Sinus Facts
Have you ever had a cold or allergy attack that wouldn't go away? If so, there's a good chance you actually had sinusitis. Experts estimate that 37 million people are afflicted with sinusitis each year, making it one of the most common health conditions in America. That number may be significantly higher, since the symptoms of bacterial sinusitis often mimic those of colds or allergies, and many sufferers never see a doctor for proper diagnosis and treatment with an antibiotic.
What is sinusitis?
Acute bacterial sinusitis is an infection of the sinus cavities caused by bacteria. It usually is preceded by a cold, allergy attack, or irritation by environmental pollutants. Unlike a cold, or allergy, bacterial sinusitis requires a physician's diagnosis and treatment with an antibiotic to cure the infection and prevent future complications.
Normally, mucus collecting in the sinuses drains into the nasal passages. When you have a cold or allergy attack, your sinuses become inflamed and are unable to drain. This can lead to congestion and infection. Diagnosis of acute sinusitis usually is based on a physical examination and a discussion of your symptoms. Your doctor also may use x-rays of your sinuses or obtain a sample of your nasal discharge to test for bacteria.
When Acute Becomes Chronic Sinusitis
When you have frequent sinusitis, or the infection lasts three months or more, it could be chronic sinusitis. Symptoms of chronic sinusitis may be less severe than those of acute; however, untreated chronic sinusitis can cause damage to the sinuses and cheekbones that sometimes requires surgery to repair.
Treating Sinusitis
Bacterial sinusitis: Therapy for bacterial sinusitis should include an appropriate antibiotic. If you have three or more symptoms of sinusitis (see chart), be sure to see your doctor for diagnosis. In addition to an antibiotic, an oral or nasal spray or drop decongestant may be recommended to relieve congestion, although you should avoid prolonged use of nonprescription nasal sprays or drops. Inhaling steam or using saline nasal sprays or drops can help relieve sinus discomfort.
Antibiotic Resistance
Antibiotic resistance means that some infection-causing bacteria are immune to the effects of certain antibiotics prescribed by your doctor. Antibiotic resistance is making even common infections, such as sinusitis, challenging to treat. You can help prevent antibiotic resistance. If the doctor prescribes an antibiotic, it is important that you take all of the medication just as your doctor instructs, even if your symptoms are gone before the medicine runs out.
Chronic Sinusitis
If your doctor thinks you have chronic sinusitis, intensive antibiotic therapy may be prescribed. Surgery is sometimes necessary to remove physical obstructions that may contribute to sinusitis.
Sinus Surgery
Surgery should be considered only if medical treatment fails or if there is a nasal obstruction that cannot be corrected with medications. The type of surgery is chosen to best suit the patient and the disease. Surgery can be performed under the upper lip, behind the eyebrow, next to the nose or scalp, or inside the nose itself.
Functional endoscopic sinus surgery (FESS) is recommended for certain types of sinus disease. With the endoscope, the surgeon can look directly into the nose, while at the same time, removing diseased tissue and polyps and clearing the narrow channels between the sinuses. The decision whether to use local or general anesthesia will be made between you and your doctor, depending on your individual circumstances.
Before surgery, be sure that you have realistic expectations for the results, recovery, and postoperative care. Good results require not only good surgical techniques, but a cooperative effort between the patient and physician throughout the healing process. It is equally important for patients to follow pre- and postoperative instructions.
Preventing Sinusitis
As always, an ounce of prevention is worth a pound of cure. To avoid developing sinusitis during a cold or allergy attack, keep your sinuses clear by:
using an oral decongestant or a short course of nasal spray decongestant
gently blowing your nose, blocking one nostril while blowing through the other
drinking plenty of fluids to keep nasal discharge thin
avoiding air travel. If you must fly, use a nasal spray decongestant before take-off to prevent blockage of the sinuses allowing mucus to drain
If you have allergies, try to avoid contact with things that trigger attacks. If you cannot, use over-the-counter or prescription antihistamines and/or a prescription nasal spray to control allergy attacks
Allergy testing, followed by appropriate allergy treatments, may increase your tolerance of allergy-causing substances. If you believe you may have sinusitis, see our tips for sinusitis sufferers.
When to See a Doctor
Because the symptoms of sinusitis sometimes mimic those of colds and allergies, you may not realize you need to see a doctor. If you suspect you have sinusitis, review these signs and symptoms. If you suffer from three or more, you should see your doctor.
A Word about Children
Your child's sinuses are not fully developed until age 20. However, children can still suffer from sinus infection. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Sinusitis is difficult to diagnose in children because respiratory infections are more frequent, and symptoms can be subtle. Unlike a cold or allergy, bacterial sinusitis requires a physician's diagnosis and treatment with an antibiotic to prevent future complications.
