Acute Sinusitis

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Introduction

What is acute sinusitis?

Acute sinusitis is inflammation of the sinuses, which are the hollow spaces in the skull. The inflammation is most commonly caused by several different infectious organisms including bacteria, viruses or fungi. Most commonly, acute sinusitis is the result of inflammation, congestion and blockage caused by a cold or allergy. Acute sinusitis can also result from sinus blockage due to a deviated nasal septum, nasal bone spur, or nasal polyps.

The inflammation of the sinuses in acute sinusitis prevents nasal hairs (cilia) from removing mucus, resulting in blockage and infection. Most commonly, people develop acute sinusitis from colds and allergies that may cause too much mucus to be made or that block the opening of the sinuses. Less common causes of acute sinusitis include decongestant nasal spray abuse, smoking, swimming, or diving.

Left untreated, acute sinusitis may lead to sinus abscess formation. It can trigger severe asthma, or lead to meningitis. Seek immediate medical care (call 911) for serious symptoms, such as high fever (higher than 101 degrees Fahrenheit), difficulty breathing, or changes in vision.

Seek prompt medical care if you are being treated for acute sinusitis but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of acute sinusitis?

Acute sinusitis causes congestion of the sinuses that may result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of acute sinusitis

The most common symptoms of acute sinusitis are related to disturbances in the upper respiratory tract including:

  • Aching in the upper jaw and teeth

  • Bad breath

  • Change in hearing, taste or smell

  • Cough

  • Fatigue

  • Fever

  • Headaches

  • Pain, tenderness, swelling, and pressure around the eyes, cheeks, nose or forehead

  • Postnasal drip

  • Stuffy nose or nasal congestion

Symptoms that might indicate a serious condition

In some cases, acute sinusitis can be a serious condition that should be evaluated immediately in an emergency setting. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

  • Blurred or double vision

  • Coughing up clear, yellow, light brown, or green mucus

  • Difficulty breathing

  • High fever (higher than 101 degrees Fahrenheit)

  • Severe headache, unrelieved by over-the-counter pain medicine

  • Wheezing (whistling sound made with breathing)

Causes

What causes acute sinusitis?

Acute sinusitis is most commonly caused by a viral upper respiratory tract infection. The viral infection can lead to inflammation of the sinuses. Therefore, acute sinusitis occurs most frequently in people after they have had a cold. The cold virus attacks the lining of the sinuses, causing them to swell and become narrow. The body responds to the virus by producing more mucus, which becomes blocked in the swollen sinuses. Bacterial infection of the sinuses can also occur when mucus accumulates within the blocked sinuses, preventing the normal drainage of the sinuses.

Allergies can also cause acute sinusitis. Excessive use of decongestant nasal sprays, smoking, swimming, or diving can also increase your risk of getting sinusitis. Some people have growths called polyps in the nasal cavity that block their sinus passages and cause sinusitis.

What are the risk factors for acute sinusitis?

A number of factors increase the risk of developing acute sinusitis. Not all people with risk factors will get acute sinusitis. Risk factors for acute sinusitis include:

  • Allergic rhinitis from breathing substances you are allergic to, such as dust or pollen

  • Altitude changes

  • Cystic fibrosis

  • Enlarged adenoids

  • Nasal polyps

  • Smoking

  • Weakened immune system

Reducing your risk of acute sinusitis

You may be able to lower your risk of acute sinusitis by:

  • Avoiding close contact with people who have colds or other upper respiratory infections

  • Avoiding smoking or exposure to secondhand smoke

  • Keeping up to date with recommended immunizations

  • Practicing good hand hygiene

  • Using a clean humidifier to moisten the air at home

Treatments

How is acute sinusitis treated?

Treatment for acute sinusitis begins with seeking medical care from your health care provider. For severe cases of acute bacterial sinusitis, antibiotics are the mainstay of treatment and are highly effective. It is important to follow your treatment plan for acute sinusitis precisely and to take all of the antibiotics as instructed to avoid reinfection or recurrence.

Treatments for acute sinusitis

Typical treatments for acute sinusitis include:

  • Antibiotics when bacterial infections are present

  • Antihistamines, such as chlorpheniramine (Chlor-Trimeton), dimenhydrinate (Dramamine) or diphenhydramine (Benadryl), for allergic causes

  • Decongestants, such as pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). Decongestants are generally only recommended for short-term use.

  • Pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)

  • Saline nasal spray to irrigate the nasal passages and help clear congestion. Nasal saline is one of the most inexpensive and effective remedies to relieve sinus congestion. Apply vigorously and frequently, not just a squirt or two.

What you can do to improve your acute sinusitis

In addition to following your health care provider’s instructions and taking all medications as prescribed, you can speed your recovery by:

  • Applying moist heat to the face with a warm, wet towel

  • Avoiding alcohol, which can worsen swelling in the sinuses

  • Breathing in steam through a cloth or towel

  • Drinking hot liquids and plenty of fluids

  • Getting plenty of rest

  • Sleeping propped up with a pillow

  • Copious irrigation with nasal saline several times per day

  • Using a cool-mist humidifier

What are the potential complications of acute sinusitis?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of acute sinusitis include:

  • Abscess

  • Chronic sinusitis

  • Ear infection

  • Meningitis (infection or inflammation of the sac around the brain and spinal cord)

  • Orbital cellulitis (skin infection around the eye)

  • Osteomyelitis (bone infection)

  • Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness. This is a medical emergency that requires immediate treatment to prevent potentially permanent damage.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Sinusitis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001670/.
  2. Sinusitis. FamilyDoctor.org. http://familydoctor.org/familydoctor/en/diseases-conditions/sinusitis.html.
  3. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
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