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Sinusitis
You're coughing and sneezing and tired and achy. You think that you might be
getting a cold. Later, when the medicines you've been taking to relieve the
symptoms of the common cold are not working and you've now got a terrible
headache, you finally drag yourself to the doctor. After listening to your
history of symptoms, examining your face and forehead, and perhaps doing a sinus
X-ray, the doctor says you have sinusitis.
Sinusitis simply means your sinuses are infected or inflamed, but this gives
little indication of the misery and pain this condition can cause. Health care
experts usually divide sinusitis cases into
Health care experts estimate that 37 million Americans are affected by
sinusitis every year. Health care providers report nearly 32 million cases of
chronic sinusitis to the Centers for Disease Control and Prevention annually.
Americans spend millions of dollars each year for medications that promise
relief from their sinus symptoms.
Sinuses are hollow air spaces in the human body. When people say, "I'm having
a sinus attack," they usually are referring to symptoms in one or more of four
pairs of cavities, or sinuses, known as paranasal sinuses . These
cavities, located within the skull or bones of the head surrounding the nose,
include the
Each sinus has an opening into the nose for the free exchange of air and
mucus, and each is joined with the nasal passages by a continuous mucous
membrane lining. Therefore, anything that causes a swelling in the nose—an
infection, an allergic reaction, or another type of immune reaction—also can
affect the sinuses. Air trapped within a blocked sinus, along with pus or other
secretions, may cause pressure on the sinus wall. The result is the sometimes
intense pain of a sinus attack. Similarly, when air is prevented from entering a
paranasal sinus by a swollen membrane at the opening, a vacuum can be created
that also causes pain.
The location of your sinus pain depends on which sinus is affected.
Most people with sinusitis, however, have pain or tenderness in several
locations, and their symptoms usually do not clearly indicate which sinuses are
inflamed.
Other symptoms of sinusitis can include
In addition, the drainage of mucus from the sphenoid or other sinuses down
the back of your throat (postnasal drip) can cause you to have a sore throat.
Mucus drainage also can irritate the membranes lining your larynx (upper
windpipe). Not everyone with these symptoms, however, has sinusitis.
On rare occasions, acute sinusitis can result in brain infection and other
serious complications.
Most cases of acute sinusitis start with a common cold, which is caused by a
virus. These viral colds do not cause symptoms of sinusitis, but they do inflame
the sinuses. Both the cold and the sinus inflammation usually go away without
treatment in 2 weeks. The inflammation, however, might explain why having a cold
increases your likelihood of developing acute sinusitis. For example, your nose
reacts to an invasion by viruses that cause infections such as the common cold
or flu by producing mucus and sending white blood cells to the lining of the
nose, which congest and swell the nasal passages.
When this swelling involves the adjacent mucous membranes of your sinuses, air
and mucus are trapped behind the narrowed openings of the sinuses. When your
sinus openings become too narrow, mucus cannot drain properly. This increase in
mucus sets up prime conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as Streptococcus pneumoniae
and Haemophilus influenzae , in their upper respiratory tracts with no
problems until the body's defenses are weakened or drainage from the sinuses is
blocked by a cold or other viral infection. Thus, bacteria that may have been
living harmlessly in your nose or throat can multiply and invade your sinuses,
causing an acute sinus infection.
Sometimes, fungal infections can cause acute sinusitis. Although fungi are
abundant in the environment, they usually are harmless to healthy people,
indicating that the human body has a natural resistance to them. Fungi, such as
Aspergillus , can cause serious illness in people whose immune systems
are not functioning properly. Some people with fungal sinusitis have an
allergic-type reaction to the fungi.
Chronic inflammation of the nasal passages also can lead to sinusitis. If you
have allergic rhinitis or hay fever, you can develop episodes of acute
sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes,
and other environmental conditions, also may be complicated by sinus infections.
