Sinusitis (Sinus Infection)

What is Sinusitis?

Sinusitis means your sinuses are infected or inflamed. Your sinuses are hollow air spaces within the bones surrounding the nose. They produce mucus, which drains into the nose. If your nose is swollen, this can block the sinuses and cause pain and infection.

What Causes Sinusitis?

Sinusitis can be acute, lasting for less than four weeks, or chronic, lasting much longer. Acute sinusitis often starts as a cold, which then turns into a bacterial infection. Allergies, pollutants, nasal problems and certain diseases can also cause sinusitis.

What are the Symptoms of Sinusitis?

Symptoms of sinusitis can include fever, weakness, fatigue, cough and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip. Treatments include antibiotics, decongestants and pain relievers. Using heat pads on the inflamed area, saline nasal sprays and vaporizers can also help.

National Institute of Allergy and Infectious Diseases

Source: http://www.nlm.nih.gov/medlineplus/sinusitis.html

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More Sinusitis Information

Sinusitis refers to inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.

See also: Chronic sinusitis

Causes

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes) that are lined with mucus membranes. Healthy sinuses contain no bacteria or other germs. Usually, mucus is able to drain out and air is able to circulate.

When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.

Sinusitis can occur from one of these conditions:

• Small hairs (cilia) in the sinuses, which help move mucus out, do not work properly due to some medical conditions.
• Colds and allergies may cause too mucuh mucus to be made or block the opening of the sinuses.
• A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

Sinusitis can be:

• Acute -- symptoms last 2 - 8 weeks
• Chronic -- symptoms last much longer

Acute sinusitis is caused by damage to the lining of the sinuses from surgery or infections. Chronic sinusitis may be caused by bacteria or a fungus.

The following may increase your risk or your child's risk of developing sinusitis:

• Allergic rhinitis or hay fever
• Cystic fibrosis
• Day care
• Diseases that prevent the cilia from working properly, such as Kartagener syndrome and immotile cilia syndrome.
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Tooth infections (rare)
• Weakened immune system from HIV or chemotherapy

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Symptoms

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

• Bad breath or loss of smell
• Cough, often worse at night
• Fatigue and generally not feeling well
• Fever
• Headache -- pressure-like pain, pain behind the eyes, toothache, or facial tenderness
• Nasal congestion and discharge
• Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 8 weeks.

Symptoms of sinusitis in children include:

• Cold or respiratory illness that has been improving and then begins to get worse
• High fever, along with a darkened nasal discharge, for at least 3 days
• Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

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Exams and Tests

The doctor will examine you or your child for sinusitis by:

• Looking in the nose for signs of polyps
• Shining a light against the sinus (transillumination) for signs of inflammation
• Tapping over a sinus area to find infection

Regular x-rays of the sinuses are not very accurate for diagnosing sinusitis.

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis. This is usually done by doctor who specializes in ear, nose, and throat problems (ENT).

However, these tests are not very sensitive at detecting sinusitis, and are often considered unnecessary.

A CT scan of the sinuses may also be used to help diagnose sinusitis. If sinusitis is thought to involve a tumor or fungal infection, an MRI of the sinuses may be necessary.

If you or your child has chronic or recurrent sinusitis, other tests may include:

• Allergy testing
• Blood tests for HIV or other tests for poor immune function
• Ciliary function tests
• Nasal cytology
• Sweat chloride tests for cystic fibrosis

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Treatment

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

• Apply a warm, moist washcloth to your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Inhale steam 2 - 4 times per day (for example, sitting in the bathroom with the shower running).
• Spray with nasal saline several times per day.
• Use a humidifier.

Be careful with over-the-counter spray nasal decongestants. They may help at first, but using them beyond 3 - 5 days can actually worsen nasal congestion.

Also, for sinus pain or pressure:

• Avoid flying when you are congested.
• Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
• Try acetaminophen or ibuprofen.

Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:

• Children with nasal discharge, possibly with a cough, that is not getting better after 2 - 3 weeks
• Fever higher than 102.2° Fahrenheit (39° Celsius)
• Severe swelling around the eyes
• Headache or pain in the face

At some point, your doctor will consider prescription medications, antibiotics, further testing, or referral to an ear, nose, and throat (ENT) or allergy specialist.

Other treatments for sinusitis include:

• Allergy shots (immunotherapy) to help prevent the disease from returning
• Avoiding allergy triggers
• Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are swollen structures (such as nasal polyps) or allergies

Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

Surgery to clean and drain the sinuses may also be necessary, especially in patients whose inflammation returns, despite medical treatment. An ENT specialist (also known as an otolaryngologist) can perform this surgery.

