Sinusitis

The four types of sinusitis include:

• Acute sinusitis lasts no more than 30 days. It is the most common type of sinusitis. Most cases of acute sinusitis develop after a viral upper respiratory tract infection, such as the common cold. Bacteria and, less commonly, fungi also cause acute sinusitis. A bacterial or fungal sinus infection that develops after an upper respiratory infection is what’s called a secondary infection. (The viral infection is the primary infection.)

• Chronic sinusitis lasts at least 90 days. It is long-lasting inflammation and swelling of one or more sinuses. Infections, allergies, irritants, and nasal or sinus abnormalities are some of the underlying causes of chronic sinusitis. Acute sinus infections can lead to chronic sinusitis, and people with chronic sinusitis can also develop acute sinus infections. However, chronic sinusitis is not simply a sinus infection that hasn’t cleared up. It is a separate diagnosis and often involves different treatments than acute sinusitis.

    

• Subacute sinusitis lasts between 30 and 90 days. Symptoms may become worse and persist for up to 12 weeks before clearing up.   

• Recurrent sinusitis is four or more episodes of acute sinusitis in one year.

How sinusitis affects people can vary. It is often easy to confuse sinusitis with migraine headache, since they have similar symptoms.

The most common symptoms of sinusitis are:

• Bad breath
  
• Diminished smell and taste
  
• Fatigue
  
• Fever
  
• Headache, which may be worse when bending over or lying down
  
• Pain around the upper jaw, similar to a toothache
  
• Pain or pressure in the face or area in and around the eyes, which may be worse when bending over or lying down
  
• Postnasal drip
  
• Sleep problems
  
• Stuffy nose and difficulty breathing through the nose because of sinus inflammation and swelling
  
• Swelling around the nose, eyes and eyelids
  
• Thick green nasal discharge
  

In some cases, sinusitis can result in serious complications, such as orbital cellulitis (infection of the eye socket), meningitis, and brain abscess. Seek immediate medical care (call 911) for any of these symptoms:

• Change in level of consciousness or alertness, such as passing out or unresponsiveness
  
• Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
  
• High fever (higher than 101°F)
  
• Purple-red colored rash of tiny dots
  
• Seizure
  
• Stiff neck
  

Sinusitis is usually caused by a viral infection. Only about 2% of acute sinusitis cases are bacterial, usually as a complication of a viral respiratory infection like the common cold. Fungal sinus infections are even more rare than bacterial sinusitis. Mold and yeast are common causes of fungal sinus infections.

Sinusitis itself is not contagious, but the microbe that caused it is. Viruses that cause sinusitis can spread from person to person when someone with a respiratory tract infection or cold talks, coughs or sneezes. This shoots contaminated droplets into the air, where they can be breathed into the mouth and nose by others. This person can develop the initial respiratory infection, but not necessarily sinusitis.

You can also become infected and possibly develop sinusitis by touching a person, surface or object contaminated by viruses, bacteria or fungi, then touching your mouth or nose without thoroughly washing your hands.

Chronic sinusitis can result from unresolved acute sinusitis, persistent hay fever, nasal inflammation, a deviated septum, and other conditions. Any condition that results in a buildup of mucus, congestion and swelling inside the nasal and sinus passages can lead to chronic sinusitis.

A number of factors increase your risk of developing sinusitis. Risk factors include:

• Allergies

• Anatomic variations, such as a deviated nasal septum

• Asthma

• Cystic fibrosis

• Diabetes

• Exposure of the deep areas of the nose to bacteria, viruses or fungi through such activities as picking the nose

• Hay fever or allergic rhinitis

• Immune-compromised patients, such as individuals with HIV/AIDS, transplant patients, or people taking drugs that compromise the immune system

• Nose injury or trauma

• Poor hygiene habits, such as not washing your hands frequently, especially after touching a person who is sick or touching surfaces that are often contaminated with bacteria, viruses or fungi, such as doorknobs, computer keyboards, and telephones

• Smoking and exposure to secondhand smoke

• Tooth abscess

• Upper respiratory tract infection

Not all people with risk factors will get sinusitis, but you can lower your risk of sinusitis by:

• Avoiding contact with a person who has an infectious illness

• Avoiding dehydration

• Avoiding nasal trauma by wearing recommended protective equipment for dangerous activities or contact sports

• Avoiding touching your eyes, nose and mouth, which can transmit bacteria, viruses and fungi from your hands into your nose and sinuses

• Covering your mouth and nose with your elbow (not your hand) or a tissue when sneezing or coughing

• Seeking regular dental care to prevent or promptly treat tooth abscesses

• Seeking regular medical care and treatment for hay fever and allergic rhinitis

• Using appropriate antibacterial cleaners to clean hands and surfaces

• Washing hands frequently with soap and water for at least 15 seconds, especially after contact with a person who has an infectious illness

A healthcare provider will usually diagnose sinusitis based on your symptoms, such as nasal discharge combined with head and facial pain. Questions your provider may ask about your symptoms include:

• How long have you been experiencing sinusitis symptoms?

• Have you experienced these symptoms before? When and how often?

• Do you have allergies?

• Did you have a cold or other type of respiratory infection recently?

