Sinusitis

What is sinusitis?
Sinusitis is an inflammation (swelling) of the sinuses. Normally, our sinuses are filled with air. When sinuses become blocked and filled with fluid, bacteria can grow and cause infection (sinusitis). Conditions that cause 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 deviated septum (a shift in the nasal cavity). Allergies (such as hay fever) can also cause swelling and poor drainage of the sinuses.

There are two types of sinusitis:
Acute sinusitis -- A sudden onset of symptoms that responds well to antibiotics and decongestants.

Chronic sinusitis -- Characterized by at least four recurrences of sinusitis or infection that last 12 weeks or longer. 

Who is at risk to develop sinusitis?
About 3-5 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions are at a higher risk of having sinusitis:

In children, common causal environmental factors include: allergies, illness from other children at daycare or school, pacifiers, bottle drinking when lying on their backs and smoke in their environment.

In adults, the contributing factors are most frequently infections. Smoking is a major consideration.

What are the signs and symptoms of acute sinusitis?
Symptoms include: 

Acute sinusitis can last four weeks or more. This condition may be diagnosed when the patient 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?
Victims of chronic sinusitis may have the following symptoms for 12 weeks or more: 

Additional symptoms may include:

What should one expect during the physical examination?
At a specialist's office, the patient will receive a thorough ear, nose and throat examination. During that physical examination, the physician will explore the facial features where swelling and erythema (redness of the skin) over the cheekbone exists. Facial swelling and redness are generally more predominant in the morning; as the patient remains upright, the symptoms gradually improve. The examination may include the physician feeling and pressing the sinuses for tenderness. The physician also may tap your teeth to see if you have an inflamed paranasal sinus.

What other diagnostic procedures might be taken?
Other diagnostic tests may include a study of the mucus culture, nasal endoscopy, x-rays, allergy testing, or CT scan of the sinuses.

What is nasal endoscopy?
An endoscope is a special fiberoptic instrument for the examination of the interior of the nose. It is used for conducting a visual examination of the nose and sinus drainage areas.

A nasal endoscopy offers the ear, nose and throat specialist a reliable, visual view of all the accessible areas of the sinus drainage pathways. First the patient's nasal cavity is anesthetized using a local agent, a rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity. The procedure is utilized to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the ENT specialist also looks for pus as well as polyp formation, and structural abnormalities that will cause the patients to suffer from recurrent sinusitis.

How does a physician determine the best treatment of acute or chronic sinusitis?
To obtain the best treatment option, the physician needs to properly assess the patient's history and symptoms and then progress through a structured physical examination.

How is acute sinusitis treated?
Acute sinusitis is generally treated with 10 to 14 days of treatment with antibiotics. With treatment, the symptoms usually disappear and antibiotics are no longer required for that episode. Oral and topical decongestants may be prescribed to alleviate the symptoms. 

How is chronic sinusitis treated?
Warm moist air may alleviate sinus congestion. A vaporizer or steam from a pan of boiled water (removed from heat) are both recommended. Warm compresses are useful in relieving pain in the nose and sinuses. Saline nose drops are also safe for home use. Use of non-prescription drops or sprays might be effective in controlling symptoms. However, non-prescription drops should not be used beyond their recommended use, usually 4 to 5 days. Antibiotics may also be prescribed.

What other course of treatment can be recommended?
To reduce congestion, the physician may prescribe nasal sprays, nose drops or oral decongestant medicine. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection.) An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for treatment for any fungal infection. 

Will any changes in lifestyle be suggested during diagnosis and treatment?
Smoking is never recommended, but if you do smoke, you should refrain during treatment for sinus problems. No special diet is required, but drinking extra fluids helps to thin secretions.

Is sinus surgery necessary?
Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus through by millions of cilia (a hair-like extension of a cell.) Irritation and swelling from an allergy can narrow the opening of the sinus and block mucus movement. If antibiotics are not effective in opening the sinus, surgery may be necessary.

What does the surgical procedure entail?
The basic endoscopic surgical procedure is performed under local or general anesthesia. Most patients can return to normal activities within five to seven days; full recovery usually takes about four to six weeks.

What does surgery accomplish?
The surgery should enlarge the natural opening to the sinuses. Otolaryngologists--head and neck surgeons-- have found endoscopic surgery to be highly effective in restoring normal functioning of the sinuses. The procedure removes areas of obstruction resulting in the normal flow of mucus. A turbinectomy may also be performed to permanently shrink the swollen membranes of the nose. This is done in the office and takes a few minutes. The anesthetic used is very similar to what is used in routine dental procedures. 

What are the consequences of leaving infected sinuses untreated?
Delay in treatment for sinusitis will result in suffering from unnecessary pain and discomfort. In rare circumstances, meningitis or brain abscess and infection of the bone can occur.

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 12/2/2004

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