Acute sinusitis is much more common in some people than in the general
population. For example, sinusitis occurs more often in people who have reduced
immune function (such as those with primary immune deficiency diseases or HIV
infection) and with abnormality of mucus secretion or mucus movement (such as
those with cystic fibrosis).
It can be difficult to determine the cause of chronic sinusitis. Some
investigators think it is an infectious disease but others are not certain. It
is an inflammatory disease that often occurs in patients with asthma. If you
have asthma, an allergic disease, you may have chronic sinusitis with
exacerbations. If you are allergic to airborne allergens, such as dust, mold,
and pollen, which trigger allergic rhinitis, you may develop chronic sinusitis.
An immune response to antigens in fungi may be responsible for at least some
cases of chronic sinusitis. In addition, people who are allergic to fungi can
develop a condition called "allergic fungal sinusitis." If you are subject to
getting chronic sinusitis, damp weather, especially in northern temperate
climates, or pollutants in the air and in buildings also can affect you.
If you have an immune deficiency disease or an abnormality in the way mucus
moves through and from your respiratory system (e.g., primary immune deficiency,
HIV infection, and cystic fibrosis) you might develop chronic sinusitis with
frequent flare-ups of acute sinusitis due to infections. In otherwise normal
individuals, sinusitis may or may not be infectious. In addition, if you have
severe asthma, nasal polyps (small growths in the nose), or a severe asthma
attacks caused by aspirin and aspirin-like medicines such as ibuprofen, you
might have chronic sinusitis
Because your nose can get stuffy when you have a condition like the common
cold, you may confuse simple nasal congestion with sinusitis. A cold, however,
usually lasts about 7 to 14 days and disappears without treatment. Acute
sinusitis often lasts longer and typically causes more symptoms than just a
cold.
Your doctor can diagnose sinusitis by listening to your symptoms, doing a
physical examination, taking X-rays, and if necessary, an MRI or CT scan
(magnetic resonance imaging and computed tomography).
After diagnosing sinusitis and identifying a possible cause, a doctor can
suggest treatments that will reduce your inflammation and relieve your symptoms.
If you have acute sinusitis, your doctor may recommend
You should, however, use over-the-counter or prescription decongestant nose
drops and sprays for only few days. If you use these medicines for longer
periods, they can lead to even more congestion and swelling of your nasal
passages.
If bacteria cause your sinusitis, antibiotics used along with a nasal or oral
decongestant will usually help. Your doctor can prescribe an antibiotic that
fights the type of bacteria most commonly associated with sinusitis.
Many cases of acute sinusitis will end without antibiotics. If you have allergic
disease along with sinusitis, however, you may need medicine to relieve your
allergy symptoms. If you already have asthma then get sinusitis, you may
experience worsening of your asthma and should be in close touch with your
doctor.
In addition, your doctor may prescribe a steroid nasal spray, along with other
treatments, to reduce your sinus congestion, swelling, and inflammation.
Doctors often find it difficult to treat chronic sinusitis successfully,
realizing that symptoms persist even after taking antibiotics for a long period.
As discussed below, many doctors treat with steroids such as steroid nasal
sprays. Many doctors do treat chronic sinusitis as though it is an infection, by
using antibiotics and decongestants. Other doctors use both antibiotics and
steroid nasal sprays. Further research is needed to determine what is the best
treatment.
Some people with severe asthma are said to have dramatic improvement of their
symptoms when their chronic sinusitis is treated with antibiotics.
Doctors commonly prescribe steroid nasal sprays to reduce inflammation in
chronic sinusitis. Although doctors occasionally prescribe these sprays to treat
people with chronic sinusitis over a long period, doctors don't fully understand
the long-term safety of these medications, especially in children. Therefore,
doctors will consider whether the benefits outweigh any risks of using steroid
nasal sprays.
If you have severe chronic sinusitis, your doctor may prescribe oral steroids,
such as prednisone. Because oral steroids are powerful medicines and can have
significant side effects, you should take them only when other medicines have
not worked.
