by Carson-DeWitt R

Sinusitis

(Sinus Infection; Acute Sinusitis; Chronic Sinusitis)

Definition

Sinusitis is inflammation of the sinus cavities. The sinus cavities are air-filled spaces in the skull. It is usually associated with infection.
Sinusitis is called acute if it lasts for less than 4 weeks, subacute if it lasts 4-12 weeks, and chronic if symptoms last for more than 3 months. You may have recurrent sinusitis if you have repeated bouts of acute sinusitis.
Sinus Infection
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Causes

Infectious sinusitis is caused by a bacterial, viral, or (rarely) fungal infection of fluid in the sinus cavities.

Risk Factors

Factors that may increase your chance of sinusitis include:

Symptoms

Sinusitis may cause:
  • Facial congestion or fullness
  • Facial pain or pressure that increases when you bend over or press on the area
  • Headache
  • Cough, which is often worse at night
  • Nasal congestion not responding well to either decongestants or antihistamines
  • Runny nose or postnasal drip
  • Thick, yellow, or green mucus
  • Bad breath
  • Ear pain, pressure, or fullness
  • Fever
  • Fatigue
  • Dental pain

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Sinusitis is diagnosed based on its symptoms and tenderness of the sinuses when pressed.
Tests may include:
  • Holding a flashlight up to the sinuses to see if they light up
  • CT scan or x-ray of the sinuses to look for fluid in the sinus
  • Endoscopic examination of the sinuses—threading a tiny, lighted tube into the nasal cavities to view the sinus opening
  • Removing sinus fluid through a needle for testing (rare)
You have may acute sinusitis when the following occurs:
  • History of 10 or more days of colored mucous, or visibly infected mucus
  • Tenderness over the sinuses
  • Fever
  • Difficulty smelling

Treatment

Home Care

  • Hydrating—Drinking lots of fluids may keep your nasal secretions thin. This will avoid plugging up your nasal passages and sinuses. Saline nasal sprays or irrigation may also loosen nasal secretions.
  • Using steam treatments—Keep a humidifier running in your bedroom. Fill a bowl with steaming water every couple of hours. Make a steam tent with a towel over your head. This will let you breathe in the steam.
  • Nasal and sinus washes.

Medications

  • Antibiotics—Used to treat bacterial infections.
  • Over-the-counter pain relievers.
    • Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
  • Antihistamines—Help sinusitis symptoms if they are caused by allergies.
  • Intranasal corticosteroids—These are inhaled directly into your nose through a nasal spray. Corticosteroids may help relieve congestion by decreasing swelling in the lining of the nose in people with allergies.
  • Decongestants—Use either decongestant pills or nasal sprays to shrink nasal passages. Do not use nasal sprays for longer than 3-4 days in a row.
  • Guaifenesin—Helps you cough up secretions, but hydration is more effective.

Surgery

Surgery is a last resort for people with very troublesome, serious chronic sinusitis. It includes:
  • Repair of a deviated septum
  • Removal of nasal polyps
  • Functional endoscopic sinus surgery—a lighted scope is used to enlarge the sinuses to improve drainage
  • Balloon sinuplasty—a tube with a balloon attached is inserted into the sinuses (the balloon is inflated to open the sinus passages)

Prevention

To help reduce your chance of sinusitis:
  • Have allergy testing to find out what things you are allergic to and to learn how to treat your allergies.
  • Avoid substances you know you are allergic to.
  • If you have allergies, stick with your treatment plan.
  • If you get a cold, drink lots of fluids and use a decongestant.
  • Use sinus washes as directed.
  • Blow your nose gently, while pressing one nostril closed.
  • If you must travel by air, use a nasal spray decongestant to decrease inflammation prior to takeoff and landing.
  • Use a humidifier when you have a cold, allergic symptoms, or sinusitis.
  • Use HEPA filters for your furnace and vacuum cleaner to remove allergens from the air.
  • Avoid cigarette smoke.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov

CANADIAN RESOURCES

Allergy Asthma Information Association
http://aaia.ca
Calgary Allergy Network
http://www.calgaryallergy.ca

References

Acute sinusitis in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 4, 2014. Accessed September 29, 2014.
Acute sinusitis in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 7, 2014. Accessed September 29, 2014.
Allergic rhinitis, sinusitis, and rhinosinusitis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/allergic-rhinitis-sinusitis-and-rhinosinusitis. Accessed September 29, 2014.
Aring AM, Chan MM. Acute rhinosinusitis in adults. Am Fam Physician. 2011;83(9):1057-1063.
Chronic rhinosinusitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 14, 2014. Accessed September 29, 2014.
Mandell GL, Douglas RG, et al. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone, Inc; 2000.
Okuyemi KS, Tsue TT. Radiologic imaging in the management of sinusitis. Am Fam Physician. 2002;66(10):1882-1886.
Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
Sinusitis (sinus infection). National Institute of Allergy and Infectious Disease, National Institutes of Health (NIH) website. Available at: http://www.niaid.nih.gov/topics/sinusitis/Pages/index.aspx. Accessed September 29, 2014.
Stewart AE, Vaughan WC. Balloon sinuplasty versus surgical management of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2010;10(3):181-187.
1/10/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: A randomized controlled trial. JAMA. 2007;298(21):2487-2496.
12/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2009;(4):CD005149.

Revision Information

  • Reviewer: David Horn, MD
  • Review Date: 08/2015
  • Update Date: 09/30/2014

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