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The sinuses are hollow areas in the skull that are arranged in pairs. Sinusitis occurs when the tissue lining the sinuses in the skull around the nose (the paranasal sinuses) becomes inflamed and infected. Acute sinusitis usually lasts about 1-4 weeks, while chronic sinusitis is diagnosed when symptoms last three or more months. The third form, recurrent acute sinusitis, occurs more than three times a year.
Paranasal Sinuses |
Although sinusitis may begin during or after a viral infection, the condition itself is usually due to a bacterial infection or allergic conditions.
Acute infectious sinusitis may be caused by any number of bacteria, including:
- Hemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Staphylococcus aureus
- Streptococcus pyogenes
These are all bacteria that are often found in the nose and throat of healthy people and which cause other common conditions, such as bronchitis and ear infections .
Certain other bacteria and fungi, such as Aspergillus, can be a cause of chronic sinusitis.
Sinus Infection |
There are three main factors that predispose a person to developing sinusitis:
- Blockage of the small openings that run between the sinuses and the nose
- Malfunction of the tiny hairs (cilia) that are responsible for moving mucus and organisms out of the sinuses and nose
- Overproduction of mucus
Sinusitis is an extremely common problem. In a given year, about 37 million Americans suffer from sinusitis.
What are the risk factors for sinusitis?
[What are the symptoms of sinusitis?
What are the treatments for sinusitis?
Are there screening tests for sinusitis?
[How can I reduce my risk of sinusitis?
Symptoms of sinus infection are very similar to those of the common cold. However, when due to a cold virus, such symptoms typically improve after a few days. If you continue to have nasal symptoms 10-14 days after having a cold , then you may have developed a sinus infection.
Blockage of Sinuses |
Symptoms of sinus infection may include:
- Nasal congestion
- Nasal discharge that may be
- Thick
- Greenish
- Yellowish
- Headache (in acute sinusitis)
- Ear pain
- Toothache (dental pain)
- Facial pain and pressure that increases when you lie down or lean over
- Facial fullness or congestion
- Nagging cough that may get worse when lying down
- Fever
- Decreased energy or fatigue
- Bad breath
- Unpleasant taste in your mouth
- Decreased sense of smell
- Fever, especially in children
Most experts believe that sinus infection does not cause chronic headaches. However alteration in sinus pressure associated with weather changes might provoke headaches in susceptible people.
The sinuses are hollow areas in the skull that are arranged in pairs. Sinusitis occurs when the tissue lining the sinuses in the skull around the nose (the paranasal sinuses) becomes inflamed and infected. Acute sinusitis usually lasts about 1-4 weeks, while chronic sinusitis is diagnosed when symptoms last three or more months. The third form, recurrent acute sinusitis, occurs more than three times a year.
Paranasal Sinuses |
Although sinusitis may begin during or after a viral infection, the condition itself is usually due to a bacterial infection or allergic conditions.
Acute infectious sinusitis may be caused by any number of bacteria, including:
- Hemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
- Staphylococcus aureus
- Streptococcus pyogenes
These are all bacteria that are often found in the nose and throat of healthy people and which cause other common conditions, such as bronchitis and ear infections .
Certain other bacteria and fungi, such as Aspergillus, can be a cause of chronic sinusitis.
Sinus Infection |
There are three main factors that predispose a person to developing sinusitis:
- Blockage of the small openings that run between the sinuses and the nose
- Malfunction of the tiny hairs (cilia) that are responsible for moving mucus and organisms out of the sinuses and nose
- Overproduction of mucus
Sinusitis is an extremely common problem. In a given year, about 37 million Americans suffer from sinusitis.
What are the risk factors for sinusitis?
What are the symptoms of sinusitis?
What are the treatments for sinusitis?
Are there screening tests for sinusitis?
How can I reduce my risk of sinusitis?
References:
Alho OP. Vital infections and susceptibility to recurrent sinusitis. Curr Allergy Asthma Rep.2005;5:477-481
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
References:
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
References:
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
Symptoms of sinus infection are very similar to those of the common cold. However, when due to a cold virus, such symptoms typically improve after a few days. If you continue to have nasal symptoms 10-14 days after having a cold , then you may have developed a sinus infection.
Blockage of Sinuses |
Symptoms of sinus infection may include:
- Nasal congestion
- Nasal discharge that may be
- Thick
- Greenish
- Yellowish
- Headache (in acute sinusitis)
- Ear pain
- Toothache (dental pain)
- Facial pain and pressure that increases when you lie down or lean over
- Facial fullness or congestion
- Nagging cough that may get worse when lying down
- Fever
- Decreased energy or fatigue
- Bad breath
- Unpleasant taste in your mouth
- Decreased sense of smell
- Fever, especially in children
Most experts believe that sinus infection does not cause chronic headaches. However alteration in sinus pressure associated with weather changes might provoke headaches in susceptible people.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop sinusitis with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing sinusitis. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors for sinusitis include the following:
Smoking
Smoking and being exposed to second-hand smoke increases your risk of developing sinusitis.
