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Sinusitis: Causes, Symptoms and Treatment Options

Sinusitis occurs when the linings of the sinuses and cavities of the nose become inflamed. Other common names for this condition are rhinosinusitis and sinus infection. The body has four pairs of hollow sinuses: frontal sinuses (in the forehead), ethmoid sinuses (between the eyes), sphenoid sinuses (behind the eyes) and maxillary sinuses (behind the cheekbones), and any of them can become inflamed. More than 10% of the population are affected by sinusitis each year.

The sinus lining can thicken and swell when conditions such as allergies or colds damage its cells. This may result in blocking the small openings between the nose and the sinuses and inhibiting the free flow of air and mucus. When this happens sinusitis may develop with symptoms such as pain caused by air trapped in the sinuses causing increased pressure on the sinus wall or inflammation and fever as mucus and pus inside the sinuses become breeding grounds for bacteria, viruses or even fungi. If the symptoms persist, further complications may develop, including:

  • Orbital cellulitis – infection of the eye socket, potentially causing vision loss
  • Osteomyelitis – infection of the facial bones
  • Meningitis – infection of the brain lining, which can lead to brain damage
  • Blood vessel complications that can lead to aneurysm and blood clots
  • Chronic nasal and sinus congestion
  • Loss of sense of smell
  • Chronic facial pain
  • Chronic headaches
  • Chronic bad breath

Types of Sinusitis

Sinusitis can be classified according to the duration of the inflammation of each episode as acute or chronic sinusitis and whether or not it is caused by an infection as infectious or non-infectious sinusitis.

Acute Sinusitis

We speak of acute sinusitis when symptoms last fewer than four weeks. A viral infection usually triggers acute sinusitis, which often begins suddenly after a bout with a common cold. However, allergies can also cause acute sinusitis. When several bouts of acute sinusitis occur within 12 months, they are referred to as recurrent sinusitis.

Acute sinusitis usually causes postnasal drainage and discomfort in the eyes, forehead and cheeks. Headache, nasal congestion, toothache, cough and fever are other common symptoms. Many cases of acute sinusitis do not require medical treatment, except for those caused by bacterial infection, which are treated with antibiotics.

Chronic Sinusitis

Most cases of sinusitis are chronic. Chronic sinusitis is characterized by two or more bouts of sinusitis per year, with each of them lasting for at least eight weeks. Episodes of chronic sinusitis can be caused by infections that are treated with antibiotics; or by a chronic inflammatory disorder similar to bronchial asthma which is treated with corticosteroids.

Chronic sinusitis often results from untreated acute sinusitis. Then it has similar symptoms to those of acute sinusitis, except for fever, which is usually not present. In addition, nasal polyps and structural problems in the nose causing cavity blockage and allergies keeping the sinus membranes inflamed for extended periods of time often play a major role in chronic sinusitis.

Infectious Sinusitis

As it was mentioned earlier sinusitis may also be classified as either infectious or non-infectious. Infectious sinusitis is usually caused by a viral infection. Less frequently, it stems from bacterial or fungal growth. Types of infectious sinusitis are:

Viral sinusitis is usually due to an upper respiratory tract infection.

Bacterial sinusitis occurs when bacteria grow inside the sinuses. Swelling and narrowing of the eustachian tube due to inflammation prevents drainage from the middle ear, which may also cause bacterial sinusitis.

Fungal sinusitis is common in people with weakened immune system, allergies to environmental fungi or people who have experienced injuries to the sinuses.

Non-infectious Sinusitis

Non-infectious sinusitis usually stems from allergies (e.g. pollen allergy) or other irritants (e.g. cold air sinusitis) triggering an allergic reaction, which causes the lining of the nose and sinuses to become inflamed.

Causes of Sinusitis

Inflammation of sinuses can be caused by anything that interferes with airflow into the sinuses and mucus drainage out of the sinuses. When the sinuses get blocked, mucus inside the sinus cavity cannot drain to the back of the throat. This provides an ideal breeding ground for viruses and bacteria, resulting in infection. Pus that starts to form has nowhere to drain, thus further exacerbating the situation. Medical conditions that can trigger sinusitis include:

  • Colds, viruses and other respiratory infections
  • Allergies
  • Exposure to fungi
  • Asthma
  • Tumors or growths in the sinuses
  • Sensitivity to environmental factors, including pollutants, cold or damp weather
  • Sensitivity to certain medications such as aspirin
  • Structural abnormalities in the nose and other blockages
  • Overuse of decongestant nasal sprays
  • Dental infections that spread to the sinuses
  • Failure of the cilia to move mucus, which may be due to tobacco smoke and illnesses such as cystic fibrosis, immotile cilia syndrome, Kartagener syndrome and immune deficiency diseases like AIDS.
  • Use of cocaine or other illegal drugs that are snorted

Symptoms of Sinusitis

A sinus headache is one of several symptoms shared by both, acute and chronic sinusitis. This nonvascular headache is caused by pressure build-up in sinus cavities. Other frequent symptoms of sinusitis include:

