Disease: Sinus Infection

What Is a Sinus Infection?

Sinusitis affects up to 20 percent of people at some point, and can be caused by viruses, bacteria, or other factors.

The sinuses filter and humidify the air you inhale. The membrane that lines each sinus contains mucus and tiny hair-like cells called cilia, which collect and sweep out pollutants, micro-organisms, dust, and dirt from the nasal passages.

In healthy people, sinus secretions are always moving and draining into the nasal cavity. Sinusitis — a painful inflammation of the sinuses — can occur when the movement of those secretions is blocked or mucus is thickened.

Most medical organizations refer to sinusitis as rhinosinusitis, because the nasal cavity is almost always involved in sinus inflammation.

Who Gets Sinusitis?

Sinusitis is a very common condition that affects 16 to 20 percent of adults and children. Women are more likely to be diagnosed with sinusitis than men, and the condition is more common in the South than in other parts of the United States. Sinusitis is often very painful and leads to time off work.

Sinusitis can be acute or chronic, infectious or non-infectious. The type and severity of sinusitis is defined by the length of time that inflammation lasts.

  • Acute sinusitis often develops quickly and lasts 7 to 10 days, although it can also last up to 4 weeks.
  • Subacute sinusitis can last 4 to 12 weeks.
  • Recurrent acute sinusitis is defined as four or more episodes per year with no ongoing symptoms between episodes.
  • Chronic sinusitis involves symptoms that last more than 12 weeks.

Symptoms of Sinusitis

Having symptoms of sinusitis doesn’t necessarily mean that you have a sinus infection. The three most common symptoms of acute and chronic sinusitis in adults are:

  • Nasal congestion, blockage, or stuffiness
  • Nasal discharge (clear, yellow, green, or blood-tinged)
  • Facial pain pressure or fullness, above, below, or behind the eyes.

Sometimes you might also have a fever with these symptoms, and children with acute sinus infection might also have a cough and thick, yellow-green discharge.

The symptoms of acute bacterial sinusitis are similar to acute viral sinusitis or viral upper respiratory tract infections (like the cold or influenza). The main difference is that symptoms of acute bacterial sinusitis infection typically last longer than 10 days, or start to improve, and then get worse after 5 to 7 days (called “double sickening”).

Chronic Sinusitis

In chronic sinusitis, symptoms are often less severe than with acute sinusitis; however, symptoms of chronic sinusitis can lead to long-term damage of the nasal passages. A wider range of symptoms of sinusitis is often present in chronic sinusitis, including:

  • Fatigue
  • Little or no sense of smell
  • Ear fullness or pressure
  • Toothache, particularly in the upper molars
  • Speech that sounds like it’s nasal
  • Swelling over cheekbone or around eye, cheek, or upper teeth tender to touch
  • Bad breath (halitosis)

Although health care providers can usually diagnose acute or chronic sinusitis by reviewing signs and symptoms, the following tests can also be useful:

  • Nasal cytology
  • Nasal-sinus biopsy
  • Tests for cystic fibrosis, immunodeficiency, ciliary dysfunction
  • Nasal endoscopy
  • Computerized tomography (CT) scan

Other tests might be used to rule out certain conditions such as allergic rhinitis, nasal polyposis, and aspirin sensitivity.

Causes of Sinusitis and Sinus Infections

Viruses that cause upper respiratory tract infections can also cause acute sinusitis. In most cases, acute sinusitis is triggered by, or follows, a cold or flu.

There are several underlying causes of chronic sinus inflammation, including allergies (e.g., allergic rhinitis, hay fever), poor air quality, and anatomic variations in the nose (a deviated septum or nasal polyps). Other triggers for chronic sinusitis include:

  • Cigarette smoking and secondhand smoke
  • Changes in air temperature or air pressure (e.g., from swimming, diving or flying)
  • Hormonal conditions (including those that occur in pregnancy)
  • Immune deficiency (e.g., cystic fibrosis, HIV)
  • Fungus
  • Bacteria
  • Overuse of nasal decongestants

In some cases, bacteria can trigger sinus infection. Everyone has bacteria in their noses and throats (e.g., Streptococcus pneumonia and Hemophilus influenza). If the sinuses are not draining properly, these bacteria can multiply and cause infection in the nose and sinuses.

Treatment for Sinus Infections

Most people with acute viral sinusitis improve without treatment in 7 to 10 days. During this time you can relieve headache and facial pain with over-the-counter painkillers, and ease sinus congestion with nasal spray corticosteroids.

A short course of antibiotics for 5 to 7 days may be necessary to treat acute bacterial sinusitis in order to prevent complications from sinus disease.

