Sinus Infection (Sinusitis)

Symptoms of sinus infection include pain in the forehead or between the eyes, toothache, feeling of fullness in the mid-face, stuffy nose, and congestion.

The sinuses contain defenses against foreign viruses and bacteria (germs). If the normal defenses are disrupted, they may allow bacteria normally present in the nasal passages to enter any of the sinuses. Once there, the bacteria may stick to the lining cells and cause a sinus infection.

• Acute sinusitis usually lasts less than eight weeks or occurs no more than three times per year with each episode lasting no longer than 10 days. Medications are usually effective against acute sinusitis. Successful treatment counteracts damage done to the mucous lining of the sinuses and surrounding bone of the skull.
• Chronic sinusitis lasts longer than eight weeks or occurs more than four times per year with symptoms usually lasting more than 20 days.
• The sinuses are covered with a mucus layer and cells that contain little hairs on their surfaces (cilia). These help trap and propel bacteria and pollutants outward.

A detailed picture of the sinuses shows 4 major pairs of sinuses.

The human skull contains four major pairs of hollow air-filled cavities called sinuses. These are connected to the space between the nostrils and the nasal passage (behind your nose). Sinuses help insulate the skull, reduce its weight, and allow the voice to resonate within it. The four major pairs of sinuses are:

1. Frontal sinuses (in the forehead)
2. Maxillary sinuses (behind the cheekbones)
3. Ethmoid sinuses (between the eyes)
4. Sphenoid sinuses (behind the eyes)

The sinuses contain defenses against viruses and bacteria (germs). The sinuses are covered with a mucous layer and cells that contain tiny hairs on their surface (cilia) that help trap and propel bacteria and pollutants outward.

Acute sinusitis typically lasts less than eight weeks or occurs no more than three times per year with each episode lasting no longer than 10 days. Medications are generally effective against acute sinusitis. Successful treatment counteracts damage done to the mucous lining of the sinuses and surrounding bone of the skull.

Chronic or recurring sinusitis lasts longer than eight weeks or occurs more than four times per year, with symptoms usually lasting more than 20 days.

Pressure and pain in the sinuses (in different areas of the face or behind the eyes) are the main symptoms of sinusitis.

Signs and symptoms of sinus infections depend upon the sinuses that are affected, and whether the sinus infection is acute or chronic.

Common Sinus Infection Symptoms and Signs

• Stuffy nose or congestion
• Runny nose (mucus may be yellowish or greenish in color)
• Postnasal drip
• Tooth discomfort or pain
• Loss of sense of smell
• Ear pain, pressure, or fullness
• Headache
• Bad breath
• Hearing loss
• Ringing in the ears (tinnitus)
• Facial pain, tenderness, or pressure in the area of the sinuses
• Fever
• Fatigue
• Cough
• Sore throat

13 Acute Sinusitis Symptoms

1. Nasal congestion with discharge
2. Nasal drainage that may be clear or whitish in color
3. Postnasal drip (mucus drips down the throat behind the nose) often accompanied by a sore throat
4. Pain across the cheekbone, under or around the eye, or around the upper teeth
5. Ear pain or earache
6. Headache in the temple or surrounding or behind the eye
7. Pain or pressure symptoms are worse when coughing or straining
8. Fever is common
9. Pain or pressure on one or both sides of the face
10. Facial swelling
11. Dizziness
12. Itchy throat
13. Sneezing

5 Chronic Sinusitis Symptoms

Chronic sinusitis may have many of the same symptoms as acute sinusitis, but the symptoms last longer or are more severe. In addition, people with chronic sinusitis may also experience multiple symptoms, for example:

1. Pain that is worse in the late morning or when wearing glasses
2. Pain and pressure in the face worsens when leaning forward
3. Chronic sore throat and bad breath
4. Chronic toothache or increased tooth sensitivity
5. Increased facial discomfort throughout the day with an increased cough at night

Sinusitis or sinus infections usually clear up if treated early and appropriately. Aside from those who develop complications, the outlook for acute sinusitis is good. People may develop chronic sinusitis or have recurrent attacks of acute sinusitis if they have allergic or structural causes for their sinusitis.

A Viral infection damages the cells of the sinus lining, leading to inflammation.

