Sinusitis Overview

                                                         Who Gets Sinusitis?

About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis:

  • Nasal mucous membrane swelling as from a common cold
  • Blockage of drainage ducts
  • Structural differences that narrow the drainage ducts
  • Nasal polyps
  • Conditions that result in an increased risk of infection such as immune deficiencies or taking medications that suppress the immune system.

In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, pacifiers, bottle drinking while lying on one’s back, and smoke in the environment.

In adults, the contributing factors are most frequently infections and smoking.

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. Normally, sinuses are filled with air, but when sinuses become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection.

Conditions that can cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in the lining of the nose), or a deviated septum (a shift in the nasal cavity).

There are different types of sinusitis, including:

  •  Acute sinusitis: A sudden onset of cold-like symptoms such as runny, stuffy nose and facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts 4 weeks or less.
  • Subacute sinusitis: An inflammation lasting 4 to 8 weeks.
  • Chronic sinusitis: A condition characterized by sinus inflammation symptoms lasting 8 weeks or longer.
  • Recurrent sinusitis: Several attacks within a year.

What Are the Signs and Symptoms of Acute Sinusitis?

Some of the primary symptoms of acute sinusitis include:

  • Facial pain/pressure
  • Nasal stuffiness
  • Nasal discharge
  • Loss of smell
  • Cough/congestion

Additional symptoms may include:

  • Fever
  • Bad breath
  • Fatigue
  • Dental pain

Acute sinusitis may be diagnosed when a person has two or more symptoms and/or the presence of thick, green, or yellow nasal discharge.

What Are the Signs and Symptoms of Chronic Sinusitis?


People with chronic sinusitis may have the following symptoms for 8 weeks or more:

  • Facial congestion/fullness
  • A nasal obstruction/blockage
  • Pus in the nasal cavity
  • Fever
  • Nasal discharge/discolored postnasal drainage

Additional symptoms of chronic sinusitis may include:

  • Headaches
  • Bad breath
  • Fatigue
  • Dental pain


How Is Sinusitis Diagnosed?

To diagnose sinusitis, your doctor will review your symptoms and give you a physical examination.

The exam may include the doctor feeling and pressing your sinuses for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.

Other diagnostic tests to assess the potential causes for sinusitis may include a mucus culture, nasal endoscopy (see below), X-rays, allergy testing, CT scan of the sinuses, or blood work.


The sinuses are air-filled sacs in the facial bones of the head. They have several functions, including warming incoming air and helping to form certain sounds. When the sinuses become infected and inflamed, the condition is known as sinusitis. Sinusitis ranges from a minor annoyance to a serious condition that might require surgery.

The four pairs of sinuses are listed below, in order from highest frequency of infection to least:
Maxillary sinuses, located in the cheekbone, right below the eye sockets
Ethmoid sinuses, located behind the bridge of the nose
Frontal sinuses, located in the lower forehead, in the middle of the head just above the eye sockets
Sphenoid sinuses, located behind the eyes

The sinuses are lined with cells covered with small, hair-like projections called cilia, which help clear mucus from the chambers and keep them bacteria free (Rubin BK et al 2004). When the ability to clear the passageways is blocked, however, the sinuses may become infected. Sinusitis is classified by duration of illness (acute or chronic), by cause (infectious or other), and by the type of infectious agent involved (bacterial, fungal, or viral). According to the National Institutes for Health, approximately 37 million Americans are affected by sinusitis every year. Health care providers report nearly 32 million cases of chronic sinusitis every year (National Institute of Allergy and Infectious Diseases 2005).

Even if it is not considered serious, sinusitis can have a major impact on quality of life (Bhattacharyya N 2003; Chester AC 2003; Linder JA et al 2003). In rare cases, sinusitis can cause infections of the brain and other complications (National Institute of Allergy and Infectious Diseases 2005).

Researchers in Japan have found a link between chronic sinusitis in older people and cognitive impairment (Matsui T et al 2003). A study of an older population found significant differences in Mini-Mental Status Examination. Examination scores between people with chronic sinusitis and those without (Matsui T et al 2003) underscore the importance of treating sinusitis infections appropriately in this age group.
Causes and Risk Factors for Sinusitis

Acute sinusitis is almost always caused by bacteria, fungi, or viruses. Bacteria that cause sinusitis include streptococcal and staphylococcal strains, which also cause the common cold. Fungi are known to cause sinusitis, but mainly in immunocompromised people (such as those with HIV/AIDS) or people who are sensitive to fungi (Shin SH et al 2004; Parikh SL et al 2004). People at highest risk for sinusitis are those with allergies, asthma, or an increased immune response to fungi; smokers; or those with compromised immune systems (Kasper DL et al 2005).

Noninfectious risk factors for sinusitis include rapid changes in air pressure (e.g., when diving, flying, or high-altitude hiking) and exposure to chemical irritants (Rubin BK et al 2004; American Academy of Family Physicians 2005). Additional risk factors for sinusitis are conditions that cause sinus obstruction, such as tumors, and conditions that alter mucus clearance, such as cystic fibrosis (Rubin BK et al 2004).
Diagnosis of Sinusitis

No single test confirms a diagnosis of sinusitis. In most cases, the diagnosis will be made on the basis of symptoms, which depend on which sinus or sinuses are affected. Common symptoms include:
Pain in the forehead, over the area where the frontal sinuses are located
Upper jaw pain
Pain in the eyes
Swelling of the eyelids or areas around the eyes
Neck pain
Tenderness on the sides of the nose
Loss of smell
Thick or colored nasal discharge
Conventional Treatment of Sinusitis

Decongestants. The major decongestants used in over-the-counter medications are phenylephrine and pseudoephedrine. Decongestants are usually coupled with a pain reliever, such as acetaminophen, ibuprofen, or aspirin. Over-the-counter medications are used to (1) reopen the nasal passages by reducing the volume of mucus, (2) reduce nasal congestion, (3) relieve pain and pressure, and (4) reduce the potential for complications.

Antibiotics. Antibiotics are used to treat bacterial sinusitis (Rubin BK et al 2004). In very serious cases, intravenous antibiotics may be recommended (Rubin BK et al 2004). They are ineffective in viral sinusitis.

Pain relievers. Pain relievers are often used in conjunction with decongestants. Acetaminophen, ibuprofen, and aspirin are all commonly used in sinusitis.

Corticosteroids. Steroids are used to suppress inflammation. They may be used in topical nasal sprays.

Nonpharmacological therapies. Sinusitis sufferers sometimes use the following therapies, sometimes in combination with pharmaceuticals.
Steam treatment
A warm, moist towel to the face
A humidifier
Nasal saline wash
If symptoms are mild to moderate, some healthcare providers will delay treatment with medications in favor of nasal saline solution. However, if symptoms continue for seven days or longer, more aggressive treatment is implemented.
Surgical treatment to debride abscesses or to remove impacted mucus is used for very serious cases of sinusitis.

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