Sinusitis
Know what your nose knows
When fluid is trapped in your sinuses, a condition known as sinusitis develops. Often this is caused when your mucus membranes swell up, preventing fluid from draining out of your sinuses. It can also be caused by a deviated septum or other obstruction of the nasal passages, or by immersing your head in water containing bacteria. Sinusitis can result in swelling, facial pain, nasal discharge, and fever, among other symptoms.
Treatment options for sinusitis range from prescription medications to dietary supplements to self-help techniques. Because of the connection between sinusitis and infection, in order to prevent it from coming back it is important to stay aware of the environmental and behavioral triggers that can lead to this sinusitis.
Pronunciation
sine-yuh-SY-tis
Synonyms
- Sinus infection
Detailed Description
Sinusitis is an infection of any one of the eight sinuses adjacent to the nose. These sinuses are categorized in four groups.
- Frontal sinuses: just above the eyes
- Ethmoid sinuses: between the eyes just over the nose
- Maxillary sinuses: on either side of the nose below the eyes
- Sphenoid sinuses: at the base of the skull behind all of the other sinus cavities
Contact with an allergen, virus, bacteria, or fungus causes the linings of the sinuses (mucus membranes) to swell. This swelling obstructs drainage and leads to a blockage that feeds bacteria, which then leads to the infection called sinusitis. Sinusitis may be short-lived and acute, or a long-standing, chronic condition.
Characteristics of Sinusitis
You will probably have nasal congestion and may also experience tenderness, pain, and redness around the sinuses. During the early stages of sinusitis, you may experience a greenish-yellow, possibly blood-tinged discharge. In later stages discharge may be blocked. Headaches that worsen in the morning or when bending forward, cheek pain that may resemble a toothache, and nonproductive coughs can all indicate sinusitis. A general feeling of weakness and fever or chills may accompany sinusitis.
Sometimes, if you pay attention to the precise symptoms, it may be possible to determine which sinus area is affected. If the pain is centered over your cheeks just below your eyes, or is connected to a toothache or headache, it might be maxillary sinusitis. Headaches over your forehead are often connected to frontal sinusitis. Splitting headache pain behind and between the eyes could be a symptom of ethmoid sinusitis. If the pain does not stay in a specific area and is felt in the front or back of the head, it is possible that you have sphenoid sinusitis.
How Common Is Sinusitis?
Sinusitis is one of the most common health problems in the United States, affecting an estimated 14% of the population. This percentage is currently increasing. Sinusitis affects people of all ages. Males and females are equally affected by sinusitis.
What You Can Expect
This condition is usually curable. Most people respond to one of the many ways of treating sinusitis. In chronic cases, however, recurrence is common and may require surgical drainage.
Established Causes
Many causes or conditions may lead to sinusitis.
- Infection, often caused by cold or other upper respiratory infection
- Irritation to the nasal passages from allergies
- Swimming (especially jumping into the water without holding your nose)
- Bacterial, viral, or fungal infections
- Chronic nasal swelling nasal allergy, viscous mucous, or sudden temperature changes
- Nasal polyps or a deviated septum blocking nasal passages
- Swimming in polluted water
- Cigarette smoke, dust and other pollutants
- Dental infection, which can spread to the maxillary sinus and cause infection there
Risk Factors
Because of the connection between sinusitis and contagious agents (like the viruses that lead to colds, which are the most common cause of sinusitis), many of the following risk factors increase exposure to those agents or describe activities that affect the immune system.
- Smoking
- Exposure to others in public places
- Illness that has lowered resistance
- Excessive nose-blowing during an upper respiratory infection
- Swimming in contaminated water, especially jumping into the water without holding your nose
- Abscess in an upper tooth
- Immunosuppression, as in people who have organ transplants and are taking drugs to suppress the immune function in order to prevent rejection
- Continuous positive airway pressure -- a technique used in obstructive sleep apnea to keep the upper airways open during sleep
- Air travel during upper respiratory infection
- Increased incidence of upper respiratory infection in winter, when people are indoors and in closer contact with one another
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They do not necessarily causes sinusitis.
Symptoms
- Nasal congestion with greenish-yellow (sometimes blood-tinged) discharge
- Headaches, or feelings of pressure inside the head
- Headache that is worse in the morning or when bending forward
- Pain in the eyes, or in the cheeks (resembling a toothache)
- Postnasal drip
- Nonproductive cough
- Disturbed sleep
- Fever
Conditions That May Be Mistaken for Sinusitis
Some other diseases resemble sinusitis, such as:
- The common cold
- Vasomotor rhinitis
- Allergic rhinitis
- Foreign bodies
- Polyps, cysts, and tumors in a sinus (uncommon)
How Sinusitis Is Diagnosed
After a medical evaluation and physical exam, further testing depends on the symptoms and how well the patient responds to treatment. Your doctor will want to know your current symptoms and the course of the illness, and in the physical exam will look for tenderness and examine inside the nose, mouth, and ears.