Causes of Acute Sinus Infections

• Acute sinusitis usually follows a viral infection in the upper respiratory tract, but allergy-causing substances (allergens) or pollutants may also trigger acute sinusitis. A Viral infection damages the cells of the sinus lining, leading to inflammation. The lining thickens, obstructing the nasal passage. This passage connects to the sinuses. The obstruction disrupts the process that removes bacteria normally present in the nasal passages, and the bacteria begin to multiply and invade the lining of the sinus. This causes the symptoms of sinus infection. Allergens and pollutants produce a similar effect.
• Bacteria that normally cause acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These microorganisms, along with Staphylococcus aureus and some anaerobes (bacteria that live without oxygen), are involved in chronic sinusitis.

Causes of Chronic Sinus Infections

• Chronic sinus infections are caused by viruses, bacteria, allergens, pollutants, and fungal infections, especially people with diseases that weaken the immune system, for example, HIV/AIDS, leukemia and other cancers, and diabetes.
• Medications that are designed to modify the immune system may increase the risk of developing sinus infections.

Call a doctor when if you have pain or pressure in the upper face accompanied by:

• Nasal congestion or discharge
• Postnasal drip (chronic sinusitis)
• Fever
• Ongoing bad breath unrelated to dental problems

People who have facial pain, headaches, and fever may indicate a sinus infection.

Fever can be a symptom of a sinus infection or a cold. Simple nasal congestion with a low-grade fever and a runny nose probably indicates a cold and may not call for medications or antibiotics.

If left undiagnosed and untreated complications of sinusitis can occur that may lead to severe medical problems and possibly death. If you have the following symptoms, you may have a medical emergency and should seek immediate evaluation in a hospital's emergency department:

• Headache, fever, and soft tissue swelling over the forehead (frontal sinus) may indicate an infection of the frontal bone, called Pott's puffy tumor or osteomyelitis. Usually, this complication is limited to children.
• Ethmoid sinusitis can cause infection of the eye socket. The eyelid may swell and become droopy. Vision changes are rare but are signs of serious complications. Fever and severe illness are usually present. With this infection, you may lose the ability to move an eye, and permanent blindness may result. Symptoms of sinusitis associated with pain when moving the eye, redness of the eyes or face, or swelling around the eye are an emergency and should be evaluated immediately.
• Ethmoid or frontal sinusitis can cause a blood clot in the sinus area around the front and top of the face. Symptoms may be similar to those of an eye socket infection with the addition of a pupil that is larger than usual (dilated). Usually, ethmoid or frontal sinusitis affects both sides of the face.
• If you experiences personality changes, headache, neck stiffness, high fever, altered consciousness, visual problems, seizures, or rash on the body, infection may have spread to the brain or the lining tissues of the brain (meningitis). This is a severe illness and a medical emergency. Coma and lead to death.

The diagnosis of a sinus infection is made based on a medical history assessment and a physical examination. Adequately distinguishing sinusitis from a simple upper respiratory infection or a common cold is important.

• Usually, sinusitis caused by bacteria will need antibiotic treatment to cure the infection.
• Upper respiratory tract infections (URIs) and colds are viral illnesses so antibiotics have no benefit, and it may cause antibiotic resistance, which limits your body's ability to cure future infections.

CT scan: In most cases, diagnosing acute sinusitis requires no testing. When testing is indicated, a CT scan will clearly depict all the paranasal sinuses, the nasal passages, and the surrounding structures. A CT scan may indicate a sinus infection if any of these conditions is present:

• Air-fluid levels in one or more sinuses
• Total blockage in one or more sinuses
• Thickening of the inner lining (mucosa) of the sinuses
• Mucosal thickening can occur in people without symptoms of sinusitis. CT scan findings must be correlated with a person's symptoms and physical examination findings to diagnose a sinus infection.

Ultrasound: Another noninvasive diagnostic tool is ultrasound. The procedure is fast, reliable, and less expensive than a CT scan, although the results are not as detailed.

