What is sinusitis?
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 care experts usually divide sinusitis cases
into
- Acute, which lasts for 3 weeks or less
- Chronic, which usually lasts for 3 to 8 weeks but can continue
for months or even years
- Recurrent, which is several acute attacks within a year
Health care experts estimate that 37 million Americans are
affected by sinusitis every year. Health care workers report 33
million cases of chronic sinusitis to the U.S. Centers for Disease
Control and Prevention annually. Americans spend millions of dollars
each year for medications that promise relief from their sinus
symptoms.
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 the:
- 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 an
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.
What are the symptoms of sinusitis?
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 indicate that your frontal sinuses are inflammed.
- Infection in the maxillary sinuses can cause your upper jaw
and teeth to ache and your cheeks to become tender to the touch.
- Since the ethmoid sinuses are near the tear ducts in the
corner of the eyes, 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 the sides of your nose are touched, a loss of smell, and a
stuffy nose.
- Although the sphenoid sinuses are less frequently affected,
infection in this area can cause earaches, neck pain, and deep
aching at the top of your head.
Most people with sinusitis, however, have pain or tenderness in
several locations, and their symptoms usually do not clearly
indicate which sinuses are inflamed.
Other symptoms of sinusitis can include
- Fever
- Weakness
- Tiredness
- A cough that may be more severe at night
- Runny nose (rhinitis) or nasal congestion
In addition, the drainage of mucus from the sphenoids 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.
What are 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, indicating that the human body has a natural
resistance to them. 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 or 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.
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 immune
deficiency diseases or HIV infection) and with abnormality of mucus
secretion or mucus movement (such as those with cystic
fibrosis).
What causes chronic sinusitis?
If you have asthma, an allergic disease, you may have frequent
episodes of chronic sinusitis.
If you are allergic to airborne allergens, such as dust, mold,
and pollen, which trigger allergic rhinitis, you may develop chronic
sinusitis. In addition, people who are allergic to fungi can develop
a condition called "allergic fungal sinusitis."
If you are subject to getting chronic sinusitis, damp weather,
especially in northern temperate climates, or pollutants in the air
and in buildings also can affect you.
Like acute sinusitis, you might develop chronic sinusitis if you
have an immune deficiency disease or an abnormality in the way mucus
moves through and from your respiratory system (e.g., immune
deficiency, HIV infection, and cystic fibrosis). In addition, if you
have severe asthma, nasal polyps (small growths in the nose), or a
severe asthmatic response to aspirin and aspirin-like medicines such
as ibuprofen, you might have chronic sinusitis often.
How is sinusitis diagnosed?
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 doctor can diagnose sinusitis by listening to your symptoms,
doing a physical examination, and taking X-rays, and if necessary,
an MRI or CT scan (magnetic resonance imaging and computed
tomography).
How is sinusitis treated?
After diagnosing sinusitis and identifying a possible cause, a
doctor can suggest treatments that will reduce your inflammation and
relieve your symptoms. Acute sinusitis
If you have acute sinusitis, your doctor 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 doctor 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 infectious sinusitis, however,
you may need medicine to relieve your allergy symptoms. If you
already have asthma then get sinusitis, you may experience worsening
of your asthma and should be in close touch with your doctor.
In addition, your doctor may prescribe a steroid nasal spray,
along with other treatments, to reduce your sinus congestion,
swelling, and inflammation. Chronic sinusitis
Doctors often find it difficult to treat chronic sinusitis
successfully, realizing that symptoms persist even after taking
antibiotics for a long period. In general, however, treating chronic
sinusitis, such as with antibiotics and decongestants, is similar to
treating acute sinusitis.
Some people with severe asthma have dramatic improvement of their
symptoms when their chronic sinusitis is treated with
antibiotics.
Doctors commonly prescribe steroid nasal sprays to reduce
inflammation in chronic sinusitis. Although doctors occasionally
prescribe them to treat people with chronic sinusitis over a long
period, they don't fully understand the long-term safety of these
medications, especially in children. Therefore, doctors will
consider whether the benefits outweigh any risks of using steroid
nasal sprays.
If you have severe chronic sinusitis, your doctor 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 the
vast majority of people who undergo surgery have fewer symptoms and
better quality of life.
In children, problems often are eliminated by removal of adenoids
obstructing nasal-sinus passages.
Adults who have had allergic and infectious conditions over the
years sometimes develop nasal polyps that interfere with proper
drainage. Removal of these polyps and/or repair of a deviated septum
to ensure an open airway often provides 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.
How can I prevent sinusitis?
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
dust, mold, pollen, or food-or any of the hundreds of allergens that
can trigger an upper respiratory reaction-you should consult your
doctor. Your doctor can use various tests to determine whether you
have an allergy and its cause. This will help you and your doctor
take appropriate steps to reduce or limit your allergy symptoms.
Drinking alcohol also causes nasal and sinus membranes to
swell.
If you are prone to sinusitis, it may be uncomfortable for you to
swim in pools treated with chlorine, since it irritates the lining
of the nose and sinuses.
Divers often get sinus congestion and infection when water is
forced 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 doctors recommend using decongestant nose drops or inhalers
before your flight to avoid this problem.
What research is going on?
Scientific studies have shown a close relationship between having
allergic rhinitis and chronic sinusitis. In fact, some studies state
that up to 80 percent of adults with chronic sinusitis also had
allergic rhinitis. There is also an association between asthma and
sinusitis. Some researchers think that as many as 75 percent of
people with asthma also get sinusitis.
Scientists are
investigating whether chronic sinusitis has genetic causes. They
have found that the alterations in genes which cause cystic fibrosis
may also contribute to chronic sinusitis. This research focus will
give scientists new insights into the cause of the disease in some
people and points to new strategies for diagnosis and treatment.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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Where can I get more information about sinusitis?
MEDLINEplus
National Library of Medicine
http://www.nlm.nih.gov/medlineplus/sinusitis.html
American Academy of Allergy, Asthma and Immunology
611 East
Wells Street
Milwaukee, WI 53202
1-800-822-ASMA (2762)
http://www.aaaai.org/
Joint Council of Allergy, Asthma, and Immunology
50 N.
Brockway, Suite 3.3
Palatine, IL 60067
(847) 934-1918
http://www.jcaai.org/
American Academy of Otolaryngology-Head and Neck Surgery,
Inc.
One Prince Street
Alexandria, VA 22314-3357
(703)
836-4444
http://www.entnet.org/
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