Most fungal sinus infections require surgery. Surgical repair of a deviated septum or nasal polyps may prevent the condition from returning.

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Outlook (Prognosis)

Sinus infections are usually curable with self-care measures and medical treatment. If you are having recurrent attacks, you should be checked for underlying causes such as nasal polyps or other problems, such as allergies.

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Possible Complications

Although very rare, complications may include:

• Abscess
• Bone infection (osteomyelitis)
• Meningitis
• Skin infection around the eye (orbital cellulitis)

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When to Contact a Medical Professional

Call your doctor if:

• Your symptoms last longer than 10 - 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

A green or yellow discharge does not necessarily indicate a sinus infection or the need for antibiotics.

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Prevention

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

• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
• Get an influenza vaccine each year.
• Reduce stress.
• Wash your hands often, particularly after shaking hands with others.

Other tips for preventing sinusitis:

• Avoid smoke and pollutants.
• Drink plenty of fluids to increase moisture in your body.
• Take decongestants during an upper respiratory infection.
• Treat allergies quickly and appropriately.
• Use a humidifier to increase moisture in your nose and sinuses.

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Alternative Names

Acute sinusitis; Sinus infection; Sinusitis - acute; Sinusitis - chronic; Rhinosinusitis

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References

Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for management of acute bacterial sinusitis in children 1 to 18 years of age. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006.

Slavin RG, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116:S13-S47.

Wald ER. Sinusitis. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Disease. 3rd ed. Philadelphia, Pa:Churchill Livingstone Elsevier;2008:chap 34.

Rosenfeld RM, Singer M, Jones S. Systematic review of antimicrobial therapy in patients with acute rhinosinusitis. Otolaryngol Head Neck Surg. 2007;137:S32-S45.

Update Date: 4/21/2009

Updated by: Alan Lipkin, MD, Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Source: http://www.nlm.nih.gov/medlineplus/ency/article/000647.htm

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Sinus Infection (Sinusitis)

More Sinusitis Information from the National Institute of Allegiers and Infectious Diseases

Sinusitis means your sinuses are infected or inflamed. Health experts estimate 37 million Americans are affected by sinusitis every year. Healthcare 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 healthcare costs related to sinusitis.

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Understanding Sinusitis

• Overview
• Cause
• Symptoms
• Diagnosis
• Treatment
• Prevention
• Complications
• Research

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Sinusitis Overview

You're coughing, your nose is stuffy, and you feel tired and achy. You think that you might be getting a cold. Later, when the medicines you've been taking to relieve symptoms of the common cold are not working and you've 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 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 cases, which last for 4 weeks or less
• Subacute cases, which last 4 to 12 weeks
• Chronic cases, which last more than 12 weeks and can continue for months or even years
• Recurrent cases, which involve several acute attacks within a year

Health experts estimate 37 million Americans are affected by sinusitis every year. Healthcare 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 healthcare costs related to sinusitis.

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What Are Sinuses?

When people say, "I'm having a sinus attack," they usually are referring to symptoms of congestion and achiness 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 your sinuses.

Air trapped within a blocked sinus, along with pus or other secretions (liquid material) 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.

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Sinusitis Cause

Acute Sinusitis

Most cases of acute sinusitis start with a common cold, which is caused by a virus. Colds can inflame your sinuses and cause symptoms of sinusitis. Both the cold and the sinus inflammation usually go away without treatment within 2 weeks. If the inflammation produced by the cold leads to a bacterial infection, however, then this infection is what health experts call acute sinusitis.

The inflammation caused by the cold results in swelling of the mucous membranes (linings) of your sinuses, and this can lead to air and mucus becoming trapped behind the narrowed openings of the sinuses. When mucus stays inside your sinuses and is unable to drain into your nose, it can become the source of nutrients (material that gives nourishment) for bacteria.

Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in the nose and throat, and the bacteria cause no problems. But when you have a cold, you tend to sniff or to blow your nose, and these actions cause pressure changes that can send bacteria inside the sinuses. If your sinuses then stop draining properly, bacteria that may have been living harmlessly in your nose or throat can begin to multiply in your sinuses, causing acute sinusitis.

People who suffer from allergies that affect the nose (like pollen allergy, also called hay fever), as well as people who may have chronic nasal symptoms not caused by allergy, are also prone to develop episodes of acute sinusitis. The chronic nasal problems cause the nasal membranes to swell, and the sinus passages become blocked in a manner similar to that described above for the common cold. The normally harmless bacteria in the nose and throat again lead to acute sinusitis.

