Sinusitis

(Sinus Infection)

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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

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Definition

Sinusitis is the inflammation and infection of the sinus cavities. The sinus cavities are air-filled spaces in the skull.

Acute sinusitis lasts for less than three weeks. Chronic sinusitis usually lasts for at least 3-8 months, but can last much longer. You are considered to have recurrent sinusitis if you have repeated bouts of acute sinusitis.

Causes

Sinusitis is caused by bacterial or fungal infection of the sinus cavities. The most common organisms to cause sinusitis include:

• Streptococcus pneumoniae
• Haemophilus inflenzae
• Moraxella catarrhalis
• Staphylococcus aureus
• Aspergillus fungi

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Recent cold or flu
• Asthma
• Regular exposure to second-hand smoke
• Allergies, particularly hay fever
• Frequent middle ear infections as a child
• Abnormalities of the facial bones or nasal passages, such as:
  • Deviated septum
  • Nasal polyps
  • Cleft palate
  • Large adenoids
• Certain chronic illnesses, including:
  • Cystic fibrosis
  • Kartagener's syndrome
  • Wegener's granulomatosis
• HIV infection
• Diabetes
• Taking antibiotics or steroids for another medical condition
• Head injury or a medical condition requiring a tube inserted in the nose

Symptoms

Symptoms include:

• Nasal congestion
• Runny nose or post-nasal drip
• Thick, yellow or green mucus
• Cough, often worse at night
• Ear pain
• Headache
• Fever
• Pain and/or pressure sensation in the jaw, around the eye or cheekbone, or around the teeth that increase when you bend over or press on the area
• Bad breath
• Bad taste in your mouth

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Sinusitis is usually diagnosed based on its symptoms and tenderness of the sinuses when pressed.

Tests may include:

• Sinus x-rays
• CT scan or MRI scan of the sinuses
• Holding a flashlight up to the sinuses in a dark room to see if they are illuminated
• Endoscopic examination of the sinuses – threading a tiny, lighted tube into the sinus cavities to view the sinuses
• Removing sinus fluid through a needle for testing (rare)

Treatment

Fluids

Drinking lots of fluids can help keep your nasal secretions thin. This will help avoid plugging up your nasal passages and sinuses.

Steam Treatments

Consider keeping a humidifier running in your bedroom. Fill a bowl with steaming water every couple of hours, and make a steam tent with a towel over your head so that you can breathe in the steam.

Decongestants

Use either decongestant pills or nasal sprays to try to shrink nasal passages. Don't use nasal sprays for longer than 3-4 days in a row.

Antibiotics

Your doctor may decide to give you antibiotics if the infection seems to be caused by bacteria.

Nasal Irrigation

Various devices are available to allow you to run a salt-water solution through your nose and into your sinuses.

Over-the-counter Pain Medication

You can use acetaminophen, ibuprofen, or aspirin to treat sinus pain.

Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving a child aspirin.

Guaifenesin-containing Cough Medicines

These can help you cough up secretions.

Surgical Procedures

Surgery is a last resort for people with very troublesome, serious chronic sinusitis. It includes:

• Repair of a deviated septum
• Removal of nasal polyps
• Functional endoscopic sinus surgery – a lighted scope is used to enlarge the sinuses to improve drainage

Prevention

If you have a tendency to get sinusitis following a cold or allergy attack, try these preventive measures:

• Have allergy testing to determine what things you are allergic to and to learn how to treat your allergies.
• Avoid substances you know you are allergic to.
• If you have allergies, consider using cortisone nasal spray or antihistamines to decrease inflammation of your nasal passages.
• If you get a cold, drink lots of fluids.
• If you get a cold, use a decongestant (either pills or nasal spray).
• Blow your nose gently, while pressing one nostril closed.
• Try not to fly in an airplane when you are congested. If you must fly, use a nasal spray decongestant to decrease inflammation prior to take-off and landing.
• Use a humidifier when you have a cold, allergic symptoms, or sinusitis.
• Consider getting HEPA filters for your furnace and vacuum cleaner to remove allergens from the air.
• Avoid cigarette smoke.

Organizations

American Academy of Otolarngology – Head and Neck Surgery
http://www.entnet.org/

SOURCES:

American Academy of Otolaryngology – Head and Neck Surgery

Principles and Practice of Infectious Diseases, 5th ed. Churchill Livingstone, Inc., 2000.

National Institute of Allergy and Infectious Disease

Conn's Current Therapy 2001, 53rd ed. W. B. Saunders Company, 2001.

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Last reviewed June 2001 by Medical Review Board