Sinus Infection (Sinusitis)

Overview

What is sinusitis?

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. The sinuses are four paired cavities (spaces) in the head. They are connected by narrow channels. The sinuses make thin mucus that drains out of the channels of the nose. This drainage helps keep the nose clean and free of bacteria. Normally filled with air, the sinuses can get blocked and filled with fluid. When that happens, bacteria can grow and cause an infection (bacterial sinusitis).

This is also called rhinosinusitis, with “rhino” meaning “nose.” The nasal tissue is almost always swollen if sinus tissue is inflamed.

What are the different types of sinuses near the nose and eyes?

The paranasal sinuses are located in your head near your nose and eyes. They are named after the bones that provide their structure.

  • The ethmoidal sinuses are located between your eyes.
  • The maxillary sinuses are located below your eyes.
  • The sphenoidal sinuses are located behind your eyes.
  • The frontal sinuses are located above your eyes.

The biggest sinus cavity is the maxillary cavity, and it is one of the cavities that most often becomes infected.

There are different types of sinusitis:

  • Acute bacterial sinusitis: This term refers to a sudden onset of cold symptoms such as runny nose, stuffy nose, and facial pain that does not go away after 10 days, or symptoms that seem to improve but then return and are worse than the initial symptoms (termed “double sickening”). It responds well to antibiotics and decongestants.
  • Chronic sinusitis: This term refers to a condition defined by nasal congestion, drainage, facial pain/pressure, and decreased sense of smell for at least 12 weeks.
  • Subacute sinusitis: This term is used when the symptoms last four to twelve weeks.
  • Recurrent acute sinusitis: This term is used when the symptoms come back four or more times in one year and last less than two weeks each time.

Who gets sinusitis?

A sinus infection can happen to anyone. However, people with nasal allergies, nasal polyps, asthma and abnormal nose structures are all more likely to get sinusitis. Smoking can also increase how often you get a sinus infection.

There are an estimated 31 million people in the United States with sinusitis.

How can I tell if I have a sinus infection, cold, or nasal allergy?

It can be difficult to tell the difference between a cold, allergies, and a sinus infection. The common cold typically builds, peaks, and slowly disappears. It lasts a few days to a week. A cold can transform into a sinus infection. Nasal allergy is inflammation of the nose due to irritating particles (dust, pollen, and dander). Symptoms of a nasal allergy can include sneezing, itchy nose and eyes, congestion, runny nose, and post nasal drip (mucus in the throat). Sinusitis and allergy symptoms can happen at the same time as a common cold.

If you are fighting off a cold and develop symptoms of a sinus infection or nasal allergy, see your healthcare provider. You will be asked to describe your symptoms and medical history.

Symptoms and Causes

What causes sinusitis?

Sinusitis can be caused by a virus, bacteria, or fungus that swells and blocks the sinuses. A few specific causes include:

  • The common cold.
  • Nasal and seasonal allergies, including allergies to mold.
  • Polyps (growths).
  • A deviated septum. The septum is the line of cartilage that divides your nose. A deviated septum means that it isn’t straight, so that it is closer to the nasal passage on one side of your nose, causing a blockage.
  • A weak immune system from illness or medications.

For infants and young children, spending time in day cares, using pacifiers or drinking bottles while lying down could increase the chances of getting sinusitis.

For adults, smoking increases the risks for sinus infections. If you smoke, you should stop. Smoking is harmful to you and to the people around you.

Is sinusitis contagious?

You can’t spread bacterial sinusitis, but you can spread viruses that lead to sinusitis. Remember to follow good hand washing practices, to avoid people if you are sick and to sneeze or cough into your elbow if you have to sneeze or cough.

What are the signs and symptoms of sinusitis?

Common signs and symptoms of sinusitis include:

  • Post nasal drip (mucus drips down the throat).
  • Nasal discharge (thick yellow or green discharge from nose) or stuffy nose
  • Facial pressure (particularly around the nose, eyes, and forehead), headache and or pain in your teeth or ears.
  • Halitosis (bad breath)
  • Cough.
  • Tiredness.
  • Fever.

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Diagnosis and Tests

How is sinusitis diagnosed?

Your healthcare provider will ask you a lot of questions in order to develop a detailed medical history and find out about your symptoms. They will also do a physical examination. During the exam, your care provider will check your ears, nose and throat for any swelling, draining or blockage. An endoscope (a small lighted/optical instrument) may be used to look inside the nose. In some cases, you might be referred to an ear, nose and throat (ENT) specialist. If you needed an imaging exam, your provider would order a computed tomography (CT) scan.

Management and Treatment

How is sinusitis treated?

Sinusitis is treated in several ways, each depending on how severe the case of sinusitis is.

A simple sinusitis infection is treated with:

  • Decongestants.
  • Over-the-counter cold and allergy medications.
  • Nasal saline irrigation.
  • Drinking fluids (sinusitis is a viral infection and fluids will help).