Your Medical History
If you have a history of lowered immune function, allergic reactions, or bacterial or viral infections, your physician may watch more closely for sinusitis.
Laboratory Work
It is unlikely you will need any lab work, especially if this is your first or only an occasional episode. If you do need tests, they may include a study of nasal discharge to identify the type of bacteria. You may also need X-rays of the sinuses. A CT (computed tomography) scan of the sinuses is more reliable than X-ray in making a diagnosis of sinusitis.
Specific Tests
In extreme cases, you may require further tests:
- Endoscopy: may help identify areas of persistent infection
- Sinuscopy: may be used to remove cysts that might develop
Imaging
Imaging techniques are very useful in diagnosing sinusitis.
- X-rays may provide information about blocked sinuses, helping to distinguish the common cold from a sinus infection
- CT scans will identify the precise location of chronic sinus infections
Goals of Treatment
When treating sinusitis, your doctor's initial goal will be to re-establish drainage of the sinuses and clear the acute infection, relieving the discomfort caused by the symptoms.
Treatment Overview
Sinusitis is usually curable, though the possibility of recurrence is high.
Sinusitis can usually be treated effectively with a combination of self care, medication, and individualized medical procedures.
Drug Therapy
Drugs most commonly prescribed
You might want to try starting off with a decongestant, such as pseudoephedrine (the ingredient in Sudafed), which may help shrink swollen nasal passages. However, decongestants should only be used for a short period of time as they may actually worsen the condition by drying the nasal passages.
Acetaminophen (Tylenol) or NSAIDs (such as ibuprofen) help to alleviate pain caused by the pressure-filled sinus infection.
Saline sprays or washes may help loosen and clear thick secretions.
If sinusitis persists, consult your doctor who may prescribe an antibiotic for you if you have bacterial sinus infections.
Surgery
In rare cases, surgery may be used to drain blocked sinuses.
Treatment Considerations
Nose drops are meant for use by one person only, and should be discarded after treatment. Sharing nose drops may infect others.
Avoid nonprescription nose drops or sprays. They can become addictive, interfering with normal nasal functions, which can cause recurring problems. Use prescription nose drops for the recommended time only. Salt water sprays or drops can help, and are safe.
Appropriate Health Settings
Unless you need surgery, outpatient care is usually sufficient.
Managing Sinusitis Treatment
To manage sinusitis, the best place to start is in your own home. Like a cold, the condition may go away with time and rest. However, with acute and chronic cases, your doctor will most likely prescribe antibiotics.
- First, try home remedies. Keep a moist atmosphere in your room and take decongestants, such as pseudoephedrine and painkillers, such as acetaminophen (Tylenol).
- Nasal secretions can be thinned for easier drainage with the use of cool-mist humidifiers or steam inhalation.
- Electric heating pads or warm compresses can be used directly on the nasal area and sinuses to help relieve pain.
- For a young child who is not able to blow his or her nose, a nasal aspirator can gently suction each nostril before applying saline drops. Suction again 10 minutes after using nose drops. Sinusitis is uncommon in very young children.
- If the condition persists for more than a week, consult your doctor, who may prescribe an antibiotic.
- If this does not seem to ease the condition, you may need other antibiotics to target other types of bacterial infections.
- If none of this helps the condition, surgery may be necessary to drain the infected areas.
Possible Complications
Possible complications of sinusitis include:
- Meningitis (inflammation of the brain or spinal cord)
- Abscess (a pus-containing cavity surrounded by infection; usually must be drained)
- Thrombosis (clots of blood in vessels near the sinuses)
Quality of Life
Sinusitis can be painful and tiring, but the condition is not likely to last too long. For chronic cases, where the symptoms may appear as many as three times per year and become fairly debilitating, consultation with an ear, nose, and throat (ENT) specialist or surgery may be considered.
Considerations for Women
Pregnancy
Talk to your doctor about which kinds of drugs are safe to use during pregnancy.
Nursing Mothers
The only risk is with the antibiotics that your doctor may prescribe for infection. Antibiotics may create problems if the baby is allergic to ampicillin or amoxicillin. However, antibiotics are generally considered to be compatible with breastfeeding. Your doctor can choose one that is safe; be sure to tell him or her you are breastfeeding.
