What is sinusitis?
Sinusitis is an infection of the air spaces of the head (sinus cavities). There
are numerous symptoms patients complain of when talking of "sinus" problems, but often these generic
symptoms have nothing to do with sinusitis.
Many patients without real infections within the sinus cavities will have headache, nasal congestion,
post-nasal drainage, cough, decreased sense of smell and increased nasal mucous.
A diagnosis of sinusitis is made based on abnormal X-ray findings.
What is otitis?
Otitis is an infection of the middle ear space. Otitis may be either acute or chronic. In acute
otitis, there is generally pain, fever and hearing loss. In chronic otitis, hearing loss and ear
drainage are more frequent. Chronic otitis may be associated with eardrum perforations or mastoid
disease. The diagnosis is generally made during an office examination.
What causes sinusitis and otitis?
The middle ear and sinus cavity are both air-containing spaces that are connected to the nasal
chamber by a short tube. In the sinus, the tube is called the ostia. In the ear, the tube is called
the Eustachian tube.
When either of these openings is blocked, the air contained within the cavity is
absorbed by the body, resulting in a vacuum. This vacuum pulls fluid from the surrounding tissues
into the cavity. Bacteria can then settle into the fluid and grow, resulting in an active infection.
Once the infection has occurred, symptoms follow and complications may develop. Your physician's
major challenge is concern over the complications of sinusitis and otitis.
Who is predisposed to developing sinusitis and otitis?
People who have a problem that results in the following conditions may predispose themselves to
recurrent sinusitis and/or otitis:
- Nasal mucous membrane swelling
- Blockage of the drainage ducts
- Anatomic abnormalities that narrow the drainage ducts
- Problems that result in an increased susceptibility to infection
In children, common predisposing factors include allergies, exposure to respiratory
infections from other children at day care centers, use of pacifiers (sucking increases saliva
production, which can help bacteria travel to the middle ear), bottle drinking when lying on their
backs (eustachian tubes do not function as well when the baby is lying flat), exposure to second-hand
smoke, and adenoid enlargement.
In adults, the predisposing factors are most frequently environmental. Smoking is also
a major consideration.
What are the symptoms?
In acute, severe sinusitis, there is generally high fever and severe pain. This presentation,
however, is not very common. In the more chronic cases, there are few symptoms that can be counted
upon for a definitive clinical diagnosis of sinusitis.
Health care providers depend, to a significant extent, upon X-ray and CAT scan
findings.
When are sinusitis or otitis suspected?
Sinusitis is suspected in patients who have upper respiratory tract symptoms (similar to those of a
cold or flu) that persist longer than 10 days. Chronic otitis is suspected in patients who experience
hearing loss associated with upper respiratory tract infections or have ear drainage.
In either situation, it is appropriate to seek your doctor's assistance for an
evaluation of your medical history and a physical examination. X-rays, hearing tests and other tests
may be necessary for your doctor to come to a definitive diagnostic conclusion. Evaluations to
determine underlying contributing factors may be necessary as well. In addition, neoplasms (abnormal
new tissue growth) must be ruled out.
What is the treatment?
Generally, otitis and sinusitis can be managed medically. A high fluid intake, active humidification,
oral and nasal decongestants, topical nasal steroids and often antibiotics are frequently
recommended. Use of over-the-counter nasal sprays (with the exception of pure saline) are
discouraged.
When medical management does not resolve the problem, surgery to drain the infection
and improve the anatomic situation that led to the obstruction may be necessary.
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This information is provided by the Cleveland Clinic and is not intended to replace
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for advice about a specific medical condition. This document was last reviewed on: 11/1/2003
