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You’re coughing and sneezing and tired and achy. You
think that you might be getting a cold. Later, when the medicines
you’ve been taking to relieve the symptoms of the common
cold are not working and you’ve now got a terrible
headache, you finally drag yourself to the doctor. After
listening to your history of symptoms, examining your face
and forehead, and perhaps doing a sinus X-ray, the doctor
says you have sinusitis.
Sinusitis simply means your sinuses are infected or inflamed,
but this gives little indication of the misery and pain this
condition can cause. Health experts usually divide sinusitis
cases into • Acute, which last for 4 weeks or less • Subacute,
which lasts 4 to 8 weeks • Chronic, which usually last
up to 8 weeks but can continue for months or even years • Recurrent,
which are several acute attacks within a year, and may be
caused by different organisms
Health experts estimate that 37 million Americans are affected
by sinusitis every year. Health care providers report nearly
32 million cases of chronic sinusitis to the Centers for
Disease Control and Prevention annually. Americans spend
$5.8 billion each year on health care costs related to sinusitis.
What are sinuses?
Sinuses are hollow air spaces in the human body. When people
say, “I'm having a sinus attack,” they usually
are referring to symptoms in one or more of four pairs of
cavities, or sinuses, known as paranasal sinuses .
These cavities, located within the skull or bones of the
head surrounding the nose, include
- 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. Therefore, anything
that causes a swelling in the nose—an infection, an
allergic reaction, or another type of 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. Similarly, 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.
SOME CAUSES OF ACUTE SINUSITIS
Most cases of acute sinusitis start with a common cold,
which is caused by a virus. These viral colds do not cause
symptoms of sinusitis, but they do inflame the sinuses. Both
the cold and the sinus inflammation usually go away without
treatment in 2 weeks. The inflammation, however, might explain
why having a cold increases your likelihood of developing
acute sinusitis. For example, your nose reacts to an invasion
by viruses that cause infections such as the common cold
or flu by producing mucus and sending white blood cells to
the lining of the nose, which congest and swell the nasal
passages.
When this swelling involves the adjacent mucous membranes
of your sinuses, air and mucus are trapped behind the narrowed
openings of the sinuses. When your sinus openings become
too narrow, mucus cannot drain properly. This increase in
mucus sets up prime conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as Streptococcus
pneumoniae and Haemophilus influenzae , in
their upper respiratory tracts with no problems until the
body's defenses are weakened or drainage from the sinuses
is blocked by a cold or other viral infection. Thus, bacteria
that may have been living harmlessly in your nose or throat
can multiply and invade your sinuses, causing an acute
sinus infection.
Sometimes, fungal infections can cause acute sinusitis.
Although fungi are abundant in the environment, they usually
are harmless to healthy people because the human body has
a natural resistance to fungi. Fungi, such as Aspergillus ,
can cause serious illness in people whose immune systems
are not functioning properly. Some people with fungal sinusitis
have an allergic-type reaction to the fungi.
Chronic inflammation of the nasal passages also can lead
to sinusitis. If you have allergic rhinitis, also called
hay fever, you can develop episodes of acute sinusitis. Vasomotor
rhinitis, caused by humidity, cold air, alcohol, perfumes,
and other environmental conditions, also may be complicated
by sinus infections. (Rhinitis simply means runny nose.)
Acute sinusitis is much more common in some people than
in the general population. For example, sinusitis occurs
more often in people who have reduced immune function (such
as those with primary immune deficiency diseases or HIV infection)
and with abnormality of mucus secretion or mucus movement
(such as those with cystic fibrosis).
CAUSES OF CHRONIC SINUSITIS
It can be difficult to determine the cause of chronic sinusitis.
Some health experts think it is an infectious disease, but
others are not certain. It is an inflammatory disease that
often occurs in people with asthma. If you have asthma, which
is an allergic disease, you may have chronic sinusitis which
may make it worse. If you are allergic to airborne allergens,
such as house dust mites, mold, and pollen, which trigger
allergic rhinitis, you may develop chronic sinusitis. An
allergic reaction to certain fungi may be responsible for
at least some cases of chronic sinusitis. In addition, people
who are allergic to fungi can develop a condition called “allergic
fungal sinusitis.”
If you are prone to getting chronic sinusitis, damp weather,
especially in northern temperate climates, or pollutants
in the air and in buildings also can affect you.
If you have an immune deficiency disorder or an abnormality
in the way mucus moves through and from your respiratory
system (for example, primary immune deficiency, HIV infection,
or cystic fibrosis), you might develop chronic sinusitis
with frequent bouts of acute sinusitis due to infections.