If your symptoms symptoms persist despite therapy, you may need a referral to an otolaryngologist or ENT (a specialist that treats ear, nose, and throat problems). The doctor may:

• Visualize the nasal passages and the connection to the sinuses with a nasopharyngoscope, or sino-nasal endoscope. This is a fiberoptic, flexible or rigid tube that the doctor inserts through the nose and enables the doctor to view the nasal passageways and see if the sinuses are open and draining correctly. Anatomical causes of breathing difficulties may be found, for example:
  • A deviated nasal septum
    Nasal polyps
  • Enlarged adenoids and tonsils
  • Abnormalities within the nasal cavities and passageways
• The sinuses are drained to test for bacteria, viruses, and fungal infections. However, this test is more invasive. During the procedure, the doctor inserts a needle into the sinus through skin (or gum) and bone to attempt to withdraw fluid, which is then can be sent to the lab to test for the cause of the infection. Usually, your doctor will have the test results in less than two days.
• You may be given antibiotics to treat the infection, and If necessary, alleviate discomfort with local anesthesia (you are awake for this procedure).
• Rarely, draining the sinuses is used because a CT scan may all that is necessary to diagnose the cause of sinus infections and sinusitis.

Home care can help relieve sinus infection or sinusitis symptoms, open the sinuses, and alleviate dryness.

Home Remedies to Promote Drainage

• Drink plenty of water and hydrating beverages such as hot tea.
• Inhale steam two to four times per day by leaning over a bowl of hot water (not while the water is on the stove) or using a steam vaporizer. Inhale the steam for about 10 minutes. Taking a hot, steamy shower may also work. Mentholated preparations, such as Vicks Vapo-Rub, can be added to the water or vaporizer to aid in opening the passageways.

OTC Medications to Thin Mucus

Expectorants are medications that help expel mucus from the lungs and respiratory passages. They help thin mucous secretions, enhancing drainage from the sinuses. The most common is guaifenesin (contained in Robitussin and Mucinex). OTC sinus medications also can combine decongestants and cough suppressants to reduce symptoms and eliminate the need for the use of many prescription medications. Read label ingredients to find the right combination of ingredients or ask the pharmacist.

OTC Medications to Relieve Pain

Pain medication such as ibuprofen (Motrin and Advil) and naproxen (Aleve) can reduce pain and inflammation. These medications help to open the airways by reducing swelling. Acetaminophen (Tylenol) can be used for pain and fever but does not help with inflammation.

Nasal Saline Irrigation

There are several methods of nasal irrigation, and a popular sinus remedy is the Neti-pot, a ceramic pot that looks like a cross between a small teapot and Aladdin's magic lamp.

• Some ENT physicians recommend nasal irrigation with a Neti-pot to help clear crusting in the nasal passages. Many people with chronic sinus symptoms use the Neti-pot to alleviate congestion, facial pain and pressure, and reduce the need for antibiotics and nasal sprays.
• Before using nasal saline irrigation, discuss it with your health-care professional.

Sterile saline nasal sprays also can be used to irrigate the sinuses, and are available at most pharmacies.

The main treatment goals for sinus infections or sinusitis involve:

• Reducing swelling or inflammation in the nasal passages and sinuses
• Curing the infection
• Promoting sinus drainage
• Maintaining open sinuses

Blood cells and lining cells of the mucosa in the sinuses can normally fight off foreign invaders. However, if overwhelmed by viruses, bacteria. or allergens, sinus inflammation (sinusitis) may occur. With appropriate therapy, a short-lived infection can be treated effectively. Because foreign substances trigger numerous reactions, many treatments are available to treat inflammation symptoms.

Decongestants help reduce airway obstruction and are important in the initial treatment to alleviate symptoms of sinus infections and sinusitis.

