Sinusitis

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Overview

Acute sinusitis is a bacterial infection in one or more sinuses, which include the maxillary, ethmoid, and frontal sinuses. Acute sinusitis is typically preceded by a viral upper respiratory infection (URI), such as the common cold.

Incidence and Prevalence

Approximately 15% of people in the United States suffer from sinusitis, and about 30 million seek treatment each year. One-third of people who experience a URI develop acute sinusitis.

Causes and Risk Factors

Acute sinusitis usually occurs following a viral URI and may also occur with allergies and fungal infection that causes inflammation of the mucous membranes. Swollen mucous membranes trap and promote the growth of bacteria that cause infection, such as Haemophilus influenzae, streptococci, pneumococci, and staphylococci, because swelling prevents normal drainage from the sinus opening (ostium). Maxillary sinusitis is also associated with chronic dental infection.

Risk factors include seasonal allergies (hay fever), change in atmospheric pressure (e.g., flying, mountain climbing, swimming), and pollutants that damage the cilia of the mucous membrane responsible for drainage, like cigarette smoke.

Signs and Symptoms

People with sinusitis experience the following:

• Cough (caused by postnasal drip)
  
• Nasal congestion
  
• Pain and tenderness around the affected sinuses
  
• Postnasal drip
  
• Pressure in the face and head
  
• Yellow or green nasal discharge
  

Maxillary sinusitis causes pain around the cheek and upper teeth and an infected ethmoid sinus produces pain over the nose or behind the eyes. Pain is caused by pressure in the sinus. A blocked ostium causes oxygen in the sinus to be absorbed into the blood vessels of the mucous membrane, causing negative pressure (vacuum sinusitis). The vacuum then draws more mucus out of the membrane, resulting in positive pressure and pain.

Fever may accompany infection.

Diagnosis

Diagnosis is often made by observing symptoms and reviewing the patient's history of URI. Nasal endoscopy is a procedure that involves using a rigid, lighted instrument to examine the nasal passages and postnasal area with magnification. A topical anesthetic is sprayed into the nose and the endoscope is passed through the nostril. A CT scan (computerized tomography) can be used to determine the extent of infection; infected sinuses appear opaque or can have air-fluid levels

Treatment

The goal of treatment is to eliminate infection and encourage the sinuses to drain. Temporary use of decongestants (e.g., phenylephrine, Alconefrin®, Duration®) and corticosteroid nasal sprays (e.g., fluticasone, Flonase®) may promote drainage. These treatments cause blood vessels in the nasal passages and sinuses to constrict, which reduces inflammation. Side effects associated with overuse of decongestants include dizziness, headache, elevated heart rate, nervousness, and insomnia. Steroid sprays are known to cause headache, nasal irritation, and nosebleed. Use of decongestants is not recommended in patients with high blood pressure or thyroid problems. Decongestants use can also lead to physical dependence.

Antibiotics, are prescribed for 7 to 10 days. Side effects include nausea, abdominal pain, and vomiting.

Nonmedical treatments, such as drinking plenty of water, can thin mucus and promote drainage. Inhaling steam during a shower or from a basin of boiled water provides some relief. Covering the head and basin with a towel maximizes the effect.

Prevention

Routinely using nasal lavage can prevent mucus from building up, which provides a friendly environment for bacteria and viruses.

Staying well hydrated by drinking plenty of water daily to keep mucus thin is also a good preventive measure.

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