In addition, if you have severe asthma, nasal polyps (small
growths in the nose), or a severe asthma attack caused by
aspirin and aspirin-like medicines such as ibuprofen, you
might have chronic sinusitis.
SYMPTOMS
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 mean 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.
- The ethmoid sinuses are near the tear ducts in the corner
of your eyes. Therefore, 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 you touch the sides of your
nose, a loss of smell, and a stuffy nose.
- Infection in the sphenoid sinuses can cause earaches,
neck pain, and deep aching at the top of your head, although
these sinuses are less frequently affected.
Most people with sinusitis, however, have pain or tenderness
in several locations, and their symptoms usually do not clearly
show which sinuses are inflamed.
Other symptoms of sinusitis can include
- Fever
- Weakness
- Tiredness
- A cough that may be more severe at night
- Rhinitis or nasal congestion
In addition, the drainage of mucus from the sphenoid 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.
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 health care provider can usually diagnose acute sinusitis
by listening to your symptoms and doing a physical examination,
which includes examining your nasal tissues. If your symptoms
are vague or persist, your health care provider may order
a CT (computed tomography) scan to confirm that you have
sinusitis.
Laboratory tests to diagnose chronic sinusitis may include
- Blood tests to rule out other conditions associated with
sinusitis like an immune deficiency disorder or cystic
fibrosis
- Cultures (special blood tests) to detect bacterial or
fungal infection
- Biopsy to determine the health of the cells lining the
nasal cavity
TREATMENT
After diagnosing sinusitis and identifying a possible cause,
your health care provider can suggest treatments that will
reduce your inflammation and relieve your symptoms.
Acute sinusitis
If you have acute sinusitis, your health care provider 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
health care provider 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 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 health care provider.
In addition, your health care provider may prescribe a steroid
nasal spray, along with other treatments, to reduce your
sinus congestion, swelling, and inflammation.
Chronic sinusitis
Health care providers often find it difficult to treat chronic
sinusitis successfully, realizing that symptoms persist even
after taking antibiotics for a long period. As discussed
below, many health care providers treat sinusitis with steroids
such as steroid nasal sprays. Many health care providers
treat chronic sinusitis as though it is an infection, by
using antibiotics and decongestants. Others use both antibiotics
along with steroid nasal sprays. Further research is needed
to determine what the best treatment is.
Some people with severe asthma are said to have dramatic
improvement of their symptoms when their chronic sinusitis
is treated with antibiotics.
Health care providers commonly prescribe steroid nasal sprays
to reduce inflammation in chronic sinusitis. Although they
occasionally prescribe these sprays to treat people with
chronic sinusitis over a long period, health experts don’t
fully understand the long-term safety of these medicines,
especially in children. Therefore, health care providers
will consider whether the benefits outweigh any risks of
using steroid nasal sprays.
If you have severe chronic sinusitis, your health care provider
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 most people who undergo surgery have fewer symptoms
and better quality of life.
In children, problems often are eliminated by removing adenoids
obstructing their nasal-sinus passages.
Adults who have had allergies and infections over the years
sometimes develop nasal polyps that interfere with proper
nasal drainage. Removal of these polyps and/or repair of
a deviated septum to ensure an open airway often gives them
considerable relief from sinus symptoms.
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. Surgery should be considered only after failure
of medical treatment.
PREVENTION
Although you cannot prevent all sinus disorders—any
more than you can avoid all colds or bacterial infections—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 house dust mites, mold, pollen, or food—or any of
the hundreds of allergens that can trigger an upper respiratory
reaction—you should consult your health care provider
who can use various tests to find out whether you have an
allergy and if so, its cause. This will help you and your
health care provider take the right steps to reduce or limit
your allergy symptoms.
Other activities that can cause sinus problems include
- Drinking alcohol which causes nasal and sinus membranes
to swell
- Swimming in pools treated with chlorine, which irritates
the lining of the nose and sinuses
- Diving, which forces water into the sinuses from the
nasal passages
You may 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 eustachian tubes in your ears. Therefore,
you might feel discomfort in your sinus or middle ear during
the plane’s ascent or descent. Some health experts
recommend using decongestant nose drops or inhalers before
a flight to avoid this problem.
To read the rest of this article, and related information
from the National Institute of Allergy and Infectious Diseases
(NIAID), please click here: http://www.niaid.nih.gov/factsheets/sinusitis.htm
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