Sinusitis

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Introduction

What is sinusitis?

Sinusitis, commonly called a sinus infection, is an inflammation and infection of the air-filled spaces that are located within the bones in and around the nose (paranasal sinuses). This results in swelling of the mucus membranes that line the sinuses, pain and pressure in and around the eyes and cheekbones, and a thick green discharge from the nose.

Sinusitis is a common condition that is caused by a viral infection, bacterial infection, or rarely, a fungal infection. Sinusitis occurs when the body’s immune system is unable to stop harmful bacteria, viruses or fungi from reproducing in the sinuses. Fungal infections are more commonly seen in individuals with diabetes or who are compromised immune systems. Sinusitis can also be caused by allergies and autoimmune diseases.

Treatment for sinusitis varies depending on the cause, severity of symptoms, presence of complications, and a person’s medical history. Treatment may include a humidifier, medications or possibly surgery.

In some cases, sinusitis can spread from the sinuses to the nervous system and lead to life-threatening infections and complications, such as meningitis and brain abscess. Seek prompt medical care if you develop symptoms of sinusitis or if you have sinusitis that is not getting better. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of sinusitis that are accompanied by a change in alertness or consciousness, double vision, a seizure, or a stiff neck.

Symptoms

What are the symptoms of sinusitis?

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

  • Diminished smell and taste
  • 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
  • Post-nasal drip
  • Sleep disorder
  • 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

Serious symptoms that might indicate a life-threatening condition

In some cases, sinusitis can result in serious complications, such as orbital cellulites (infection of the eye socket), meningitis and brain abscess. Seek immediate medical care (call 911) if you, or someone you are with, have 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 degrees Fahrenheit)

  • Purple-red colored rash of tiny dots

  • Seizure

  • Stiff neck

Causes

What causes sinusitis?

Sinusitis is caused by a viral infection, bacterial infection, or rarely, a fungal infection. Infections that cause sinusitis can be spread from person to person when someone with a respiratory tract infection or cold talks, coughs or sneezes. This shoots droplets contaminated with bacteria, viruses or fungi into the air, where they can be breathed into the nose and sinuses by others.

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

What are the risk factors for catching sinusitis?

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

  • Anatomic variations such as a deviated nasal septum
  • Diabetes
  • Exposure of the deep areas of the nose to bacteria, viruses or fungi through such activities as picking the nose
  • Immune-compromised patients such as individuals with HIV/AIDS, are transplant patients or are 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 second-hand smoke

Reducing your risk of sinusitis

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

Treatments

How is sinusitis treated?

The treatment plan for sinusitis uses a multipronged approach aimed at relieving nasal congestion, clearing the infection, improving breathing, and reducing pain and pressure.

General treatment of sinusitis includes:

  • Avoiding caffeine and alcohol
  • Avoid 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
  • Saline irrigation with a  neti pot or nose drops
  • Using a cool-mist vaporizer to moisten and loosen nasal discharge

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 health care provider.

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

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

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 a viral sinusitis or the flu. 

What are the possible complications of sinusitis?

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 health care professional design specifically for you. Complications of sinusitis are life threatening and include:

  • Abscesses of the bones around the sinuses
  • Adverse effects of treatment
  • Brain abscess
  • Cavernous sinus thrombosis
  • Meningitis
  • Progression of symptoms
  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 6
  1. Sinusitis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000647.htm
  2. Sinusitis. FamilyDoctor.org. http://familydoctor.org/familydoctor/en/diseases-conditions/sinusitis.html
  3. Acute Sinusitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/symptoms-causes/syc-20351671
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