Sinusitis

Alternative names

Definition

Sinusitis refers to inflammation of the sinuses. This is generally caused by a viral, bacterial, or fungal infection.

The sinuses are air-filled spaces around the forehead, cheeks, and eyes that are lined with mucous membranes. Healthy sinuses are sterile (meaning that they contain no bacteria or other organisms) and open, allowing mucus to drain and air to circulate.

When inflamed, the sinuses become blocked with mucus and can become infected. Each year, over 30 million adults and children get sinusitis.

Sinusitis can be acute (lasting anywhere from 2 to 8 weeks) or chronic, with symptoms lingering much longer.

Causes, incidence, and risk factors

Sinusitis usually follows respiratory infections, such as colds , or an allergic reaction. Some people never get sinusitis, and others develop sinusitis frequently.

Other risks for developing sinusitis include:

• Having asthma
• Overuse of nasal decongestants (rather than continuing to relieve congestion, the problem gets worse when these are used too often or for too long)
• Having a deviated nasal septum, nasal bone spur, or polyp
• Presence of a foreign body in your nose
• Frequent swimming or diving
• Dental work
• Pregnancy
• Changes in altitude (flying or climbing)
• Air pollution and smoke
• Gastroesophageal reflux disease (GERD)

Symptoms

The classic symptoms of acute sinusitis usually follow a cold that does not improve, or one that worsens after 5 to 7 days of symptoms. They include:

Signs and tests

Your doctor will test for sinusitis by:

• Tapping over a sinus area. Tenderness may indicate infection.
• Shining a light against the sinus (called transillumination). If dark, this indicates possible inflammation.

Other tests that might be considered include:

• Viewing the sinuses through a fiberoptic scope
• Ultrasound
• X-ray of the sinuses
• Cultures of the material from the nose

However, these tests are relatively insensitive for detecting sinusitis, and are often considered unnecessary.

A CT scan of the sinuses is a much better test to help diagnose sinusitis. If sinusitis is thought to involve tumor or fungal infections, an MRI of the sinuses may be necessary.

If you have chronic or recurrent sinusitis, further laboratory evaluation may be necessary to look for an underlying disorder. This may involve sweat chloride tests for cystic fibrosis, ciliary function tests, blood tests for HIV or other tests for immunodeficiency, allergy testing, or nasal cytology (checking the cells in the nasal secretions).

Treatment

Try the following measures to help reduce congestion in your sinuses:

Expectations (prognosis)

Sinus infections are usually curable with self-care measures and medical treatment. If you are having recurrent attacks, you should be evaluated for underlying causes (such as nasal polyps or another structural problem).

Complications

Although very rare, complications that may arise include:

• Osteomyelitis -- infection that spreads to the bones in the face
• Meningitis -- infection that spreads to the brain
• Orbital cellulitis -- infection that spreads to the area surrounding the eye
• Abscess
• Blood clot
• The bacteria causing your sinusitis may develop resistance to antibiotics commonly used to treat the infection; this makes it more difficult to find the best treatment for your sinus infection

Calling your health care provider

Call your doctor if:

• Your symptoms last longer than 10 to 14 days or you have a cold that gets worse after 7 days.
• You have a severe headache, unrelieved by over-the-counter pain medicine.
• You have a fever.
• You still have symptoms after taking all of your antibiotics properly.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

Update Date: 10/28/2003