis?
Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. There are two types of sinusitis:
- Acute sinusitis: a sudden onset of cold symptoms such as runny nose, stuffy nose, and facial pain that does not go away after 7 to 10 days. It responds well to antibiotics and decongestants.
- Chronic sinusitis: characterized by nasal congestion, drainage, facial pain/pressure, and decreased sense of smell for at least 12 weeks.
Who gets sinusitis?
About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis:
- Nasal mucus membrane swelling, as from a common cold
- Blockage of drainage ducts
- Structure differences that narrow the drainage ducts
- Conditions that result in an increased risk of infection
In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, and smoke in the environment.
In adults, the contributing factors are most frequently infections, allergies, and smoking.
What are the signs and symptoms of acute sinusitis?
The primary symptoms of acute sinusitis include:
- Facial pain/pressure
- Nasal stuffiness
- Nasal discharge
- Loss of smell
Additional symptoms may include:
- Bad breath
- Dental pain
What are the signs and symptoms of chronic sinusitis?
People with chronic sinusitis may have the following symptoms for 12 weeks or more:
- Facial congestion/fullness
- A nasal obstruction/blockage
- Nasal discharge/discolored postnasal drainage
- Decreased sense of smell
Additional symptoms may include:
- Dental pain
- Thick nasal discharge
How is sinusitis diagnosed?
To diagnose sinusitis, your doctor will discuss your symptoms and examine your nose for swelling and drainage and face for swelling over the cheekbone area. Your personal history is most important in diagnosing sinusitis.
Facial swelling is generally more prominent in the morning. As you remain upright, the symptoms gradually improve. During the exam, the doctor may feel and press your sinuses to check for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.
Other diagnostic tests may include nasal endoscopy (see below), sinus X-rays, allergy testing, or CT scan of the sinuses.
What is nasal endoscopy?
An endoscope is a special tube-like instrument equipped with tiny lights and cameras. It is used to examine the interior of the nose and sinus drainage areas.
A nasal endoscopy allows your doctor to view the accessible areas of the sinus drainage pathways. First your nasal cavity is numbed using a local anesthetic. A rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity.
The procedure is used to observe signs of obstruction as well as to detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the doctor also looks for pus, polyp formation, and any structural abnormalities that would cause you to suffer from recurrent sinusitis.
How is sinusitis treated?
Acute sinusitis. If you have a simple sinusitis infection, your health care provider may recommend treatment with decongestants like Sudafed and steam inhalations alone, as most sinusitis is viral. Antibiotics are generally needed if symptoms do not improve in 7 to 10 days and if they seem to be getting worse.
If antibiotics are administered, they are given for 10 to 14 days. With treatment, the symptoms usually disappear and antibiotics are no longer required. Oral and topical decongestants may be prescribed to alleviate the symptoms. Use of prescription intranasal steroid sprays might be effective in controlling symptoms. However, non-prescription drops or sprays should not be used beyond their recommended period--usually four to five days--or they may actually increase congestion.
Chronic sinusitis. Warm moist air may alleviate sinus congestion. Using a vaporizer or inhaling steam from a pan of boiling water (removed from heat) may also help. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use. Nonprescription drops or sprays might be effective in controlling symptoms; however, they should not be used beyond their recommended period of time. Nasal steroid sprays that shrink swollen membranes of the nose are beneficial. Antibiotics may also be prescribed.
Avoidance of triggers is important. Allergies should be controlled and irritants, such as smoke, should be avoided.
Other treatment options
To reduce congestion, your doctor may prescribe nasal sprays (some may contain steroids), nose drops, or oral decongestant medicine. If you suffer from severe chronic sinusitis, oral steroids might be prescribed to reduce inflammation (usually only when other medications have not worked). Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for treatment of any fungal infection, although these infections are rare.
Will I need to make lifestyle changes?
Smoking is never recommended, but if you do smoke, strongly consider a smoking cessation program, as this may be the main reason you have sinus infections. No special diet is required, but drinking extra fluids helps to thin secretions.