The following symptoms may indicate a sinus infection in your child:
a "cold" lasting more than 10 to 14 days, sometimes with low-grade fever
thick yellow-green nasal drainage
post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
headache, usually not before age 6
irritability or fatigue
swelling around the eyes
If despite appropriate medical therapy these symptoms persist, care should be taken to seek an underlying cause. The role of allergy and frequent upper respiratory infections should be considered.
20 Questions about Your Sinuses
Q. How common is sinusitis?
A. More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.
Q. What is sinusitis?
A. Sinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants; chronic sinusitis is characterized by at least four recurrences of acute sinusitis. Either medication or surgery is a possible treatment.
Q. What are the signs and symptoms of acute sinusitis?
A. For acute sinusitis, symptoms include facial pain/pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough not due to asthma (in children). Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, dental pain, and cough.
Acute sinusitis can last four weeks or more. This condition may be present when the patient has two or more symptoms and/or the presence of thick, green or yellow nasal discharge. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection.
Q. How is acute sinusitis treated?
A. Acute sinusitis is generally treated with ten to 14 days of antibiotic care. With treatment, the symptoms disappear, and antibiotics are no longer required for that episode. Oral and topical decongestants also may be prescribed to alleviate the symptoms.
Q. What are the signs and symptoms of chronic sinusitis?
A. Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: facial pain/pressure, facial congestion/fullness, nasal obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus in the nasal cavity, and at times, fever. They may also have headache, bad breath, and fatigue.
Q. What measures can be taken at home to relieve sinus pain?
A. Warm moist air may alleviate sinus congestion. Experts recommend a vaporizer or steam from a pan of boiled water (removed from the heat). Humidifiers should be used only when a clean filter is in place to preclude spraying bacteria or fungal spores into the air. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also helpful in moisturizing nasal passages.
Q. How effective are non-prescription nose drops or sprays?
A. Use of nonprescription drops or sprays might help control symptoms. However, extended use of non-prescription decongestant nasal sprays could aggravate symptoms and should not be used beyond their label recommendation. Saline nasal sprays or drops are safe for continuous use.
Q. How does a physician determine the best treatment for acute or chronic sinusitis?
A. To obtain the best treatment option, the physician needs to properly assess the patient' s history and symptoms and then progress through a structured physical examination.
Q. What should one expect during the physical examination for sinusitis?
A. At a specialist' s office, the patient will receive a thorough ear, nose, and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exist. Facial swelling and redness are generally worse in the morning; as the patient remains upright, the symptoms gradually improve. The physician may feel and press the sinuses for tenderness. Additionally, the physician may tap the teeth to help identify an inflamed paranasal sinus.
Q. What other diagnostic procedures might be taken?
A. Other diagnostic tests may include a study of a mucous culture, endoscopy, x-rays, allergy testing, or CT scan of the sinuses.
Q. What is nasal endoscopy?
A. An endoscope is a special fiber optic instrument for the examination of the interior of a canal or hollow viscus. It allows a visual examination of the nose and sinus drainage areas.
Q. Why does an ear, nose, and throat specialist perform nasal endoscopy?
A. Nasal endoscopy offers the physician specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First, the patient' s nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a position to view the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the physician specialist also looks for pus as well as polyp formation and structural abnormalities that may cause recurrent sinusitis.
Q. What course of treatment will the physician recommend?
A. To reduce congestion, the physician may prescribe nasal sprays, nose drops, or oral decongestants. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). Antihistamines may be recommended for the treatment of allergies.
Q. Will any changes in lifestyle be suggested during treatment?
A. Smoking is never condoned, but if one has the habit, it is important to refrain during treatment for sinus problems. A special diet is not required, but drinking extra fluids helps to thin mucus.
Q. When is sinus surgery necessary?
A. Mucus is developed by the body to act as a lubricant. In the sinus cavities, the lubricant is moved across mucous membrane linings toward the opening of each sinus by millions of cilia (a mobile extension of a cell). Inflammation from allergy causes membrane swelling and the sinus opening to narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus surgery can correct the problem.
Q. What does the surgical procedure entail?
A. The basic endoscopic surgical procedure is performed under local or general anesthesia. The patient returns to normal activities within four days; full recovery takes about four weeks.
Q. What does sinus surgery accomplish?
A. The surgery should enlarge the natural opening to the sinuses, leaving as many cilia in place as possible. Otolaryngologist--head and neck surgeons have found endoscopic surgery to be highly effective in restoring normal function to the sinuses. The procedure removes areas of obstruction, resulting in the normal flow of mucus.
Q. What are the consequences of not treating infected sinuses?
A. Not seeking treatment for sinusitis will result in unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone or bone marrow can occur.
Q. Where should sinus pain sufferers seek treatment?
A. If you suffer from severe sinus pain, you should seek treatment from an otolaryngologist--head and neck surgeon, a specialist who can treat your condition with medical and/or surgical remedies.