• OTC nasal sprays: oxymetazoline (Afrin), phenylephrine (Neo-Synephrine), and naphazoline (Naphcon) work the fastest, within one to three minutes. These drugs should not be used for more than three days because they become less effective and more frequent applications become necessary to attain the same results. This "rebound" phenomenon can be reduced by alternating between nostrils and using the medicine less frequently. Some people over-treat their nasal congestion with nasal sprays and become dependent upon it in order to breathe more easily (a disorder called rhinitis medicamentosum). Overcoming the dependency requires a difficult withdrawal program that involves:
  • Oral decongestants
  • Saline
  • Steroid nasal sprays
  • Systemic steroids
  • A combination there several
• OTC steroid nasal sprays: budesonide (Rhinocort), fluticasone (Flonase), and triamcinolone (Nasacort) are steroids that can also help reduce inflammation of the nasal passages. These medications can take multiple doses before you start feeling the effects. Side effects of nasal steroids may include nosebleeds or sore throat.
• OTC oral decongestants: OTC oral decongestants (in tablet or liquid form) contain the active ingredients pseudoephedrine (Sudafed) or phenylephrine. They work much slower than nasal sprays do, and achieve their effect within 30-60 minutes. As with the nasal preparations, oral decongestants may OTC oral decongestants are less effective if you use them over a long time. The rebound phenomenon exists but is not as severe as with spray preparations. Preparations containing pseudoephedrine are now kept behind the counter at the pharmacy/ however, they still available without a prescription.

What Are the Side Effects of Nasal and Oral Decongestants?

Both nasal and oral decongestants have side effects, which include:

• Increased heart rate
• Increased blood pressure
• Insomnia
• Nervousness
• Anxiety
• Tremor
• Dry mouth
• Blurry vision
• Headaches

They also may cause an inability to urinate.

Talk to your doctor before using decongestants or if you have a history of:

• Heart disease
• High blood pressure
• Anxiety
• Urinary problems, especially prostate disorders

Combining decongestants with OTC or prescribed medications with similar side effects may cause dangerous complications.

Home remedies that open and hydrate the sinuses may promote drainage. Please refer to home remedies for information about how to:

• Increase daily fluids
• Inhaling steam
• Take expectorants and pain relievers
• Irrigate the sinuses with saline

If environmental allergies cause sinusitis, antihistamines may help reduce swelling of the mucous membranes. Allergens stimulate white blood cells in the blood and tissues to release histamine into the circulation, which causes nasal congestion.

• Some of the older sedating OTC antihistamines (diphenhydramine [Benadryl]) are no longer recommended because they tend to dry out and thicken the mucus, making drainage more difficult.
• Non-sedating antihistamines such as fexofenadine (Allegra), cetirizine (Zyrtec), levocetirizine (Xyzal), loratadine (Claritin), or desloratadine (Clarinex) do not seem to dry out the mucosa. If nasal congestion is severe, a decongestant can be added (for example, Allegra-D or Claritin-D).

Medications that Cure Sinus Infections

The goal in treating sinus infections is to eliminate bacteria from the sinus cavities with antibiotics. This helps prevent complications, relieve symptoms, and reduce the risk of chronic sinusitis.

• In acute, uncomplicated sinus infections, a synthetic penicillin, for example, amoxicillin (Amoxil, Polymox, or Trimox), which is prescribed to most people to cure acute sinus infections. Amoxicilin is effective against the ususal causes of sinus infections, and is inexpensive. The most common side effects of amoxicillin include allergic reactions (throat swelling, hives) and an upset stomach.
• People allergic to penicillin can take a sulfur-containing antibiotic called trimethoprim/sulfamethoxazole or TMP/SMX (Bactrim, Cotrim, or Septra). Sulfa drugs are not recommended for people who are allergic to sulfur.
• People who have several episodes, or partially treated acute sinusitis or those who have chronic sinusitis may become resistant to amoxicillin and TMP/SMX. Synthetic penicillins and cephalosporins such as amoxicillin/clavulanate (Augmentin), cefuroxime (Ceftin), and loracarbef (Lorabid) can cure most sinus infections.
• Eventually, overuse of these "broad-spectrum" antibiotics may lead to organisms evolving that can resist even the most potent antibiotics available. Simpler antibiotics, for example, amoxicillin, should be used first and taken for the entire duration (14-21 days).

Medications to Keep the Sinuses Open

One or more OTC or prescription therapies may be all that is necessary to treat acute sinusitis. In addition, using intranasal or oral steroids (prednisone) with recurrent episodes of acute sinusitis or chronic sinusitis may reduce symptoms.