Rarely, 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 fungus. However, in people whose immune system is not functioning properly, fungus, such as Aspergillus, can cause acute sinusitis. (Aspergillus is commonly found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation.)

In general, people who have reduced immune function (such as those with primary immune deficiency disease or HIV infection) or abnormalities in mucus secretion or mucus movement (such as those with cystic fibrosis) are more likely to suffer from sinusitis.

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Chronic Sinusitis

In chronic sinusitis, the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed. Most experts now use the term "chronic rhinosinusitis" to describe this condition, and they also recommend that the condition be divided into rhinosinusitis with or without nasal polyps. Nasal polyps are grape-like growths of the sinus membranes that protrude into the sinuses or into the nasal passages. Polyps make it even more difficult for the sinuses to drain and for air to pass through the nose.

The causes of chronic sinusitis are largely unknown. The condition often occurs in people with asthma, the majority of whom have allergies. It is possible that constant exposure to inhaled allergens that are present year-round, such as house dust mites, pets, mold (a kind of fungus), and cockroaches cause chronic inflammation of the nose and the sinuses.

An allergic reaction to certain fungi may be responsible for at least some cases of chronic sinusitis; this condition is called "allergic fungal sinusitis." At least half of all people with chronic rhinosinusitis do not have allergies, however.

Most health experts believe that chronic rhinosinusitis is not an infectious disease (like acute sinusitis). If you suffer frequent episodes of acute sinusitis, however, you may be prone to develop chronic rhinosinusitis. Other causes of chronic rhinosinusitis may be an immune deficiency disorder (for example, primary immune deficiency disease or HIV infection) or an abnormality in the quality of mucus produced by the respiratory system (cystic fibrosis).

Another group of people who may develop chronic sinusitis are those with significant anatomic (structure) variations inside the nose, such as a deviated septum, that lead to blockage of mucus.

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Sinusitis Symptoms

One of the most common symptoms of sinusitis is pain, and the location depends on which sinus is affected.

• If you have a pain in your forehead over the frontal sinuses when you are touched, your frontal sinuses may be inflamed.
• If your upper jaw and teeth ache, and your cheeks become tender to the touch, you may have an infection in the maxillary sinuses.
• If you have swelling of the eyelids and tissues around your eyes, and pain between your eyes, you may have inflammation of the ethmoid sinuses that are near the tear ducts in the corner of your eyes. Ethmoid inflammation also can cause a stuffy nose, a loss of smell, and tenderness when you touch the sides of your nose.
• If you have earaches, neck pain, and deep achiness at the top of your head, you may have infection in the sphenoid sinuses, although these sinuses are less frequently affected.

Most people with sinusitis have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.

In addition to the pain, people with sinusitis frequently have thick nasal secretions that are yellow, green, or blood-tinged. Sometimes these secretions, referred to as post-nasal drip, drain in the back of the throat and are difficult to get rid of. Also, acute and chronic sinusitis are strongly associated with nasal symptoms such as a stuffy nose, as well as with a general feeling of fullness over the entire face.

Less common symptoms of sinusitis can include

• Tiredness
• Decreased sense of smell
• Cough that may be more severe at night
• Sore throat
• Bad breath
• Fever

On rare occasions, acute sinusitis can result in brain infection and other serious complications.

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Sinusitis 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 goes away without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than a cold.

Your healthcare provider can usually diagnose acute sinusitis by noting your symptoms and doing a physical examination, which includes examining your nasal tissues. If your symptoms are vague or persist, your healthcare provider may order a computed tomography (CT) scan, a form of X-ray, to confirm that you have sinusitis.

Laboratory tests your healthcare provider may use to diagnose chronic sinusitis include

• Blood tests to rule out conditions associated with sinusitis, like an immune deficiency disorder
• A sweat test or a blood test to rule out cystic fibrosis
• Tests on the material that is inside your sinuses to detect bacterial or fungal infection
• Biopsy of the membranes (linings) of the nose or sinuses to determine the health of the cells lining these cavities

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Sinusitis Treatment

After diagnosing sinusitis and identifying a possible cause, your healthcare provider can suggest various treatments.

Acute Sinusitis

If you have acute sinusitis, your healthcare provider may recommend

• Antibiotics to control a bacterial infection, if present
• Pain relievers to reduce any pain
• Decongestants to reduce congestion

Even if you have acute sinusitis, your provider may choose not to use an antibiotic because many cases of acute sinusitis will end on their own. But if you do not feel better after a few days you should contact your provider again.