Although home remedies cannot cure sinus infection, they might give you some
comfort.
When medical treatment fails, surgery may be the only alternative for
treating chronic sinusitis. Research studies suggest that the vast majority of
people who undergo surgery have fewer symptoms and better quality of life.
In children, problems often are eliminated by removal of adenoids obstructing
nasal-sinus passages.
Adults who have had allergic and infectious conditions over the years sometimes
develop nasal polyps that interfere with proper drainage. Removal of these
polyps and/or repair of a deviated septum to ensure an open airway often
provides considerable relief from sinus symptoms.
The most common surgery done today is functional endoscopic sinus surgery, in
which the natural openings from the sinuses are enlarged to allow drainage. This
type of surgery is less invasive than conventional sinus surgery, and serious
complications are rare.
Although you cannot prevent all sinus disorders—any more than you can avoid
all colds or bacterial infections—you can do certain things to reduce the number
and severity of the attacks and possibly prevent acute sinusitis from becoming
chronic.
If you are prone to getting sinus disorders, especially if you have
allergies, you should avoid cigarette smoke and other air pollutants. If your
allergies inflame your nasal passages, you are more likely to have a strong
reaction to all irritants.
If you suspect that your sinus inflammation may be related to dust, mold,
pollen, or food—or any of the hundreds of allergens that can trigger an upper
respiratory reaction—you should consult your doctor. Your doctor can use various
tests to determine whether you have an allergy and its cause. This will help you
and your doctor take appropriate steps to reduce or limit your allergy symptoms.
Drinking alcohol also causes nasal and sinus membranes to swell.
If you are prone to sinusitis, it may be uncomfortable for you to swim in pools
treated with chlorine, since it irritates the lining of the nose and sinuses.
Divers often get sinus congestion and infection when water is forced into the
sinuses from the nasal passages.
You may find that air travel poses a problem if you are suffering from acute or
chronic sinusitis. As air pressure in a plane is reduced, pressure can build up
in your head blocking your sinuses or eustachian tubes in your ears. Therefore,
you might feel discomfort in your sinus or middle ear during the plane's ascent
or descent. Some health experts recommend using decongestant nose drops or
inhalers before a flight to avoid this problem.
At least two-thirds of sinusitis cases caused by bacteria are due to two
organisms that can also cause otitis media (middle ear infection) in children as
well as pneumonia and acute exacerbations of chronic bronchitis. NIAID is
supporting multiple studies to better understand the basis for infectivity of
these organisms as well as identifying potential candidates for future vaccines
strategies that could eliminate these diseases.
A project supported by NIAID is developing an advanced "sinuscope" that will
permit improved airway evaluation during a medical examination especially when
surgical intervention is contemplated.
Scientific studies have shown a close relationship between having asthma and
sinusitis. As many as 75 percent of people with asthma also get sinusitis. Some
studies state that up to 80 percent of adults with chronic sinusitis also had
allergic rhinitis. NIAID conducts and supports research on allergic diseases as
well as bacteria and fungus that can cause sinusitis. This research is focused
on developing better treatments and ways to prevent these diseases.
Scientists supported by NIAID and other institutions are investigating whether
chronic sinusitis has genetic causes. They have found that certain alterations
in the gene that causes cystic fibrosis may also increase the likelihood of
developing chronic sinusitis. This research will give scientists new insights
into the cause of the disease in some people and points to new strategies for
diagnosis and treatment.
Another NIAID-supported research study has recently demonstrated that blood
cells from patients with chronic sinusitis make chemicals that produce
inflammation when exposed to fungal antigens, suggesting that fungi may play a
role in many cases of chronic sinusitis. Further research, including clinical
trials of antifungal drugs, will help determine whether, and for whom, this new
treatment strategy holds promise.
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Joint Council of Allergy, Asthma, and Immunology
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http://www.entnet.org
NIAID is a component of the National Institutes of Health (NIH), which is an agency of the Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.
News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892