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 viral, bacterial, or (rarely) fungal infection of fluid in the sinus cavities. Infections are usually associated with acute sinusitis more than chronic.

Risk Factors

Factors that may increase your 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
• Abnormalities of the facial bones, sinuses, or nasal passages, such as:
  • Deviated septum
  • Nasal polyps
  • Cleft palate
  • Large adenoids
• Certain chronic illnesses, including:
  • Cystic fibrosis
  • Kartagener's syndrome (a chronic lung disease) and immotile cilia syndrome
  • Granulomatosis with polyangiitis —rare disease that causes blood vessel walls to become inflamed
  • Sarcoidosis
• HIV infection and other disorders of the immune system
• Diabetes
• Head injury or a medical condition requiring a tube to be inserted into the nose
• Cocaine and other drugs inhaled through the nose

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
• Initial improvement with sudden worsening of symptoms over the course of a few weeks

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

Most sinus infections are caused by a virus and will pass on their own in 7-10 days. Home care and medications can help manage symptoms.

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

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
  • Stick with your allergy 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.