The Facts about Sinusitis

When someone has sinusitis it means that their sinuses are infected or inflamed, but this gives little indication of the misery and pain this condition can cause. Health care experts usually divide sinusitis cases into three categories:

• Acute, which lasts for 3 weeks or less
• Chronic, which usually lasts for 3 to 8 weeks but can continue for months or even years
• Recurrent, or several acute attacks within a year

Four pairs of sinuses are located within the skull and bones of the head surrounding the nose:

• Frontal sinuses over the eyes in the brow area
• Maxillary sinuses inside each cheekbone
• Ethmoid sinuses just behind the bridge of the nose and between the eyes
• Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes

Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Anything that causes a swelling in the nose - an infection, an allergic reaction, or an immune reaction - also can affect the sinuses.

Air trapped within a blocked sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. When air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.

Symptoms of Sinusitis
The location of your sinus pain depends on which sinus is affected.

• Headache when you wake up in the morning is typical of a sinus problem.
• Pain when your forehead over the frontal sinuses is touched may indicate that your frontal sinuses are inflamed
• Infection in the maxillary sinuses can cause your upper jaw and teeth to ache and your cheeks to become tender to the touch.
• Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes. Ethmoid inflammation also can cause tenderness when the sides of your nose are touched, a loss of smell, and a stuffy nose.
• Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of your head.

Most people with sinusitis have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.

Other symptoms of sinusitis can include fever, weakness, tiredness, a cough that may be more severe at night, and a runny nose or nasal congestion

In addition, the drainage of mucus from the sphenoids or other sinuses down the back of your throat (postnasal drip) can cause you to have a sore throat. Mucus drainage also can irritate the membranes lining your larynx (upper windpipe). Not everyone with these symptoms, however, has sinusitis. On rare occasions, acute sinusitis can result in brain infection and other serious complications.

Causes
Most cases of acute sinusitis start with a common cold, caused by a virus. When air and mucus are trapped behind the narrowed openings of the inflamed sinuses, normal bacteria that may have been living harmlessly in your nose or throat can multiply and invade your sinuses, causing an acute infection.

If you have asthma, an allergic disease, you may have frequent episodes of chronic sinusitis.

If you are allergic to airborne allergens, such as dust, mold, and pollen, which trigger allergic rhinitis, you may develop chronic sinusitis. In addition, people who are allergic to fungi can develop a condition called "allergic fungal sinusitis."

Diagnosis
Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold.

Your doctor can diagnose sinusitis by listening to your symptoms, doing a physical examination, and taking X-rays, and if necessary, an MRI or CT scan.

Treatment
After diagnosing sinusitis and identifying a possible cause, a doctor can suggest treatments that will reduce your inflammation and relieve your symptoms.

Acute sinusitis
If you have acute sinusitis, your doctor may recommend

• Decongestants to reduce congestion
• Antibiotics to control a bacterial infection, if present
• Pain relievers to reduce any pain

You should, however, use over-the-counter or prescription decongestant nose drops and sprays for only few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages.

If bacteria cause your sinusitis, antibiotics used along with a nasal or oral decongestant will usually help. Your doctor can prescribe an antibiotic that fights the type of bacteria most commonly associated with sinusitis.

Many cases of acute sinusitis will end without antibiotics. If you have allergic disease along with infectious sinusitis, however, you may need medicine to relieve your allergy symptoms. If you already have asthma and then get sinusitis, you may experience worsening of your asthma and should be in close touch with your doctor.

In addition, your doctor may prescribe a steroid nasal spray, along with other treatments, to reduce your sinus congestion, swelling, and inflammation.

Chronic sinusitis
Doctors often find it difficult to treat chronic sinusitis successfully, realizing that symptoms persist even after patients take antibiotics for a long period. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis.

Doctors commonly prescribe steroid nasal sprays to reduce inflammation in chronic sinusitis. If you have severe chronic sinusitis, your doctor may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.

Although home remedies cannot cure sinus infection, they might give you some comfort.

• Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities.
• Saline nasal spray, which you can buy in a drug store, can give relief.
• Gentle heat applied over the inflamed area is comforting.

When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life.

The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare.

Prevention
Although you cannot prevent all sinus disorders, you can do certain things to reduce the number and severity of the attacks and possibly prevent acute sinusitis from becoming chronic.

• You may get some relief from your symptoms with a humidifier, particularly if room air in your home is heated by a dry forced-air system.
• Air conditioners help to provide an even temperature.
• Electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.

If you are prone to getting sinus disorders, especially if you have allergies, you should avoid cigarette smoke and other air pollutants. If your allergies inflame your nasal passages, you are more likely to have a strong reaction to all irritants.

If you suspect that your sinus inflammation may be related to dust, mold, pollen, or food-or any of the hundreds of allergens that can trigger an upper respiratory reaction-you should consult your doctor. Your doctor can use various tests to determine whether you have an allergy.

Drinking alcohol also causes nasal and sinus membranes to swell.

If you are prone to sinusitis, it may be uncomfortable for you to swim in pools treated with chlorine, since it irritates the lining of the nose and sinuses. Divers often get sinus congestion and infection when water is forced into the sinuses from the nasal passages.

You might find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head, blocking your sinuses or the eustachian tubes in your ears. Therefore, you might feel discomfort in your sinus or middle ear during the plane's ascent or descent. Some doctors recommend using decongestant nose drops or inhalers before a flight to avoid this problem.

Research
Scientific studies have shown a close relationship between having allergic rhinitis (hay fever) and chronic sinusitis. In fact, some studies state that up to 80% of adults with chronic sinusitis also had allergic rhinitis. There is also an association between asthma and sinusitis. Some researchers think that as many as 75% of people with asthma also get sinusitis. The National Institute of Allergy and Infectious Diseases (NIAID) conducts and supports research on allergic diseases as well as bacteria and fungus that can cause sinusitis. This research is focused on developing better treatments and ways to prevent these diseases.

This information was provided by the National Institute of Allergy and Infectious Diseases.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.