Certain Medical Conditions
The following medical conditions increase your chances of getting sinusitis:
- A recent cold
- Medication, such as prolonged use of decongestant sprays
- Nasal obstruction due to:
- Polyps
- Deviated septum
- Facial bone abnormalities
- Swollen adenoids
- Cleft palate
- Tumor
- Allergies
- Certain chronic illnesses, including:
- Cystic fibrosis
- Kartagener’s syndrome (a disorder of the cilia throughout the body)
- Wegener's granulomatosis
- AIDS
- Diabetes
- Immobile cila syndrome
- Head injury or a medical condition requiring a tube inserted in the nose
Age
In general, elderly people and young people have a higher risk of developing respiratory tract infections , including sinusitis.
Gender
Women have a greater chance of developing sinusitis than men.
Ethnic Background
Whites and blacks have a higher risk of developing sinusitis than do Hispanics.
Environmental Factors
- Traveling to high altitudes
- Air pollution
- Living in the Midwest or southern United States
Activities
Flying and diving both increase your chance of getting sinusitis.
References:
Bhattacharyya N. Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis. Laryngoscope.2006;116:1-22.
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
References:
Acute sinusitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed September 12, 2008.
Chronic sinusitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed September 12, 2008.
Evans KL. Fortnightly review: diagnosis and management of sinusitis. BMJ.1994;309:1415-1422.
Fagnan LJ. Acute sinusitis: a cost-effective approach to diagnosis and treatment. Am Fam Physician.1998 Nov 15.
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
Zinreich SJ. Progress in sinonasal imaging. Ann Otol Rhinol Largyngol Suppl.2006;196:61-65.
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Tests or Guidelines
There are no screening tests or screening guidelines for the early diagnosis of either acute or chronic sinusitis. Acute sinusitis is a temporary condition that generally is easily treated with medications and often resolves without any treatment. Screening for chronic sinusitis might find affected persons who have no symptoms, but there is no evidence that their health would be improved by presymptomatic treatment for this condition.
References:
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
Sinusitis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/ . Accessed September 12, 2008.
Your doctor will ask about your symptoms. A physical examination may reveal tenderness when your doctor taps or presses over the area of your sinuses or on the teeth in your upper jaw. In many cases of acute sinusitis, your doctor can diagnose sinusitis based on your symptoms and the physical exam. However, in recurrent and chronic sinusitis, other tests may be performed.
These tests may include:
Transillumination
This simple procedure involves shining a bright light (as from a flashlight) over your cheek in a dark room. If no light illuminates certain areas of your face, then it’s likely that you have a sinus infection. This test, though, is not very reliable and is not commonly performed.
Nasal Culture
Your doctor might send a sample of your nasal discharge to a laboratory, where it can be tested for the presence of bacteria. Accurate evaluation of a nasal culture usually requires that the culture be obtained during nasal endoscopy. Some patients with chronic sinusitis may benefit from nasal culture. However, if you are healthy and have acute sinusitis, a nasal culture is usually not done.
Nasal Cytology
Your doctor might send a sample of your nasal discharge to a laboratory to help determine other causes of your sinusitis.
Sinus X-ray
X-rays of the sinuses are of limited use for diagnosing the presence of sinusitis within certain sinuses. Infection in other pairs of sinuses (such as the ethmoid sinuses) may require other types of imaging tests.
CT scan
This type of imaging study can be very useful for diagnosing sinusitis, including in those areas not well visualized by sinus x-rays. CT scans are particularly effective for diagnosing chronic sinusitis.
Magnetic Resonance Imaging (MRI)
Your doctor may order this test if a tumor or fungal infection is suspected. Overall, MRI is not very helpful for diagnosing this condition.
Sweat Chloride Test
This is a test for cystic fibrosis in children who also have polyps and/or infection caused by Pseudomonasorganisms.
Blood Tests for Immune Function
These tests may be requested by your doctor if you have recurrent or chronic sinusitis.
Cilary Function
This is a specialized test performed if all other tests fail to identify the cause of recurrent, chronic sinusitis.
Sinus Puncture
If there’s some confusion about your diagnosis, your doctor may choose to send you to a specialist to have a sinus puncture performed. This involves using a needle to remove a bit of fluid from within your sinuses. This fluid will then be sent to a lab to identify the infecting bacteria and to determine the most effective type of antibiotic for treatment. In most cases, nasal endoscopy with culture provides the same amount of information with less discomfort.
Nasal Endoscopy
This procedure uses a slim, flexible tube with a fiberoptic light at the end (endoscope). It is inserted into your nose. Your doctor can inspect the the mucosa of the nose and the openings of the sinuses. If indicated, he can also take samples or biopsies through the endoscope for lab examination to look for fungus, tumor, or other uncommon cause of your sinusitis.