  • Cold symptoms that last more than a week
  • Aching in the upper teeth or jaw
  • Ear pain
  • Nasal congestion
  • Profuse, thick, mostly green colored nasal discharge
  • Bad-tasting postnasal drip
  • Cough
  • Weakness
  • Fatigue
  • Bad breath
  • Headache when leaning forward
  • Sore throat
  • Reduced sense of smell

Although patients typically have pain or tenderness in more than one location, certain symptoms may help you identify the sinuses which are likely to be affected. These symptoms include:

  • Facial pain when touching the forehead indicates inflammation of the frontal sinuses.
  • Achiness of the upper teeth and jaw and tenderness in the cheeks when touched suggests the presence of infection in the maxillary sinuses (i.e. behind the cheekbones).
  • Neck pain, earaches and a deep ache at the top of the head signals infection of the sphenoid sinuses which are located behind the eyes.
  • Pain between the eyes and swelling of the eyelids and tissues around the eyes is indicative of the inflammation of the ethmoid sinuses which are located between the eyes.

Where symptoms of acute and chronic sinusitis differ include:

  • Duration of symptoms. Acute sinusitis typically lasts less than a month whereas chronic sinusitis can stretch on for months and it tends to recur.
  • Severity of symptoms. Symptoms tend to be more pronounced in acute sinusitis.
  • Fever. Acute sinusitis is often accompanied by low-grade fever, unlike chronic sinusitis.

Certain symptoms of sinusitis may indicate that complications have developed, requiring prompt medical attention. They include:

  • Pain, swelling or redness on the face or around the eyes
  • Fever greater than 38 degrees Celsius (100.5 degrees Fahrenheit)
  • Confusion
  • Stiff neck
  • Severe headache

Diagnosing Sinusitis

An accurate diagnosis can be sometimes difficult because the symptoms of sinusitis are often similar to those of allergies and colds. During the physical examination, a doctor will look for tenderness over the sinus cavities, swelling of the mucous glands, swelling around the eyes, nasal secretions and postnasal drip. You will be asked about recent colds, history of allergies and whether you smoke. Occasionally, a sample of nasal discharge is collected and tested for the presence of bacteria to distinguish infectious from non-infectious sinusitis. The following tests are commonly used to help the doctor diagnose sinusitis:

Nasal endoscopy, also called a rhinoscopy, uses an endoscope (with camera) to visually examine the area where the sinuses and middle ear drain into the nose.

Imaging tests, such as computed axial tomography (CAT) scan or magnetic resonance imaging (MRI), may help define the extent of sinusitis and the degree of blockage.

Fungal cultures may sometimes be performed to identify the presence of fungi or bacteria, though they are not very useful.

Biopsy of the cells lining the nasal cavity may help diagnose fungal infections.

Allergy skin testing. When allergies are a suspected cause of sinusitis, allergy tests may be ordered to identify the type of allergies triggering the symptoms.

Blood tests may be ordered to rule out diseases associated with sinusitis, including cystic fibrosis and immune system deficiencies.

Treatment of Sinusitis

Treatment options depend on whether we are dealing with acute (short-term but more severe) or chronic (milder but long-lasting) sinusitis. Acute sinusitis usually resolves on its own without treatment. If you do need a treatment, your doctor may prescribe decongestants to open the sinuses and reduce the volume of mucus that is present. Treatment with antibiotics may be required to cure an infection caused by bacteria.

Chronic sinusitis is typically more difficult to treat as several different medications may be needed to successfully cure this condition. They may include decongestants, antibiotics, antihistamines, mucus-thinning medications and anti-inflammatory corticosteroid nasal sprays (or oral or injected corticosteroids to relieve inflammation from severe sinusitis). Flushing nose with saltwater or saline before using the nasal corticosteroid spray may help remove mucus and bacteria from the nose and sinuses.

If allergy is the cause of chronic sinusitis, immunotherapy (allergy shots) may help reduce sensitivity to certain allergens. Over-the-counter pain medications may be recommended to relieve sinus headaches and lessen fever.

Alternative Treatments for Sinusitis

There are certain non-drug treatments that may help alleviate symptoms associated with sinusitis, for example by keeping nasal passages moist and thus reducing nasal congestion. These alternative therapies include:

  • Breathing in hot, moist air, such as from steaming water in a bowl, for about ten minutes two to four times a day under a towel over your head.
  • Rinsing nasal cavities with saltwater to help remove mucus and bacteria from the sinuses.
  • Applying hot packs to the face to ease facial pain.

Endoscopic Sinus Surgery

Sometimes surgery may be needed to treat sinusitis. Surgery is an option for patients with physical abnormality that is responsible for symptoms, such as nasal polyps, crookedness in the wall dividing the nostrils or other physical problems. It may also be recommended to other patients as a treatment of last resort when medications have failed. During endoscopic sinus surgery, the natural openings of the sinuses may be enlarged by removing the tissue or shaving away the polyp to facilitate drainage. Serious complications are rare with endoscopic sinus surgery. In children, the removal of nose and throat lymphoid tissue often eliminates the blockage that is causing problems. Surgery may also be needed in patients suffering from some forms of fungal sinusitis to remove the fungus and thus prevent potential damage to the sinuses, eyes or brain.