Sinusitis (Sinus Infection)

Definition

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

Acute sinusitis lasts for less than three weeks. Chronic sinusitis is diagnosed when symptoms last for at least three months. You are considered to have recurrent sinusitis if you have repeated bouts of acute sinusitis.

Causes

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

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

Risk Factors

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

Risk factors for sinusitis include:

• Recent viral infection
• Smoking or exposure to second-hand smoke
• Other sources of indoor or outdoor air pollution
• Allergies , particularly hay fever
• 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 (a chronic lung disease)
  • Wegener's granulomatosis (rare disease that causes the walls of blood vessels to become inflamed)
  • Asthma
  • Sarcoidosis
• HIV infection
• Diabetes
• Head injury or a medical condition requiring a tube inserted in the nose

Symptoms

Symptoms of sinusitis may include:

• Nasal congestion not responding well to either decongestants or antihistamines
• Runny nose or postnasal drip
• Thick, yellow, or green mucus
• Cough, often worse at night
• Ear pain, pressure, or fullness
• Headache
• Fever
• Dental pain
• Facial pain or pressure that increases when you bend over or press on the area
• Facial congestion or fullness
• Bad breath
• Fatigue

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:

• Holding a flashlight up to the sinuses to see if they are illuminated
• CT scan of the sinuses—a type of x-ray that uses a computer to make pictures of structures inside the head
• 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)

The diagnosis of acute sinusitis is most certain when a history of 10 or more days of colored mucus is combined with tenderness over the sinuses and visible mucus on inspection of the nose. Most doctors do not find further testing necessary or helpful in the management of uncomplicated acute sinusitis.

Treatment

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 and 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.