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Sinusitis

(Sinus Infection; Acute Sinusitis; Chronic Sinusitis)
  • Definition

    Sinusitis is inflammation of the sinus cavities. It is usually associated with infection. The sinus cavities are air-filled spaces in the skull.
    Sinusitis is called acute if it lasts for less than 4 weeks, subacute if it lasts 4-12 weeks, and chronic if symptoms last for more than 3 months. You may have recurrent sinusitis if you have repeated bouts of acute sinusitis.
    Sinus Infection
    IMAGE
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    Infectious sinusitis is caused by bacterial, viral, or rarely fungal infection of fluid in the sinus cavities.
  • Risk Factors

    Factors that may increase your chance of sinusitis include:
  • Symptoms

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

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Sinusitis is 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 light up
    • CT scan or x-ray of the sinuses to look for fluid in the sinus
    • 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)
    You have may acute sinusitis when the following occurs:
    • History of 10 or more days of colored mucous, or visibly infected mucus
    • Tenderness over the sinuses
    • Fever
    • Difficulty smelling
  • Treatment

    Home Care
    • Hydrating—Drinking lots of fluids may keep your nasal secretions thin. This will avoid plugging up your nasal passages and sinuses. Saline nasal sprays or irrigation may also loosen nasal secretions.
    • Using steam treatments—Keep a humidifier running in your bedroom. Fill a bowl with steaming water every couple of hours. Make a steam tent with a towel over your head. This will let you breathe in the steam.
    • Nasal and sinus washes.
    Medications
    • Antibiotics—Used to treat bacterial infections.
    • Over-the-counter pain relievers.
      • Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
    • Antihistamines—Help sinusitis symptoms if they are caused by allergies.
    • Intranasal corticosteroids—These are inhaled directly into your nose through a nasal spray. Corticosteroids may help relieve congestion by decreasing swelling in the lining of the nose in people with allergies.
    • Decongestants—Use either decongestant pills or nasal sprays to shrink nasal passages. Do not use nasal sprays for longer than 3-4 days in a row.
    • Guaifenesin—Helps you cough up secretions, but hydration is more effective.
    Surgery
    Surgery is a last resort for people with very troublesome, serious chronic sinusitis. It includes:
    • Repair of a deviated septum
    • Removal of nasal polyps
    • Functional endoscopic sinus surgery—a lighted scope is used to enlarge the sinuses to improve drainage
    • Balloon sinuplasty—a tube with a balloon attached is inserted into the sinuses (the balloon is inflated to open the sinus passages)
  • Prevention

    To help reduce your chance of sinusitis:
    • Have allergy testing to find out 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, stick with your treatment plan.
    • If you get a cold, drink lots of fluids and use a decongestant.
    • Use sinus washes as directed.
    • Blow your nose gently, while pressing one nostril closed.
    • If you must travel by air, use a nasal spray decongestant to decrease inflammation prior to takeoff and landing.
    • Use a humidifier when you have a cold, allergic symptoms, or sinusitis.
    • Use HEPA filters for your furnace and vacuum cleaner to remove allergens from the air.
    • Avoid cigarette smoke.
  • RESOURCES

    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org

    National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov

    CANADIAN RESOURCES

    Allergy Asthma Information Association http://aaia.ca

    Calgary Allergy Network http://www.calgaryallergy.ca

    References

    Acute sinusitis in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 4, 2014. Accessed September 29, 2014.

    Acute sinusitis in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 7, 2014. Accessed September 29, 2014.

    Allergic rhinitis, sinusitis, and rhinosinusitis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/allergic-rhinitis-sinusitis-and-rhinosinusitis. Accessed September 29, 2014.

    Aring AM, Chan MM. Acute rhinosinusitis in adults. Am Fam Physician. 2011;83(9):1057-1063.

    Chronic rhinosinusitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 14, 2014. Accessed September 29, 2014.

    Mandell GL, Douglas RG, et al. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone, Inc; 2000.

    Okuyemi KS, Tsue TT. Radiologic imaging in the management of sinusitis. Am Fam Physician. 2002;66:1882-1886.

    Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

    Sinusitis. National Institute of Allergy and Infectious Disease, National Institutes of Health (NIH) website. Available at: http://www.niaid.nih.gov/topics/sinusitis/Pages/index.aspx. Accessed September 29, 2014.

    Stewart AE, Vaughan WC. Balloon sinuplasty versus surgical management of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2010;10(3):181-187.

    1/10/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA. 2007;298:2487-2496.

    12/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2009;(4):CD005149.

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