If symptoms of sinusitis don't improve after 10 days, your doctor may prescribe:

  • Antibiotics (for seven days in adults and 10 days in children).
  • Oral or topical decongestants.
  • Prescription intranasal steroid sprays. (Don't use non-prescription sprays or drops for longer than three to five days — they may actually increase congestion).

Long-term (chronic) sinusitis may be treated by focusing on the underlying condition (typically allergies). This is usually treated with:

  • Intranasal steroid sprays.
  • Topical antihistamine sprays or oral pills.
  • Leukotriene antagonists to reduce swelling and allergy symptoms.
  • Rinsing the nose with saline solutions that might also contain other types of medication.

When sinusitis isn't controlled by one of the above treatments, a CT scan is used to take a better look at your sinuses. Depending on the results, surgery may be needed to correct structural problems in your sinuses. This is most likely to happen if you have polyps and/or a fungal infection.

What complications are associated with sinus infection?

Although it does not happen very often, untreated sinus infections can become life-threatening by causing meningitis or infecting the brain, eyes, or nearby bone. Meningitis is an infection of the membranes (meninges) that cover the brain and spinal cord.

Do I need antibiotics for every sinus infection?

Many sinus infections are caused by viruses, the ones that cause the common cold. These types of infections are not cured by antibiotics. Taking an antibiotic for a viral infection unnecessarily puts you at risk for side effects related to the antibiotic. In addition, the overuse of antibiotics can lead to antibiotic resistance, which may make future infections more difficult to treat.

Are complementary and alternative therapies useful for treating sinusitis?

You might find acupressure, acupuncture or facial massage helpful in reducing symptoms of sinusitis, including pressure and pain. They might also help you to relax. These treatments do not usually have unwanted side effects.

Is there a right way to blow your nose?

If you have a stuffy nose, trying to force yourself to blow your nose could make it worse. The best thing to do is to blow one side of your nose at a time gently into a tissue. You might want to first use some type of nasal rinse to loosen any material in your nose before blowing. Make sure you dispose of the tissue and then clean your hands with soap and water or an antimicrobial sanitizer.

Prevention

How can I prevent sinusitis?

Some of the home remedies used to treat sinus infections symptoms may help prevent sinusitis. These include rinsing your nose out with salt water and using medications that your provider might suggest, such as allergy medications or steroid nasal sprays.

You should avoid things you are allergic to, like dust, pollen or smoke, and try to avoid sick people. Wash your hands to reduce your chance of getting a cold or flu.

Living With

Will I need to make lifestyle changes to deal with sinus infections?

If you have indoor allergies it is recommended that you avoid triggers—animal dander and dust mites, for example—as well as take medications. Smoking is never recommended, but if you do smoke, strongly consider a program to help you quit. Smoke can also trigger allergies and prevent removal of mucous by the nose. No special diet is required, but drinking extra fluids helps to thin nasal secretions.

When should I go see the doctor about a sinus infection?

It is pretty easy to care for most sinus conditions on your own. However, if you continue to have symptoms that concern you or if your infections continue to happen, your primary care doctor might suggest you see a specialist. This could also happen if your CT scan shows something that does not look right.

A note from Cleveland Clinic

Sinusitis, or swelling of the tissues of the sinus cavities, is a common condition with many causes, including viruses and bacteria, nasal polyps or allergies. Signs and symptoms may including facial pressure, fever and tiredness. You can treat symptoms at home by resting, taking over-the-counter products and increasing your fluid intake. Make sure you contact your healthcare provider if symptoms do not improve, if sinusitis happens often or if you have any symptom that worries you.

Last reviewed by a Cleveland Clinic medical professional on 06/04/2020.

References

  • American Academy of Allergy, Asthma, & Immunology. Accessed 6/8/2020.Sinusitis. (http://www.aaaai.org/conditions-and-treatments/allergies/sinusitis)
  • Asthmas and Allergy Foundation of America. Accessed 6/8/2020.Rhinitis (Nasal Allergies). (http://www.aafa.org/page/rhinitis-nasal-allergy-hayfever.aspx)
  • American Academy of Otolaryngology. Accessed 6/8/2020.Head and Neck Surgery. Post-Nasal Drip. (http://www.entnet.org/content/post-nasal-drip)
  • StatPearls. Anatomy, Head and Neck, Nose Paranasal Sinuses.
    Accessed 6/8/2020.https://www.ncbi.nlm.nih.gov/books/NBK499826/ (https://www.ncbi.nlm.nih.gov/books/NBK499826/)
  • Cleveland Clinic CME. Disease Management Project. . Accessed 6/8/2020.Sinusitis (http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/allergy/rhino-sinusitis/)
  • Egan M, Hickner J. J Fam Pract. 2009;58(1):29-32, Accessed 6/8/2020.Saline irrigation spells relief for sinusitis sufferers. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183918/)

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