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 a deviated septum (the wall between the left and right nostril is crooked). 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 tell the difference between sinusitis, cold, and nasal allergy.
What is sinusitis?
Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. There are two types of sinusitis:
- Acute bacterial 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: a condition defined by nasal congestion, drainage, facial pain/pressure, and decreased sense of smell for at least 12 weeks.
Who gets sinusitis?
Every year approximately 1 billion Americans have at least one episode of viral sinusitis. About 37 million will develop a bacterial sinusitis. 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/tenderness
- Nasal stuffiness
- Nasal discharge (thick yellow or green discharge from nose)
- Loss of smell and taste
Additional symptoms may include:
- Fever ≥102°
- Ear pain
- Bad breath
- Ache in upper jaw and teeth
How is sinusitis diagnosed?
To diagnose sinusitis, your doctor will discuss your symptoms and examine your nose for swelling and drainage and your 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. In general, X-rays or CT scans do not play any role in the diagnosis of acute sinusitis.
Some patients may have conditions that require referral to a specialist, such as an ear, nose and throat (ENT) physician. Additional diagnostic tests may be needed. Tests for these more complicated cases may include sinus X-rays, allergy testing, CT scan of the sinuses or nasal endoscopy. Nasal endoscopy is a procedure that allows doctors to look directly inside the nose and sinus cavities.
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.
If symptoms do not improve after at least 7 to 10 days or if they seem to be getting worse, a bacterial infection may be the cause of the sinusitis. In this case, antibiotics are given for 5 to 7 days in adults and 10 to 14 days in children. With treatment, the symptoms usually disappear and antibiotics are no longer required. Oral and topical decongestants may be prescribed to relieve 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 4 to 5 days -- or they may actually increase congestion.
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 nasal secretions.
If you have indoor allergies, avoidance of triggers -- such as animal dander and dust mites -- will be recommended in addition to medications.
What happens if sinusitis is not treated?
Delaying treatment for sinusitis will result in 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 is the harm in getting an antibiotic for a common cold?
Viral infections like the common cold are not cured by antibiotics. Taking an antibiotic for a viral infection unnecessarily puts you at risk for experiencing side effects related to the antibiotic. In addition, the overuse of antibiotics leads to antibiotic resistance, which may make future infections more difficult to treat. Finally, the use of inappropriate medication increases health care costs unnecessarily.
What are the symptoms of nasal allergy?
Symptoms of nasal allergy include:
- Itchy nose
- Clear, watery nasal discharge
- Nasal blockage
- Feeling fatigued
How is nasal allergy treated?
Usually medications are prescribed to relieve symptoms. These may include antihistamines, with or without decongestants; or steroid nasal sprays. 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. Antifungal medicine may be prescribed for treatment of any fungal infection, although these infections are rare.
How can I tell if I have a sinus infection, cold, or nasal allergy?
Although the symptoms of sinusitis and nasal allergy may occur with a common cold, in general, cold-related symptoms disappear within 1 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.
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 ongoing abnormal symptoms, recurring infections, or have abnormal X-ray findings or complications, a referral to a specialist is appropriate.
- Chow, A. et al., IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clinical Infectious Diseases; 2012;54(8):1041-1045.
- 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. Accessed 8/30/2013.
- American Academy of Allergy, Asthma, and Immunology. Patients & Consumers: Tips to Remember: Sinusitis. Accessed 8/30/2013.
- American College of Allergy, Asthma & Immunology. Patients & Public: Allergies: Types of Allergies: Sinusitis. Accessed 8/30/2013.
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