You should use over-the-counter or prescription decongestant nose drops and sprays only for few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages.

If you have an allergic disease along with sinusitis, you may also need medicine to control allergies. This may include a nasal steroid spray that reduces the swelling around the sinus passages and allows the sinuses to drain. If you already have asthma and then get sinusitis, your asthma may worsen. You should stay in close touch with your healthcare provider to modify your asthma treatment if needed.

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Chronic Sinusitis

Healthcare providers often find it difficult to treat chronic sinusitis successfully. The two main forms of treatment that are used, nasal steroid sprays and long courses of oral antibiotics, alone or in combination, have not been rigorously tested in chronic sinusitis. Scientists need to do more research to determine what the best treatment is.

Many healthcare providers also recommend using saline (saltwater) washes or sprays in the nose to help remove thick secretions and allow the sinuses to drain.

If you have severe chronic sinusitis, your healthcare 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.

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Surgery

When medicine fails, surgery may be the only alternative for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. During surgery, which is usually done through the nose, the surgeon

• Enlarges the natural opening of the sinuses
• Removes any polyps
• Corrects significant anatomic deformities that contribute to the obstruction

Most people have fewer symptoms and better quality of life after surgery. In a substantial number of people, however, problems can recur after surgery, sometimes even after a short period of time.

In children, surgeons can sometimes eliminate sinus problems by removing adenoids (tissue in the back of the throat) that obstruct the nasal-sinus passages.

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Sinusitis Prevention

There are no methods that have been scientifically tested and proven to prevent acute or chronic sinusitis. However, your healthcare provider may recommend a variety of measures that may provide you with some benefit.

• Keep your nose as moist as possible with frequent use of saline (salt) sprays.
• Avoid very dry indoor environments and use a humidifier, if necessary. But be aware that if you have allergies to molds, house dust mites, or cockroaches, a humid environment may also create problems.
• Avoid exposure to irritants, such as cigarette and cigar smoke or strong odors from chemicals.
• Avoid exposure to anything you're allergic to. If you have not been tested for allergies and you are getting frequent sinus infections, ask your healthcare provider to give you an allergy evaluation or to refer you to an allergy specialist.
• Avoid long periods of swimming in pools treated with chlorine, which irritates the lining of the nose and sinuses.
• Avoid water 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 the eustachian tubes in your ears. As a result, you might feel discomfort in your sinuses or middle ear during the plane's ascent or descent. Some health experts recommend using decongestant nose drops or sprays before a flight to avoid this problem.

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Sinusitis Complications

On rare occasions, acute sinusitis can result in brain infection and other serious complications.

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Sinusitis Research

At least two-thirds of sinusitis cases are caused by two bacteria, Streptococcus pneumoniae and Haemophilus influenzae. These bacteria also can cause otitis media (middle ear infection) in children as well as pneumonia and acute worsening of chronic bronchitis in people of all ages. The National Institute of Allergy and Infectious Diseases (NIAID) is supporting many studies to better understand how these bacteria infect as well as to identify potential candidates for future vaccine strategies that could eliminate these diseases.

A project supported by NIAID is developing an advanced "sinuscope" that will permit improved airway evaluation during a medical examination, especially when a doctor is considering surgical intervention.

Scientific studies have shown a close relationship between having asthma and sinusitis. For example, the vast majority of people with moderate to severe asthma also have chronic sinusitis. Health experts have suggested that chronic sinusitis and asthma may be the same disease manifested in two parts of the respiratory system: upper and lower.

NIAID conducts and supports research on asthma that will lead to a better understanding of the causes behind chronic bronchial inflammation in asthma. This will advance our understanding of the causes of chronic sinusitis and lead to the development of more effective treatments and ways to prevent the disease.

Scientists supported by NIAID and other institutions are also investigating whether chronic sinusitis has genetic causes. They have found that certain alterations in the gene that causes cystic fibrosis may increase the likelihood of developing chronic sinusitis. This research is giving scientists new insights into the cause of the disease in some people and points to new strategies for diagnosis and treatment.

Other NIAID-supported research is examining whether chronic sinusitis can be caused by an unusual reaction to fungi normally found inside the nose and the sinuses. One study has recently shown that when blood cells from people with chronic sinusitis are exposed to fungal material, those cells make chemicals that produce inflammation. This raises the possibility that fungi may play a role in some cases of chronic sinusitis. NIAID is supporting trials of antifungal drugs to determine whether, and for whom, this new treatment strategy holds promise.

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