Sinusitis

Causes

Acute sinusitis is often caused by an infection. It may be viral, bacterial, or fungal (rare). Chronic sinusitis may happen in people who are at higher risk of infection. It may also be due to irritation from contaminants in the air like smoking, pollution, or allergens.

Risk Factors

Factors that may increase the chance of sinusitis are:

• Recent viral infection
• Smoking or exposure to secondhand smoke
• Other sources of indoor or outdoor air pollution
• Allergies or asthma
• Head injury or a health problem requiring a tube to be inserted into the nose
• Cocaine and other drugs inhaled through the nose

Problems with structures around the face may increase the risk of sinusitis. Examples are:

• Deviated septum
• Nasal polyps
• Cleft palate
• Large adenoids

Chronic illnesses that increase risk of sinusitis are:

• HIV infection and other disorders of the immune system
• Diabetes
• Cystic fibrosis
• Kartagener syndrome (a chronic lung disease) and immotile cilia syndrome
• Sarcoidosis
• Granulomatosis with polyangiitis—a rare disease that causes blood vessel walls to become inflamed

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 that does not ease with decongestants or antihistamines
• Runny nose or postnasal drip
• Thick, yellow, or green mucus
• Bad breath
• Ear pain, pressure, or fullness
• Fever
• Fatigue
• Dental pain
• Symptoms seem to improve then suddenly get worse over a few weeks

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor can diagnose sinusitis based on its symptoms and an exam. More tests may be done if sinusitis is not responding to treatment or keeps coming back.

Treatment

Most sinus infections will pass on their own in 7 to 10 days. Home care and medicine can help to manage symptoms.

Infections that last longer or keep coming back may need more care.

Supportive Care

Sinus pressure and pain may be eased by:

• Drinking plenty of water
• Using nasal and sinus washes
• Using a humidifier or inhaling steam from bowl of hot water

Medications

Medicine may help manage symptoms until the sinusitis passes. Options may include:

• Over the counter pain relievers
• Antihistamines—to ease allergy related symptoms
• Corticosteroids nose spray—to decrease swelling in the lining of the nose
• Decongestants—to shrink nasal passages
• Antibiotics—to treat some sinus infections that last longer than expected or keep coming back

Surgery

Surgery may be advised if sinusitis keeps coming back or is severe. Types of surgery that may help are:

• Repair of a deviated septum
• Removal of nasal polyps
• Functional endoscopic sinus surgery—enlarge the sinuses to improve drainage
• Balloon sinuplasty—to open the sinus passages

Prevention

To lower the risk of sinusitis:

• Take steps to prevent allergies, such as avoiding triggers and following any care plan in place
• Wash hands often
• Avoid smoking and being around secondhand smoke
• Manage chronic health problems