• What medications do you take?

• What other conditions do you have?

• Is there any reason why you may have a weakened immune system?

Viruses cause most cases of sinusitis. If your symptoms are worse than a typical upper respiratory tract infection or last longer than 10 days, your doctor may diagnose bacterial sinusitis.

You may need testing if your doctor believes you may have a more serious form of sinusitis, such as fungal sinusitis, chronic sinusitis, or recurrent sinusitis. Tests may include:

• CT scan (computed tomography), the optimal method of viewing the sinus cavities

• Nasal smear, the direct examination of nasal secretions under a microscope. This can identify or narrow down the underlying cause of sinusitis.

• Sinus puncture or culture, the needle aspiration of sinus contents after numbing the puncture site. The sample is sent to a lab to culture and identify the possible bacteria, virus or fungus causing the infection, which will guide treatment decisions. 

• Endoscopic middle meatal culture, the endoscope-guided (and less painful) aspiration of sinus contents from the middle meatus (sinus drainage pathway). An ear, nose and throat (ENT) doctor inserts the endoscope—a slim, lighted camera—into the nose to look at the sinuses, aspirate mucus, diagnose any structural problems, and perform minor treatments if necessary. Similar to a sinus puncture, the sample is sent to a lab for identification and diagnosis.

The treatment plan for sinusitis includes home care, medication and possibly surgery, with the goal of relieving nasal congestion, clearing the infection, improving breathing, and reducing pain and pressure.

General treatment of sinusitis includes:

• Avoiding caffeine and alcohol

• Avoiding exposure to irritating fumes, such as tobacco

• Drinking plenty of fluids to stay hydrated and keep nasal discharge loose

• Getting plenty of rest

• Keeping the head elevated while sleeping to reduce pressure

• Laying a warm, moist cloth over the face, which may help drain the sinuses

• Irrigating the nose with saline using a neti pot, sterile saline spray or squeeze bottle, or nose drops

• Using a warm-mist humidifier or a vaporizer to moisten and loosen nasal discharge. An alternative to a humidifier or vaporizer is to simply drape a towel over your head as you inhale steam from a bowl of hot water (boiled water that has cooled a little). Sitting in a bathroom with a hot shower also works well. Inhale steam 2 to 4 times a day.

• Using a dehumidifier or air conditioner if the air is too moist, which can make allergies and sinusitis worse

   

For some people with sinusitis, medication may be recommended or prescribed. Medications may include the following:

• Antibiotics are prescribed if the sinusitis is caused by a bacterial infection. Antibiotics will not treat sinusitis caused by a viral or fungal infection.

• Antifungal drugs are prescribed if the sinusitis is caused by a fungal infection. Antifungal drugs will not treat sinusitis caused by a viral or bacterial infection.

• Corticosteroid nasal spray to reduce the inflammation and pain of sinusitis

• Decongestants to shrink inflamed and swollen sinuses. These medications, such as Sudafed, can have serious side effects that can affect the heart in some people. They should be used only as directed by your healthcare provider.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), to control the pain, pressure and inflammation of sinusitis

• Surgery may be an option in some cases to expand the opening of infected sinuses. This is an antrostomy.

People with viral sinusitis should not use aspirin or products that contain aspirin because of the risk of developing a rare but life-threatening condition called Reye syndrome. Reye syndrome has been linked to taking aspirin during a viral illness, such as viral sinusitis or the flu.

People with healthy immune systems can clear viral sinusitis and even some cases of bacterial sinusitis without medication, but symptoms may be more severe and last longer. Alternative treatments for sinusitis, particularly chronic sinusitis, that may be beneficial include:

• Acupuncture

• Bromelain, derived from pineapples, may reduce inflammation and swelling. It can increase the risk of bleeding, so do not take bromelain supplements without first checking with your doctor. 

• Probiotics can help restore “good” bacteria lost from a course of antibiotics, if you have bacterial sinus infection.

• Quercetin, a flavonoid that has antihistamine properties, may be beneficial for people with allergy-induced sinusitis. 

• Sinupret, an herb-based formula, may thin the mucus allowing it to drain easier. Sinupret is sold as a tablet or syrup.

• Other herbal supplements, with varying levels of efficacy for improving sinusitis symptoms, include danshen, dong quai, feverfew, garlic, ginger, ginkgo, ginseng, goldenseal, green tea, licorice (not the candy), and St. John’s wort.  

Talk with your doctor before taking any supplements or herbs. They have the potential to worsen symptoms, interact with medications, and cause dangerous side effects, such as bleeding or an increase in blood pressure. It is especially important to tell your doctor about all herbal supplements and vitamins you are taking if you need sinus surgery or anesthesia, or you have a heart condition.

In some people, sinusitis can break down the body’s defenses and lead to more serious infections. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you. Complications of sinusitis can be life-threatening and include:

• Abscesses of the bones around the sinuses

• Adverse effects of treatment

• Brain abscess

• Cavernous sinus thrombosis (serious blood clot in the sinus located under the brain and behind each eye socket)

• Meningitis

• Orbital cellulitis

• Osteomyelitis

• Progression of symptoms

• Spread of infection