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Sinusitis

(Sinus Infection; Acute Sinusitis; Chronic Sinusitis; Rhinosinusitis)

Definition

Sinusitis is inflammation of the sinus cavities. The sinus cavities are air-filled spaces in the skull. It may be:

  • Acute—lasts for less than 4 weeks
  • Subacute —lasts 4 to 12 weeks
  • Chronic—if symptoms last for more than 3 months
  • Recurrent—if you have repeated bouts of acute sinusitis

Causes

Acute sinusitis is often caused by an infection. It may be viral, bacterial, or fungal (rare). Chronic sinusitis may happen in people who are at higher risk of infection. It may also be due to irritation from contaminants in the air like smoking, pollution, or allergens.

Risk Factors

Factors that may increase the chance of sinusitis include:

  • Recent viral infection
  • Smoking or exposure to second-hand smoke
  • Other sources of indoor or outdoor air pollution
  • Allergies or asthma
  • Head injury or a medical condition requiring a tube to be inserted into the nose
  • Cocaine and other drugs inhaled through the nose

Problems with structures around the face may increase the risk of sinusitis. Examples include:

Chronic illnesses the increase risk 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
  • Symptoms seem to improve then suddenly get worse over a few weeks

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor can diagnose sinusitis based on its symptoms and exam. More tests may be done if sinusitis is not responding to treatment or keeps coming back. Tests may include:

  • 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

Treatment

Most sinus infections will pass on their own in 7 to 10 days. Home care and medicine can help to manage symptoms.

Infections that last longer or keep coming back may need more care.

Home Care

Congestion in the nasal and sinus passages cause pressure and pain. It can be loosened with:

  • Drinking throughout the day
  • Nasal and sinus washes
  • Steam treatments—such as use of humidifier or inhaling steam from bowl of hot water

Medications

Medicine may help manage symptoms until the sinusitis passes. Options may include:

  • 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—if allergies are related
  • Corticosteroids nose spray—may decrease swelling in the lining of the nose caused by allergies
  • Decongestants—to shrink nasal passages. Do not use nasal sprays for longer than 3 to 4 days in a row.

Antibiotics are only effective for some sinus infections. They may be recommended if a sinus infection lasts longer than expected or keeps coming back.

Surgery

The doctor may recommend surgery if sinusitis keeps coming back or is severe. Types of surgery that may help are:

  • Repair of a deviated septum
  • Removal of nasal polyps
  • Functional endoscopic sinus surgery—enlarge the sinuses to improve drainage
  • Balloon sinuplasty—to open the sinus passages

Prevention

To help reduce the chance of sinusitis:

  • Learn how to treat allergies.
    • Avoid allergens when possible
    • Stick with allergy treatment plan
  • Drink lots of fluids when a cold is present.
  • Use sinus washes as directed.
  • Blow nose gently.
  • Use a nasal spray decongestant to decrease inflammation while traveling by air. Take it prior to takeoff and landing.
  • Use a humidifier to manage colds or allergies.
  • Use HEPA filters for furnace and vacuum cleaner.
  • Avoid cigarette smoke.
RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org

National Institute of Allergy and Infectious Diseases
https://www.niaid.nih.gov

CANADIAN RESOURCES:

Canadian Allergy, Asthma, and Immunology Foundation
https://www.allergyfoundation.ca

Allergy, Asthma, and Immunology Society of Ontario
http://allergyasthma.on.ca

REFERENCES:

Acute sinusitis in adults. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T902952/Acute-sinusitis-in-adults. Accessed January 29, 2021.

Acute sinusitis in children. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T902949/Acute-rhinosinusitis-in-children. Accessed January 29, 2021.

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 January 29, 2021.

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.dynamed.com/topics/dmp~AN~T115673/Chronic-rhinosinusitis. Accessed January 29, 2021.

Okuyemi KS, Tsue TT. Radiologic imaging in the management of sinusitis. Am Fam Physician. 2002;66(10):1882-1886.

Stewart AE, Vaughan WC. Balloon sinuplasty versus surgical management of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2010;10(3):181-187.

Last reviewed January 2021 by EBSCO Medical Review Board Shawna Grubb, RN  Last Updated: 1/29/2021