SINUSITIS AND ALLERGY
The sinuses are cavities within the skull. They drain into the nose through small holes. Sinusitis means inflammation of the nasal sinuses. Sinusitis is most commonly short-lived, such as after a viral "cold". Blockage of the drainage pathways, however, creates an environment that favours the overgrowth of bacteria resulting in long-term (chronic) sinusitis. Hayfever and polyps are the most common reasons for having recurrent or chronic sinus infection.
What are sinuses?
The sinuses are cavities within the skull. They are present in the forehead cheeks and between and behind the eyes. They are connected to the nose through small tunnels that are little wider than a pinhead. Blockage of these tunnels (due to allergy, colds or polyps) often causes pain in the face. A blocked sinus cavity creates an environment that favors the overgrowth of bacteria, a little how slime grows in stagnant water. It is believed that the main function of nasal sinuses is to warm, moisten and filter the air in the nasal cavity. They also play a role in our ability to make certain sounds when we speak or sing.
Viral "colds" and allergies are the main risk factors for developing sinusitis
Sinusitis means inflammation of the lining of the nasal sinuses. Inflammation may be due to infection, or may have other causes. When infection is the cause, symptoms often follow simple viral colds. These generally last less than 3 weeks (acute sinusitis). Longer-lasting symptoms may indicate nasal allergy or the development of a bacterial sinus infection, complicating the common cold. Other risk factors for developing recurrent or chronic sinusitis include untreated allergies, twisted nasal anatomy, smoking, nasal polyps and overuse of over-the-counter decongestant nasal sprays.
There are many symptoms and signs of sinusitis
Symptoms of sinusitis will vary according to the duration and severity of symptoms and which sinuses are involved. Some or all of the following symptoms may be present. You should see your doctor promptly if these symptoms develop.
- green / yellow mucus coming from the nose or down the back of the throat
- bad breath
- bad taste in the mouth
- sore throat
- losing the sense of smell or taste
- cough
- tiredness
- temperature or shivers
- sore upper teeth
- facial pain (but not always)
- sensation of pressure that is worse with leaning forward.
Untreated allergies are the most common risk factor for developing sinusitis
Allergy causes chronic inflammation and swelling of the lining of the nose, sinuses and the drainage holes that link them. This swelling interferes with the usual efficient clearance of bacteria from the sinus cavity. If one develops a viral "cold" as well, secretions and bacteria are trapped, creating an environment where bacteria grow very well. Allergy treatment will reduce the risk of developing sinusitis.
Environmental irritants also increase the symptoms of sinusitis
People with sinus problems and allergies should avoid environmental irritants such as tobacco, smoke and odours, which may increase symptoms. Twisted nasal anatomy, the presence of nasal polyps, overuse of decongestant nose sprays over the counter from the pharmacy can predispose to infection. Those involved with young children (such as young mums, child care workers and primary school teachers) always seem to have a cold! Diet plays no role in causing or preventing infection. A weak immune system is a very rare cause.
Effective treatment depends on correct diagnosis
Many people wrongly label their allergies as "sinus trouble", but not all of them are troubled by infection. Your doctor will normally ask questions to identify the cause of your problem. This may be followed by physical examination of nasal anatomy and allergy testing (using skin tests or RAST) to help confirm or exclude the presence of allergy as a cause or risk factor for your symptoms. Sometimes other tests such as x-rays of the sinuses or tests of immune function may be needed.
Sinusitis versus Rhinitis
Although many symptoms are similar, it is important that sinusitis is not mistaken for rhinitis. The term rhinitis means inflammation of the lining of the nose. It is often caused by allergies, irritants such as smoke, temperature changes or the overuse of decongestant nasal sprays. Poorly controlled rhinitis can, however, lead to sinusitis.
Early treatment of sinusitis reduces the need for medication
Around half of all sinusitis resolve without antibiotics. Treat symptoms promptly when first noticed often reduces the need for antibiotics. There are three principles of treatment:
Help the sinuses to drain. Salt water irrigation of the nose and sinuses thin mucus and aid sinus drainage. Commercial sprays such as Narium or FESS can be purchased from your pharmacist and used 2 or 3 times per days. Steam inhalations can also help but should be avoided in children as they may suffer from accidental burns. Surgery is sometimes needed when maximal medical therapy fails to help.
Kill the germs. If symptoms persist, appropriate antibiotics should be prescribed for an adequate duration (generally 10 - 14 days for acute sinusitis and 3-4 weeks for chronic sinusitis)
Treat underlying disease. This may involved treating your allergies, stopping smoking or removing nasal polyps.
It is important to note that information contained in this bulletin is not intended to
replace professional medical advice. Any questions regarding a medical
diagnosis or treatment should be directed to a medical practitioner.
References
Joint Task Force on Practice Parameters, Joint Council of Allergy, Asthma and Immunology. Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunology 1998; 102 (6, part 2): s107-144.
Slavin RG. Chronic sinusitis. Immun Allergy Clin N America 1996; 16: 35-47.
Kaliner MA et al. Sinusitis: bench to bedside. J Allergy Clin Immunol 1997; 99: S829-48.
