http://www.niaid.nih.gov/factsheets/sinusitis.htm
Sinusitis
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. The National Institute of
Allergy and Infectious Diseases (NIAID) conducts and supports
research on allergic diseases as well as bacteria and fungus that can
cause sinusitis. This research is focused on developing better
treatments and ways to prevent these diseases.
Scientists supported by NIAID and other institutions 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.
Another NIAID-supported research study is trying to determine whether
fungi may play a role in causing many cases of chronic sinusitis.
This research also will help scientists develop better medicines to
treat chronic sinusitis.
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