The following actions may help to reduce your risk of sinusitis:
Stop Smoking
Smoking interferes with the normal defenses in your respiratory tract that protect against infection. If you stop smoking , your respiratory tract will slowly heal itself. Ask your doctor about programs and nicotine replacement systems that can help you stop smoking.
Furthermore, exposure to both second-hand smoke and air pollution can make you more prone to sinusitis. Avoid both types of exposures to improve your respiratory health.
Avoid Infections
Although there is no evidence that you can avoid getting sinus infections, here are some basic steps that may help you avoid infections in general:
- Wash your hands frequently and thoroughly.
- Do not have close contact with people who are ill.
- Avoid exposure to toxic or damaging fumes.
- Eat a healthful diet .
- Manage stress .
- Begin a safe exercise program with the advice of your doctor.
Filter and Humidify the Air
Keeping your air humidified may help prevent your sinuses and respiratory tract from becoming overly dry. This may help reduce your chance of developing sinusitis. Furthermore, you may wish to use an air purifier to keep the air you breathe as clean as possible. These measures may improve your respiratory health.
Treat Your Allergies
If you suspect that you have allergies , get tested and talk to your doctor about treatment. Keeping your allergy symptoms to a minimum can help you decrease your susceptibility to respiratory tract infections, including sinusitis.
Discuss Sinus Surgery
Corrective surgery for deviated septum or surgical removal of the blockage in your sinus will prevent future episodes of chronic or recurrent sinusitis.
Use Nasal Decongestant Spray
If you’ve had trouble with sinusitis after flying, talk to your doctor about using a nasal decongestant spray 15 minutes before takeoff and landing. If possible, avoid flying when you have a cold .
References:
Rakel RE, Bope ET. Conn’s Current Therapy.54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Sinus infection (sinusitis). National Institute of Allergy and Infectious Diseases website. Available at: http://www3.niaid.nih.gov/topics/sinusitis/ . Accessed September 12, 2008.
Sinusitis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/ . Accessed September 12, 2008.
American Academy of Otolaryngology—Head and Neck Surgery
Address:
One Prince St.
Alexandria, VA 22314
Phone:
1-703-836-4444
Internet address:
http://www.entnet.org/
Description of services provided:
This website has a lot of material (in both English and Spanish) on various head and neck conditions, including sinusitis. Also provided are short descriptions of recent head and neck topics in the news, with links to other websites for more extensive reporting on these topics. An online service called “Find an Otolaryngologist” helps you locate a head and neck surgeon in your community.
American Rhinologic Society
Address:
9 Sunset Terrace
Warwick, NY 10990
Phone:
1-845-988-1631
Internet address:
http://www.american-rhinologic.org/
Description of services provided:
This website has several fact sheets covering information about sinusitis and other conditions that affect the sinuses. You can also look up information on current research studies on sinus conditions.
National Institute of Allergy and Infectious Diseases
Address:
NIAID Office of Communications & Public Liaison
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
Phone:
301-496-5717
Internet address:
http://www.niaid.nih.gov/
Description of services provided:
Look here for information about a variety of allergic, infectious, and skin conditions, including sinusitis. This site also contains information on research studies.
Joint Council of Allergy, Asthma, and Immunology
Address:
50 North Brockway, suite 3.3
Palatine, IL 60067
Phone:
1-847-934-1918
Internet address:
http://www.jcaai.org/
Description of services provided:
The Joint Council of Allergy, Asthma, and Immunology (JCAAI) is developed to keep healthcare providers updated on socio-economic issues that affect the field. While the site is designed for JCAAI members, you can access the list of web resources and some articles.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with sinusitis. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your doctor
About Sinusitis
- How can I tell if my symptoms are due to a cold, allergies, or sinusitis?
- Do I need to undergo any tests to definitively diagnose sinusitis?
- If I have sinusitis, am I contagious to other people?
About Your Risk of Developing Sinusitis
- Do I have a higher risk of developing sinusitis if I smoke?
- Do any of my other medical conditions or medicines make me more susceptible to sinusitis?
- What can I do to avoid developing sinusitis while flying, swimming, or climbing in high altitudes?
About Treatment Options
- Do I need an antibiotic?
- Can I use a decongestant for comfort?
- Will an oral decongestant interact with any of the other medicines I take?
- Could a decongestant cause a problem with any of my other medical conditions?
- How long is it safe to use a nasal decongestant spray?
- If I have recurring sinusitis, at what point might you recommend surgery?
- Am I a candidate for functional endoscopic sinus surgery?
- What are its potential complications?
- Are there any alternative or complementary therapies that you recommend?
About Lifestyle Changes
- Can you give me advice or referrals to programs to help me stop smoking?
- Are there any other lifestyle changes I can make to improve my immune system’s ability to fight off infection?
About Your Outlook
- How likely is it that my sinusitis will recur?
- What kinds of complications of sinusitis should I be on the lookout for?
