Sinusitis

Cause

Sinusitis can be caused by viruses, bacteria, or fungi.

When the lining of the sinus cavities gets inflamed from a viral infection like a cold, it swells. This is viral sinusitis. The swelling can block the normal drainage of fluid from the sinuses into the nose and throat. If the fluid and mucus can't drain, they build up over time. Bacteria or fungi (plural of fungus) may start to grow in them. These bacterial or fungal infections can cause more swelling and pain.

The same viruses that cause the common cold cause most cases of sinusitis.

Nasal allergies or other problems that block the nasal passages and allow fluid to build up in the sinuses can also lead to sinusitis.

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Prevention

There are several ways you may reduce your chance of getting sinusitis.

• Treat stuffiness (nasal congestion) caused by colds or allergies promptly.

  This can help you prevent a bacterial infection from developing in your sinuses.

• Avoid contact with people who have colds and other viral upper respiratory infections.
• Wash your hands often if you have contact with people who have colds or infections.
• Avoid cigarette, cigar, and pipe smoke in your home and workplace.

  Smoke causes and further irritates inflamed membranes in your nose and sinuses.

• Avoid the things that trigger your allergy attacks if you have allergies.

  Consider talking to your doctor about immunotherapy, such as allergy shots.

• Avoid breathing dry air.

  Consider using a humidifier at home and work to increase the moisture in the air.

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Symptoms

The main symptoms of sinusitis are pain and pressure in the face along with a stuffy or runny nose. Leaning forward or moving your head often increases facial pain and pressure.

Other common symptoms of sinusitis may include:

• A headache.
• Yellow or greenish discharge from the nose or down the back of the throat.
• A cough that produces mucus.
• A fever.
• Tooth pain.
• A reduced sense of taste or smell.
• Bad breath.

What Happens

Sinusitis often develops after a cold or viral infection. Most sinus infections improve on their own, but sometimes they develop into a bacterial infection. Swelling, inflammation, and mucus production caused by the cold can lead to blockage in the nasal passages, which may encourage the growth of bacteria.

There are two types of sinusitis: acute (sudden onset) and chronic (long-term). Acute sinusitis, whether it is viral or bacterial, may develop into chronic inflammation or infections that may last 12 weeks or longer. Chronic sinusitis can lead to permanent changes in the mucous membranes that line the sinuses. As a result of these changes, you may become prone to having more sinus infections that may become harder to treat.

When to Call a Doctor

Call your doctor if sinusitis does not improve after 2 days of home treatment and you have symptoms such as:

• Pain in the face or upper teeth.
• Pain extending from the bridge of the nose to the lower eyelid.
• Headache that is not relieved by an over-the-counter pain medicine, such as acetaminophen or ibuprofen.
• Fever.
• Nasal discharge that starts out clear and later becomes thick and discolored (yellow or green).
• Cold symptoms that last longer than 10 days or get worse after the first 7 days.
• Mild or chronic pain in the face that lasts longer than a month, has changed, or has not been checked by a doctor.
• Not feeling any better within 3 to 5 days after starting antibiotics for your sinus infection.

Watchful waiting

Watchful waiting is okay if you have symptoms of an early sinus infection (such as pain and pressure in your head along with a stuffy or runny nose). An early sinus infection can often be treated at home if you are in good health. If you develop symptoms of a sinus infection, start home treatment. This includes drinking lots of fluids and breathing steam from a warm shower. Use the guidelines above to decide whether you need to call a doctor.

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Exams and Tests

Your doctor can tell if you have sinusitis by asking questions about your past health and doing a physical exam. You probably won't need any other tests. But you may need more tests if medicine doesn't help. More tests are also needed if you have problems caused by the infection. Tests may include an X-ray or CT scan.

Your doctor may refer you to an ear, nose, and throat (ENT) specialist. This may be needed if you don't get better over time. An ENT specialist will take a closer look at your nasal passages and upper throat. If allergies could be causing your sinus problems, you may need to see an allergist (immunologist).

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Treatment Overview

You may not need treatment for sinusitis. But there are things you can do to feel better. For example, over-the-counter medicine can help with pain and pressure. If you don't get better on your own, your doctor may suggest a steroid nose spray or another type of nose spray. Or you may need antibiotics.

Very few people need surgery to treat sinusitis. In general, it's used only for severe cases that don't get better with medicines. But surgery may be the only way to get an infected sinus to drain as it should.

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Self-Care

• Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
• If the doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Be careful when taking over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not taking more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
• Breathe warm, moist air from a steamy shower, a hot bath, or a sink filled with hot water. Avoid cold, dry air. Using a humidifier in your home may help. Follow the directions for cleaning the machine.
• Use saline (saltwater) nasal washes. This can help keep your nasal passages open and wash out mucus and bacteria. You can buy saline nose drops at a grocery store or drugstore. Or you can make your own at home by adding 1 teaspoon of salt and 1 teaspoon of baking soda to 2 cups of distilled water. If you make your own, fill a bulb syringe with the solution, insert the tip into your nostril, and squeeze gently. Blow your nose.
• Put a hot, wet towel or a warm gel pack on your face 3 or 4 times a day for 5 to 10 minutes each time.
• Try a decongestant nasal spray like oxymetazoline (Afrin). Do not use it for more than 3 days in a row. Using it for more than 3 days can make your congestion worse.

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Medicines

Medicines may be needed when symptoms of sinusitis are severe or don't improve. You may use more than one medicine. Choices include:

• Antibiotics. They kill bacteria. Examples are amoxicillin with clavulanate and cefdinir.
• Decongestants. They reduce the swelling of the mucous membranes in the nose. Some examples are oxymetazoline (such as Afrin) and phenylephrine (such as Neo-Synephrine).
• Analgesics. They relieve pain. They include acetaminophen (such as Tylenol) and ibuprofen (such as Advil).
• Corticosteroids. They reduce inflammation in the nasal passages. Examples include beclomethasone (Beconase) and mometasone (Nasonex). Most of the time, they are used as a nasal spray.
• Mucolytics. These thin mucus. One example is guaifenesin (such as Robitussin).

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