Sinusitis is an acute (very intense) or chronic (happening repeatedly or
all the time) inflammation of the nasal sinuses - hollow cavities within the
cheek bones found around the eyes and behind the nose. The primary functions
of these sinuses are to warm, moisten and filter the air in the nasal
cavity. They also play a role in our ability to vocalize certain sounds.
Sinusitis, which is common in the winter, may last for months or years if
inadequately treated. Sinusitis can affect the nose, eyes, or middle ear,
and may be indicated by plentiful, thick, colored nasal drainage,
bad-tasting post-nasal drip, cough, head congestion and an accompanying
headache. Symptoms may also include a plugged-up nose, a feeling of facial
swelling, toothache, constant tiredness, and occasionally, a fever.
Types and causes of sinusitis
There are two types of sinusitis: acute sinusitis, which is often
caused by a bacterial infection. It usually develops as a complication of a
viral respiratory infection, common cold, especially if symptoms last more
than 7 to 10 days; and chronic sinusitis, which also may be caused by
bacterial infection, but is more often a chronic inflammatory disorder
similar to bronchial asthma.
Although colds are the most common cause of acute sinusitis, it is more
likely that people with allergies will develop sinusitis. Allergies can
trigger inflammation of the sinuses and nasal mucous linings. This
inflammation prevents the sinus cavities from clearing out bacteria, and
increases your chances of developing secondary bacterial sinusitis. If you
test positive for allergies, your physician can prescribe appropriate
medications to control your symptoms, thereby reducing the risk of
developing an infection. People with sinus problems and allergies should
avoid environmental irritants such as tobacco smoke and strong chemical
odors, which may increase symptoms.
Structural problems in the nose - such as narrow drainage passages,
tumors or polyps, or a deviated nasal septum (the bone and cartilage between
the left and right sides of the nose) - may be another cause of sinusitis.
Surgery is sometimes needed to correct these problems. Many patients with
recurring or chronic sinusitis have more than one factor that predisposes
them to infection. So, addressing only one factor may not be sufficient.
Even if symptoms seem to be localized to the sinuses, the sinuses are not
always infected. To make a correct diagnosis, a physician will take a
detailed history and perform a physical examination. The physician may also
order tests, if indicated. These tests can include allergy testing, sinus
X-ray, CT scans (which make precise images of the sinus cavities), or a
sampling of the nasal secretions or lining.
The physician also may perform an endoscopic examination. This involves
inserting a narrow, flexible fiber-optic scope into the nasal cavity through
the nostrils, which allows the physician to view the area where the sinuses
and middle ear drain into the nose in an easy, painless, "patient friendly"
Sinus infections generally require a combination of therapies. In addition
to prescribing an antibiotic when the sinusitis is caused by bacterial
infection, your physician may prescribe a medication to reduce blockage or
control allergies. This will help keep the sinus passages open. This
medicine may be a decongestant, a mucus-thinning medicine or a cortisone
nasal spray. Antihistamines, cromolyn and topical steroid nasal sprays help
control allergic inflammation.
For people with allergies, long-term treatment to control and reduce
allergic symptoms can also be effective in preventing the development of
sinusitis. This treatment may include immunotherapy (also called "allergy
shots"), anti-inflammatory medications, decongestants, and environmental
control measures. Preventative use of low dose antibiotics and sinus
drainage medications during times when symptoms will likely be worse, such
as winter, also may prevent sinusitis.
Several non-drug treatments can also be helpful. These include breathing
in hot, moist air, applying hot packs and washing the nasal cavities with
salt water. In cases of obstructed sinus passages that may require surgery,
your allergist/immunologist may refer you to an otorhinolaryngologist, or an
ear-nose-throat physician (ENT).
Sinusitis vs. rhinitis
Although many symptoms are similar, sinusitis differs from allergic rhinitis,
known as "hay fever," or non-allergic (vasomotor) rhinitis. Rhinitis is an
inflammation of the mucous membranes of the nose - not the sinuses. Allergic
rhinitis is caused by allergies and is often characterized by a runny nose,
sneezing and congestion, and itchy eyes, nose, throat and inner ears.
Non-allergic rhinitis is characterized by a swollen, inflamed nasal lining
overflowing clear nasal drainage and a stuffy nose. It may be triggered by
irritants such as smoke, changes in barometric pressure or temperature, or
overuse of over-the-counter decongestant nasal sprays. Poorly controlled
chronic or recurring rhinitis can lead to sinusitis. As you can see,
symptoms of sinusitis can vary depending on the severity of the inflammation
and the sinuses involved - all of the symptoms listed above may be present,
or only a few. It's best to consult your physician promptly if any of the
described symptoms of sinusitis develop.
Your allergist/immunologist can provide you with more information on
Tips to Remember are created by the Public Education Committee
of the American Academy of Allergy, Asthma and Immunology. This brochure was
updated in 2003.
The content of this brochure is for informational purposes only. It is
not intended to replace evaluation by a physician. If you have questions or
medical concerns, please contact your allergist/immunologist.
American Academy of Allergy,
Asthma and Immunology
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Milwaukee, WI 53202-3823
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