Sinusitis

One of the most typical ear, nose, and throat issues people face is sinusitis, also known as sinus inflammation. Based on the statistics published by the Centers for Disease Control and Prevention, up to 28.9 million adults are diagnosed with sinusitis each year.

What is Sinusitis?

Sinusitis is the inflammation of sinuses (the hollow air spaces in the bones of the skull). When sinus cavities become inflamed, you may experience a variety of symptoms like pain or nasal congestion. Many people also experience postnasal drainage and a runny nose that can sometimes become discolored and thick.

Pathophysiology of Sinusitis and Risk Factors

Sinusitis is an inflammation of the nasal passage, tissue lining, and sinuses. The most common causes of this are viral infections such as rhino-pharyngitis or allergic reactions. Both of these can trigger the immune system leading to mucosal edema in the upper respiratory tract.

While symptoms can be similar, the cause of each type is distinct:

  • Acute Bacterial/Purulent (ABP) Sinusitis - This occurs when bacteria enter through the eustachian tubes and settle in the sinus cavity.
  • Acute Non-Purulent Sinusitis - Also called uncomplicated rhinosinusitis, this occurs when bacterial growth is present but does not cause a purulent discharge.
  • Chronic or Non-Purulent (CNP) Sinusitis - This is an ongoing condition that does not resolve even after the initial infection heals.
  • Allergic (A) or Vasomotor Sinusitis - This is due to an allergic reaction to specific triggers such as pollens, plants, or pet dander.
  • Fungal Sinusitis - Fungi thrive in warm, moist places, which is why they often infect the feet and nails. This condition results from the overgrowth of fungi in the sinuses.

While this is a very common condition most people will experience one or more times in their lives, it has several risk factors, which include:

  • Tobacco smoking
  • Prolonged intake of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
  • Overuse of nasal sprays or saline solution
  • Nasal and dental infections
  • Traumatic injuries to the nose and sinuses
  • Pollen-induced allergic reactions
  • A deviated nasal septum

Signs and Symptoms

The symptoms of a sinus infection may include:

  • Dull pain and pressure in the forehead, cheeks, eyes, or teeth 
  • Postnasal drip and a runny nose with discolored nasal drainage
  • Painful nasal discharge or nasal congestion (or "stuffy nose")
  • Facial pain when chewing, yawning, and sneezing
  • Difficulty breathing through the nose as a result of the blockage in the nasal passages
  • Sore throat

Some individuals may not experience any symptoms at all. However, an untreated sinus infection can develop into more severe sinusitis symptoms such as:

  • The formation of a thick yellow or greenish nasal or facial discharge
  • Severe pain in the face, teeth, and nasal cavity from sinus blockage
  • Immunosuppression
  • Severe headaches that are worsened by movement, coughing, and bending forward

If you are experiencing any of the above symptoms, talk with one of our online doctors now to find relief.

Diagnosis

In most cases of sinusitis or a suspected sinus infection, your doctor will perform a physical examination of the nose and sinuses and ask some questions about the symptoms you're experiencing. Due to the prevalence of sinus infections, diagnosis is relatively easy, and patients can start treatment immediately.

If your doctor feels that you may be suffering from chronic sinusitis, subacute sinusitis, or bacterial infection, they may take further steps to diagnose and treat the sinusitis properly. Imaging such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or X-rays can help them observe sinus inflammation and check for nasal polyps within the sinus cavities. These tests can also show a deviated septum or other nasal cavity problems that could worsen sinusitis symptoms.

If your sinusitis continues long-term, your doctor may take a sample of mucous to identify whether your symptoms are the result of a bacterial or fungal infection. They may look at your sample under a microscope or send it for culture in more complicated cases. 

Treatment

There are various types of treatment for sinus infections, including nasal wash, antibiotics, oral steroids, and surgery. Most sinus infections can be treated easily, and many viral infections and allergic reactions even resolve over time without treatment.

Nasal washes are available as sprays or for use in a Netti pot. They can help relieve symptoms in non-purulent infection (chronic rhinosinusitis) but do not treat the underlying disease process. Thus, you shouldn't rely on nasal irrigation alone to solve acute and chronic sinusitis. If you choose to try this treatment, make sure to use a sterile wash or purified water to avoid further infection.

Fungal or bacterial infections, on the other hand, may require medication for treatment. Antibiotics are usually prescribed for acute or ABP sinusitis because they can kill the invading bacteria and shorten recovery time.

Antivirals have been proven effective in treating acute rhinosinusitis caused by viruses. Hence, doctors strongly recommend them unless the patient is allergic to common antiviral drugs (such as amantadine).

Antibiotics or antivirals are usually taken for 2–4 weeks, depending on how your condition progresses. If you don't experience a reduction in sinusitis symptoms or your condition worsens, your doctor may need to perform further tests to determine the cause of and effectively treat your recurrent sinusitis.

Persistent or chronic sinus infections, mainly caused by the bacteria Staphylococcus aureus, are often associated with nasal polyps, which can be removed via surgery if present. If these polyps recur following surgery, another procedure like laser treatment or electrocautery can provide permanent relief.

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Prognosis

About three-quarters of people with acute bacterial sinusitis recover entirely within three weeks without antibiotics. For those who experience ABP or acute non-purulent rhinosinusitis, the entire course of treatment is around ten days. 

Chronic sinusitis can be an ongoing problem that can significantly decrease your quality of life. However, proper treatment can eliminate or help control your symptoms and prevent complications like sinus tissue damage, systemic infection, and immunosuppression. 

If you are experiencing sinus problems, contact one of our doctors available online now. We can help you get the treatment you need to start feeling better today!

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