Sinusitis (Sinus Infection or Sinus Inflammation)

A “sinus” is simply a hollow space. There are many sinuses in the body, including 4 pairs inside the skull. These are called the “paranasal sinuses.” They lighten the skull and help give your voice its tone. Sinusitis is when your sinuses become inflamed and congested. It is usually caused by the common cold, but other viruses, bacteria, fungi, and allergies can also cause sinusitis. Sinusitis is also called rhinosinusitis.

The sinuses have the same kind of tissue that lines the inside of the nose. The same things that can cause swelling in the nose can also affect the sinuses, such as allergies or an infection. When the tissue inside the sinuses swells, mucus increases and disrupts normal drainage. Over time, air trapped inside swollen sinuses can create painful pressure inside the head. This is a sinus headache.

What Causes Sinusitis?

A viral infection causes most cases of sinusitis. Bacterial infections, fungal infections, allergies, asthma, and other health conditions can also cause sinusitis. If your sinuses are blocked for a long time, typically 10 days or more, you may get a bacterial infection. This secondary infection is caused by bacteria that are normally present in the respiratory tract. These bacteria multiply and cause a sinus infection when they are unable to drain out of the blocked, inflamed sinuses.

Irritants like smoke, strong odors, and air pollution can also cause sinus swelling. If you are exposed to certain irritants often, they can contribute to episodes of sinusitis. Also, bodily defects such as a deviated nasal septum, nasal polyps, and narrowed sinus openings can contribute to sinus infections.

What Are the Types of Sinusitis?

There are 2 types of sinusitis.

Acute sinusitis is a temporary swelling of the sinuses, typically lasting less than 4 weeks. The mucous membranes inside your nose, sinuses, and throat swell. This could happen when you have a common cold (viral infection) or allergies. The swelling blocks the sinus openings and prevents normal mucus from draining. This causes mucus and pressure to build up leading to facial pain and pressure, headaches, and possibly a decreased sense of smell.

Chronic sinusitis occurs when symptoms become more frequent or worse. Sinus infections may cause long-term sinus inflammation (swelling) and symptoms. If you have more than 3 sinus infections in a year or have symptoms longer than 12 weeks, you could have chronic sinusitis.

What Are the Symptoms of Sinusitis?

When a sinus infection results from blocked sinuses, symptoms may include:

• Thick white, yellow, or greenish mucus from your nose
• Postnasal drop or mucus draining down the back of your throat 
• Bad breath or a bad taste in your mouth from postnasal drip
• Blocked or stuffy nose
• Facial pressure particularly tenderness and swelling around your eyes, cheeks, nose, and forehead
• A reduced sense of smell and taste
• Fever
• Fatigue or tiredness
• Ear pressure/fullness or pain
• Headaches (commonly in the front of your head)
• Cough
• Pain or pressure in your teeth

These symptoms may be similar to some respiratory viral infections. They may require different treatments.

What Is the Treatment for Sinusitis?

The first step to treat sinusitis is to clear your nasal passages. This helps your sinuses drain properly. Draining your sinuses helps flush out a bacterial infection and irritants. If you have a bacterial infection, your doctor may also prescribe an antibiotic to fight it.

Here are a few common treatment options for sinusitis:

Nasal saline (saltwater) rinse or inhaling steam: To clear your sinuses, you rinse your nose with warm saline solution (salt water) using a neti pot or a special rinse bottle. Follow the instructions carefully.

Use lukewarm distilled or boiled water that is stored in a clean container. You can buy nasal saline packets in most pharmacies. You can also follow a recipe to make your own nasal saline rinse from the American Academy of Allergy, Asthma & Immunology.

Or you can breathe hot steam through your nose for 10 to 15 minutes, 3 to 4 times a day. Do not use steam if it triggers your asthma or makes it hard to breathe.

Nasal corticosteroid sprays: These are topical nasal sprays that contain steroids that help decrease swelling and inflammation of the nasal and sinus tissue. Use your nasal spray as directed by your doctor to avoid side effects. Point it toward your ear when you spray it into your nose and away from your nasal septum (the cartilage and bone in your nose that separates your nasal cavities). This will help to prevent nosebleeds, irritation, and damage of the nasal septum.

Allergy treatment: If allergies are causing sinusitis, allergy treatment may help. These treatments may include nasal saline rinses, antihistamines, nasal steroid sprays, nasal antihistamine sprays, leukotriene modifiers, and immunotherapy (allergy shots or tablets). An allergist can test you for allergies and help you come up with an appropriate and effective treatment plan.

Leukotriene modifiers: This is a medicine taken in pill form. It prevents your body from making or activating leukotrienes, which can cause swelling and inflammation of your nose and sinuses. It may be helpful if you have allergies.

Note: The Food and Drug Administration (FDA) has issued a black box warning about serious behavior and mood-related changes with montelukast (Singulair® and generics).

Antibiotics: Your doctor may prescribe an antibiotic to fight an infection caused by bacteria. Many doctors will prescribe antibiotics if your symptoms have not improved in about 10 days.

Antibiotics are not always needed to treat sinusitis. Talk with your doctor about whether or not you need antibiotic treatment. The overuse of antibiotics can lead to antibiotic resistance if you take them too often and/or when you don’t need them.

Decongestants: This medicine reduces stuffiness by shrinking swollen membranes (tissues) in the nose. Pseudoephedrine is a common decongestant. You can buy it over the counter in pill, liquid, and nasal spray form. It is also sometimes included with combination cold and allergy medicines that contain an antihistamine or mucolytics (medicine that thins mucus).

Talk with your doctor about using decongestants because of their potential side effects. For example, they can raise your blood pressure. If you have high blood pressure or heart disease, you may want to avoid them.

If you use nasal decongestant sprays more than 3 days in a row, they may cause the swelling and stuffiness in your nose to get worse. This can happen even after you stop using the medicine. This is called a rebound reaction.

Mucolytics: Mucolytics are a type of medicine that thin mucus and make it less sticky. This can make it easier to clear it from your nose and lungs. You can buy them over the counter. Guaifenesin (Mucinex®) is a common mucolytic. It can also come combined with a decongestant and/or antihistamine.

Oral corticosteroids: Your doctor may prescribe oral corticosteroids for severe chronic sinusitis. These are powerful medicines that treat congestion and inflammation but can have major side effects. These medicines are usually only prescribed when other medicines don’t work.

Sinus surgery: If your chronic sinusitis symptoms will not go away with these medical treatments, your doctor may recommend you see a doctor called an ear, nose, and throat (ENT) specialist about sinus surgery. There are 2 common types of sinus surgery: functional endoscopic sinus surgery and less-invasive balloon sinuplasty. Both surgeries open up blocked sinuses, restore normal sinus drainage, and may greatly help reduce symptoms.

How Can I Prevent Sinusitis?

Experts don’t know a lot about how to prevent sinusitis. But the following tips may help:

• Avoid contact with allergens or irritants that trigger your nasal allergies.
• Keep your nose as free and clear as possible by taking your allergy medicines – including topical nasal steroid sprays – and using a nasal saline rinse.
• Avoid infections by washing your hands often during common cold season. Also avoid touching your face. Limit your exposure to other people with infections.
• Talk with your doctor about lifestyle changes that may help you prevent repeated sinus infections. These may include changing your diet, drinking plenty of water, exercising on a regular basis, and reducing stress.