If you have indoor allergies, avoidance of triggers such as animal dander and dust mites will be recommended in addition to medications.
Is sinus surgery necessary?
Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus by millions of cilia (a hair-like extension of a cell). Irritation and swelling from an allergy or infection can narrow the opening of the sinus and block mucus movement. If antibiotics and other medicines are not effective in opening the sinus, surgery may be necessary. Also, if there is a structural abnormality of the sinus such as nasal polyps, which obstruct sinus drainage, surgery may be needed.
Surgery is performed under local or general anesthesia using an endoscope. Most people can return to normal activities within five to seven days following surgery; full recovery usually takes about four to six weeks.
A procedure called a somnoturboplasty may also be performed to permanently shrink the swollen membranes of the nose. This is done in the office and takes a few minutes. The anesthetic used is similar to that used in routine dental procedures.
What is new in the surgical treatment of sinusitis?
An integrated computer and computed tomography (CT) scan system allows the surgeon to observe three views of the sinuses on a monitor. The views correlate and change with the position of a small probe moved within the nasal cavity or sinuses. This gives the surgeon constant feedback on the anatomy in and around the sinuses and the location of disease within the sinuses.
What happens if sinusitis is not treated?
Delaying treatment for sinusitis will result in suffering from unnecessary pain and discomfort. It may also worsen existing health problems such as asthma. In rare circumstances, untreated sinusitis can lead to meningitis or brain abscess, and infection of the bone.
What are the symptoms of the common cold?
An upper respiratory infection, also known as the common cold, is usually caused by a virus that infects the nose and throat. A cold may cause swelling in the sinuses, preventing the outflow of mucus.
Cold symptoms include nasal congestion, runny nose, post-nasal drip (drop-by-drop release of nasal fluid into the back of the throat), headache, achiness, and fatigue. Cough and fever may also accompany these symptoms.
Cold symptoms usually build, peak, and slowly disappear. No treatment is necessary for a cold, but some medications can ease symptoms. For example, decongestants may decrease drainage and open the nasal passages. Analgesics may help with fever and headache. Cough medication may help, as well. Colds will typically last from a few days to about a week.
What are the symptoms of nasal allergy?
The following symptoms may occur when a person is suffering from a nasal allergy:
- Itchy nose
- Clear, watery nasal discharge
- Nasal obstruction
- Feeling fatigued
How is nasal allergy treated?
Usually medications are prescribed to alleviate symptoms. These may include antihistamines, with or without decongestants. Decongestant or steroid nasal sprays may also be prescribed. Other nasal sprays, which deliver antihistamines or cromolyn sodium, are sometimes helpful. If allergy symptoms are chronic, allergy testing and allergy shots (immunotherapy) may be beneficial.
How can I know if I have a sinus infection or nasal allergy?
Although the symptoms of sinusitis and nasal allergy may occur with a common cold, in general, cold-related symptoms subside within one week.
The point at which a normal cold ends and a sinus condition begins is not always easy to know. If you are fighting off a cold and develop symptoms of a sinus infection or nasal allergy, see your health care provider. You will be asked to describe your symptoms and medical history. You may also need to get X-rays or other tests.
How do I know if my sinus condition requires the care of an ear, nose, and throat specialist?
Most routine sinus conditions are easily cared for by primary care physicians. If, however, you are bothered by persistent abnormal symptoms, recurring infections, or have abnormal X-ray findings or complications, a referral to a specialist is appropriate.
Radojicic, C, Sinusitis: Allergies, antibiotics, aspirin, asthma. Cleveland Clinic Journal of Medicine 2006; 73(7): 671-678
National Institute of Allergy and Infectious Diseases. Health & Research A-Z: Sinusitis www.niaid.nih.gov Accessed 4/13/2011
American Academy of Allergy, Asthma, and Immunology. Patients & Consumers: Tips to Remember: Sinusitis. www.aaaai.org Accessed 4/13/2011
American College of Allergy, Asthma & Immunology. Patients & Public: Allergies: Types of Allergies: Sinusitis. www.acaai.org Accessed 4/13/2011
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/12/2011...#11668