Sinusitis

Sinusitis is inflammation of the sinuses that occurs with an infection from a virus, bacteria, or fungus.

  Causes, incidence, and risk factors

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes). Healthy sinuses contain no bacteria or other germs. Usually, mucus is able to drain out and air is able to circulate.
When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.
Sinusitis can occur from one of these conditions:

• Small hairs (cilia) in the sinuses, which help move mucus out, do not work properly due to some medical conditions.
• Colds and allergies may cause too much mucus to be made or block the opening of the sinuses.
• A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

Sinusitis can be called:

• Acute, when symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses.
• Chronic, when swelling and inflammation of the sinuses are present for longer than 3 months. It may be caused by bacteria or a fungus.

The following may increase your risk or your child's risk of developing sinusitis:

• Allergic rhinitis or hay fever
• Cystic fibrosis
• Day care
• Diseases that prevent the cilia from working properly
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Smoking
• Weakened immune system from HIV or chemotherapy

Symptoms

The symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that gets worse after 5 - 7 days of symptoms. Symptoms include:

• Bad breath or loss of smell
• Cough, often worse at night
• Fatigue and generally not feeling well
• Fever
• Headache -- pressure-like pain, pain behind the eyes, toothache, or tenderness of the face
• Nasal stuffiness and discharge
• Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 12 weeks.
Symptoms of sinusitis in children include:

• Cold or respiratory illness that has been improving and then begins to get worse
• High fever, along with a darkened nasal discharge, for at least 3 days
• Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

Signs and tests

The doctor will examine you or your child for sinusitis by:

• Looking in the nose for signs of polyps
• Shining a light against the sinus (transillumination) for signs of inflammation
• Tapping over a sinus area to find infection

Regular x-rays of the sinuses are not very accurate for diagnosing sinusitis.

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis. This is usually done by doctors who specialize in ear, nose, and throat problems (ENTs).
Imaging tests that may be used to decide on treatment are:

• A CT scan of the sinuses to help diagnose sinusitis or view the bones and tissues of the sinuses more closely
• An MRI of the sinuses if there might be a tumor or fungal infection

If you or your child has sinusitis that does not go away or keeps returning, other tests may include:

• Allergy testing
• Blood tests for HIV or other tests for poor immune function
• Ciliary function tests
• Nasal cultures
• Nasal cytology
• Sweat chloride tests for cystic fibrosis

Treatment

SELF CARE
Try the following measures to help reduce congestion in your sinuses:

• Apply a warm, moist washcloth to your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Inhale steam 2 - 4 times per day (for example, while sitting in the bathroom with the shower running).
• Spray with nasal saline several times per day.
• Use a humidifier.
• Use a Neti pot to flush the sinuses.

Be careful with over-the-counter spray nasal decongestants. They may help at first, but using them for more than 3 - 5 days can make nasal stuffiness worse.
Also, for sinus pain or pressure:

• Avoid flying when you are congested.
• Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
• Try acetaminophen or ibuprofen.

MEDICATIONS AND OTHER TREATMENTS
Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:

• Children with nasal discharge, possibly with a cough, that is not getting better after 2 - 3 weeks
• Fever higher than 102.2° Fahrenheit (39° Celsius)
• Headache or pain in the face
• Severe swelling around the eyes

Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.
At some point, your doctor will consider:

• Other prescription medications
• More testing
• Referral to an ear, nose, and throat (ENT) or allergy specialist

Other treatments for sinusitis include:

• Allergy shots (immunotherapy) to help prevent the disease from returning
• Avoiding allergy triggers
• Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be needed, especially in patients whose symptoms do not go away after 3 months of treatment, or in patients who have more than two or three episodes of acute sinusitis each year. An ENT specialist (also known as an otolaryngologist) can perform this surgery.
Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

Expectations (prognosis)

Sinus infections can usually be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.

Complications

Although very rare, complications may include:

• Abscess
• Bone infection (osteomyelitis)
• Meningitis
• Skin infection around the eye (orbital cellulitis)

Calling your health care provider

Call your doctor if:

• Your symptoms last longer than 10 - 14 days or you have a cold that gets worse after 7 days
• You have a severe headache that is not relieved by over-the-counter pain medicine
• You have a fever
• You still have symptoms after taking all of your antibiotics properly
• You have any changes in your vision during a sinus infection

A green or yellow discharge does not mean that you definitely have a sinus infection or need antibiotics.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
• Get an influenza vaccine each year.
• Reduce stress.
• Wash your hands often, particularly after shaking hands with others.

Other tips for preventing sinusitis:

• Avoid smoke and pollutants.
• Drink plenty of fluids to increase moisture in your body.
• Take decongestants during an upper respiratory infection.
• Treat allergies quickly and appropriately.
• Use a humidifier to increase moisture in your nose and sinuses.