OTC Steroid Nasal Sprays

• budesonide (Rhinocort)
• fluticasone (Flonase)
• triamcinolone (Nasacort)

Prescribed Steroid Medications

Commonly prescribed oral steroid medications include:

• beclomethasone (Beconase, Vancenase, Qnasl)
• flunisolide (Nasalide, Nasarel)
• azelastine hydrochloride and fluticasone propionate (Dymista)
• fluticasone (Veramyst)
• ciclesonide (Zetonna)

Nasal Sprays (Intranasal Steroids)

• Nasal sprays (intranasal steroids) work directly on the lining of the nasal passages and sinuses with little effect on the rest of the body when taken in prescribed dosages.
• Many intranasal steroids are available over-the-counter or by prescription. Some people tolerate them more than others do. Intranasal steroids are medications. These drugs do not relieve symptoms immediately like nasal and oral decongestants do, but once therapeutic drug levels are achieved, symptoms usually improve, and decongestants may not be necessary.

Steroids are potent inhibitors of inflammation.

During months when environmental allergens are most widespread, the early administration of intranasal steroids may help keep the sinuses open and draining, and prevent sinusitis.

Some people continue to have chronic sinusitis despite therapy with antibiotics and drugs for symptom relief. Those that have a CT scan indicative of a sinus infection, and any complications of sinusitis may benefit from sinus surgery.

• Usually, surgery for sinus infections is performed endoscopically using a fiberoptic nasopharyngoscope.
• The goal is to remove obstructive mucosal tissue, open the sinus-nasal passageway, and allow the sinuses to drain.
• During the surgery, nasal polyps can be removed, and a crooked nasal septum can be straightened, leading to improved breathing.
• Long-term nasal steroids and periodic antibiotics still may be necessary.

If you continue to have sinus infections, your doctor will order tests or procedures to find out why. A culture can be taken at the office or during the endoscopic surgery, which may reveal anaerobes, a type of bacteria. Treatment for this type of bacterial or fungal sinus infection are treated with broad-spectrum antibiotics.

• Sinusitis is often first diagnosed by a general practitioner, primary care physician, or internal medicine physician. A pediatrician may diagnose sinus infections in children.
• If sinusitis is chronic or severe, you may be referred to an otolaryngologist, also called an ear, nose, and throat specialist (ENT). If your sinusitis is caused by allergies, you may be referred to an allergist.
• If you experience an emergency due to your sinusitis, go to the Emergency Department at the nearest hospital.

Prevention of a sinus infection depends upon its cause.

• Avoid contracting upper respiratory tract infections. Maintain strict hand washing habits and avoid people who are suffering from a cold or the flu.
• Obtaining the flu vaccination yearly will help to prevent the flu (influenza) and subsequent infection of the upper respiratory tract.
• In some studies, zinc carbonate lozenges have been shown to reduce the duration of many cold symptoms.
• Stress reduction and a diet rich in antioxidants, especially fresh, dark-colored fruits and vegetables, may help strengthen the immune system.
• Plan for seasonal allergy attacks.
  • If a sinus infection is caused by seasonal or environmental allergies, avoiding allergens is very important. If avoidance is not an option, either OTC or prescription medication may be helpful. OTC antihistamines or decongestant nasal sprays can be used for an acute attack.
  • People who have seasonal allergies may benefit from nonsedating prescription antihistamines during allergy-season.
  • Avoid spending long periods outdoors during allergy season. Close the windows to the house and use air conditioning to filter out allergens when possible. Humidifiers may also be helpful.
  • Allergy shots, also called "immunotherapy," may be effective in reducing or eliminating sinusitis due to allergies. An allergist administers shots regularly for 3 to 5 years, which often produces a reduction or complete remission of allergy symptoms for years.
• Stay hydrated
  • Maintain good sinus hygiene by drinking plenty of fluids to keep nasal secretions thin.
  • Saline nasal sprays (available at drug stores) help keep the nasal passages moist, helping remove infectious agents. Inhaling steam from a bowl of boiling water or in a hot, steamy shower may also help.
  • Avoid air travel. If air travel is necessary, use a nasal decongestant spray prior to departure to keep the sinus passages open and use a saline nasal spray during the flight.
• Avoid allergens and irritants in the environment
  • People who suffer from chronic sinusitis should avoid areas and activities that may aggravate the condition, for example:
  • Cigarette smoke
  • Secondhand smoke
  • Diving under water in chlorinated pools
  • Stop smoking