Considerations for Older People
The symptoms of sinusitis may actually be signs of other complications, including meningitis, small benign tumors of the mucus glands, infections of the skull, or (in rare cases) brain abscess.
Supplements
- Vitamin C is often used in treating the common cold. Many naturopaths also recommend it for sinusitis -- 500 mg four times a day. It may help, although results are unproven.
Herbs
- Echinacea: an immune stimulant that may help combat the bacteria that typically causes sinusitis. Take one teaspoon two or three times a day in a juice or herbal tea.
- Goldenseal: a natural antibiotic often combined with echinacea. Also helps combat the bacteria that often cause sinusitis. Take one teaspoon two or three times a day in a juice or an herbal tea.[1]
- Garlic: a potent herbal antibiotic. Unfortunately, it works best when you chew raw cloves. If you'd rather not do this, try deodorized garlic capsules.
Source
[1]Duke, James. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.
Preventing Sinusitis
- Keep a 45% to 50% humidity level in heated buildings during the winter to prevent dryness.
- If you are prone to sinus infection, try cutting milk out of your diet. Studies have shown that this may prevent severe sinusitis.
- Quit smoking.
- If you have a history of chronic hay fever or other allergy symptoms, talk to your doctor about it.
Self-Care Measures
- Take hot baths or showers -- the steam soothes your sinuses. (But don't inhale steam from a kettle -- you may get scalded.)
- Try using a vaporizer at night to keep your nasal passages from drying out.
- Control your allergies. Hay fever sufferers are prone to sinus infections. Air-filtering vacuum cleaners and HEPA filters are part of a good environmental-control plan. Pets, carpeting, and feather bedding may provoke allergies in some people.
- Drink more fluids, which may help liquify nasal mucus (when it's liquid, it drains from the sinuses more easily).
- Several alternative treatments, including echinacea and vitamin C, may be useful for sinusitis. Learn more in Sinusitis: Alternative Care.
Websites & Organizations
Allergy and Asthma Magazine
"Sinusitis"
Associates in Otolaryngology, Head & Neck & Facial Plastic Surgery
"Sinusitis and Other Sinus Problems"
Institute for Clinical Evaluative Science
"Acute Sinusitis"
Sinuses.com
The New York Eye & Ear Infirmary
"FAQs About Nasal and Sinus Disorders"
Wellness Web
"Sinusitis"
Sources and Further Reading
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J., et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw-Hill, 1996.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, L.M., McPhee, S.J., and Papadakis, M.A. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Bamberger, DM. "Antimicrobial Treatment of Sinusitis." Semin Respir Infect. 77-84. Jun 1991.
Diaz, I, Bamberger, DM. "Acute Sinusitis." Semin Respir Infect. 14-20. Mar 1995.
Druce, HM. "Adjuncts to Medical Management of Sinusitis." Otolaryngol Head Neck Surg. 880-3. Nov 1990.
Duke, James. The Green Pharmacy. Rodale Press, Emmaus, PA, 1997.
Lindboek, M, Hjortdahl, P, Johnsen, UL. "Use of Symptoms, Signs, and Blood Tests to Diagnose Acute Sinus Infections in Primary Care: Comparison with Computed Tomography." Fam Med. 183-8. Mar 1996.
Low, DE, Desrosiers, M, McSherry, J, Garber, G, Williams, JW Jr, Remy, H, Fenton, RS, Forte, V, Balter, M, Rotstein, C, Craft, C, Dubois, J, Harding, G, Schloss, M, Miller, M, McIvor, RA, Davidson, RJ. "A Practical Guide for the Diagnosis and Treatment of Acute Sinusitis." CMAJ. S1-14. Mar 15, 1997.
Mel'en, I. "Chronic Sinusitis: Clinical and Pathophysiological Aspects." Acta Otalaryngol Suppl. 45-8. 1994.
Salman, SD, Rebeiz, EE. "Sinusitis and Headache." J Med Liban. 200-2. 1994.
Schwartz, R. "The Diagnosis and Management of Sinusitis." Nurs Pract. 58-63. Dec 1994.
Stafford, CT. "The Clinician's View of Sinusitis." Otolaryngol Head Neck Surg. 870-5. Nov 1990.
Williams, JW Jr, Simel, DL, Roberts, L, Samsa, GP. "Clinical Evaluation for Sinusitis. Making the Diagnosis by History and Physical Examination." Ann Intern Med. 705-10. Nov 1, 1992.