Sinusitis

Causes

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes) that are lined with mucus membranes. 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:

• Acute -- symptoms last up to 4 weeks
• Sub-acute -- symptoms last 4 - 12 weeks
• Chronic -- symptoms last 3 months or longer

Acute sinusitis is usually caused by a bacterial infection in the sinuses that results from an upper respiratory tract infection. Chronic sinusitis refers to long-term swelling and inflammation of the sinuses that 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, such as Kartagener syndrome and immotile cilia syndrome.
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Smoking
• Tooth infections (rare)
• Weakened immune system from HIV or chemotherapy

Symptoms

The classic symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that worsens 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 facial tenderness
• Nasal congestion 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

Exams 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).

However, these tests are not very sensitive at detecting sinusitis.

A CT scan of the sinuses may also be used to help diagnose sinusitis or to evaluate the anatomy of the sinuses to determine whether surgery will be beneficial. If sinusitis is thought to involve a tumor or fungal infection, an MRI of the sinuses may be necessary.

If you or your child has chronic or recurrent sinusitis, other tests may include:

• Allergy testing
• Blood tests for HIV or other tests for poor immune function
• Ciliary function tests
• 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, 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 actually worsen nasal congestion.

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, further testing, or 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 clean and drain the sinuses may also be necessary, especially in patients whose symptoms fail to go away after 3 months, despite medical 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 require surgery. Surgical repair of a deviated septum or nasal polyps may prevent the condition from returning.

Outlook (Prognosis)

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

Possible Complications

Although very rare, complications may include:

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

When to Contact a Medical Professional

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, unrelieved 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 necessarily indicate a sinus infection or the need for 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.

Alternative Names

Acute sinusitis; Sinus infection; Sinusitis - acute; Sinusitis - chronic; Rhinosinusitis

References

Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for management of acute bacterial sinusitis in children 1 to 18 years of age. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006.

Slavin RG, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116:S13-S47.

Rosenfeld RM, Singer M, Jones S. Systematic review of antimicrobial therapy in patients with acute rhinosinusitis. Otolaryngol Head Neck Surg. 2007;137:S32-S45.

Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137:S1-S31.

Update Date: 8/31/2011

Updated by: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington (4/18/2010).