Home remedies such as flushing the nose and sinuses with saline solution can also reduce congestion and relieve pain. If your acute symptoms recur, or chronic symptoms do not improve after 3 months, endoscopic sinus surgery can sometimes provide relief.

Sources:

  • Aring et al. Acute rhinosinusitis in adults. American Family Physician. 2011.
  • Foden et al. A guide to the management of acute rhinosinusitis in primary care:management strategy based on best evidence and recent European guidelines. British Journal Of General Practice. 2013.
  • Rosenfeld et al. Clinical practice guideline: adult sinusitis. Otolaryngology. 2007.
  • Sinusitis. American Academy of Otolaryngology-Head and Neck Surgery. 2014.

What Are the Sinuses?

You have four pairs of sinuses in your head, though their exact function is not entirely clear.

The sinuses are four pairs of hollow, air-filled, enclosed spaces that lie behind your cheeks, eyebrows, and jaw.

The maxillary sinuses lie behind your eyes and under your cheeks. The frontal sinuses are above your eyes and behind your forehead. The ethmoid sinuses — a honeycomb-like mesh of 6 to 12 small spaces — lie between your eyes on each side of your nose, and the spheroid sinuses lie behind your nose.

Structure of the Sinuses

Membranes with tiny hairs called cilia line the sinuses, and each sinus has an opening (or an ostium) into either side of the nose, which is divided into two halves by the septum.

Ridges of thin, rounded tissue covered by membrane (called turbinates or concha) line the wall of each side of the nose. Airs flows though each side of the nose, and the turbinates help filter and humidify air in the nose. Each sinus also drains into spaces between each turbinate (called the meatus).

Sinuses are present in most other mammals, as well as in birds and some reptiles. The sinuses help to improve the sense of smell in some animals (e.g. dogs, hyenas, and tigers). And like humans, domestic animals such as dogs, cats, and horses can also get sinusitis.

Function of the Sinuses

The sinuses protect the nasal passages and keep them moist by filtering unwanted particles out of the air we breathe. The membranes that line each sinus are filled with cilia and cells that make fluid called mucus.

The cilia collect and sweep out pollutants, micro-organisms, dust, and dirt into the mucus, which moves toward the throat. We usually swallow the mucus.

In addition to moderating the temperature and humidity of the air we breathe, some researchers believe the sinuses might also:

  • Lighten the weight of the skull
  • Provide resonance for the voice
  • Protect the brain, especially against blows to the face

There is not very much evidence to support these theories, however. Researchers agree that the function of the sinuses remains a bit of a puzzle.

Doctors Who Treat Sinus Conditions

Different physicians treat sinus conditions. If you have sinusitis, a primary care physician might treat you. If you have sinusitis caused by allergic rhinitis, you may need to see an allergist. Infectious disease specialists treat acute bacterial sinusitis.

If your child has a sinus condition, you will need to see a pediatrician. Otolaryngologists (ear, nose and throat specialists) perform surgery to correct paranasal abnormalities or to drain the sinuses.

Sinus Cancer and Other Sinus Conditions

Inflammation of the ethmoid sinuses, known as ethmoiditis, usually follows a cold and can affect children from the age of 3. This potentially serious condition is treated with antibiotics.

Nasal and ethmoidal polyps can grow from the sinuses, causing nasal blockage and catarrh (a buildup of excess mucus). Polyps are usually surgically removed.

Cancer may also affect the sinuses. The most common type of sinus cavity cancer is squamous cell carcinoma, which affects the cells that line the inside of the sinuses and nose.

Risk factors for sinus cancers include exposure to certain workplace chemicals, being infected with human papillomavirus virus (HPV), being male, being older than 40, and smoking.

Sources:

  • Ah-See et al. Sinusitis and its management. BMJ. 2007.
  • Rosenfeld et al. Clinical practice guideline: adult sinusitis. Otolaryngology. 2007.
  • Sinus anatomy and function. Ohio Sinus Institute.
  • Rhinitis and sinusitis in small animals. Merck Veterinary Manual. 2013.

Causes of Sinusitis

What causes a sinus infection to suddenly take hold?

In healthy people, sinus secretions are always moving and draining into the nose. But if the movement of mucus out of the sinuses is blocked, rhinosinusitis - commonly known as sinusitis, or sinus inflammation - can develop.

When blockage occurs, mucus fails to drain properly, increases in thickness, and fills the sinus spaces. At the same time, oxygen levels in the affected sinuses are reduced. The cilia (hair-like structures that filter the air in the sinuses) slow down their sweeping and cleaning, making it even harder for mucus to drain.

There are many causes of sinusitis - these may vary depending on whether you have chronic or acute sinusitis.

Allergies and Chronic Sinusitis

Allergies, air quality, and anatomic variations in the nose all contribute to the development of sinus inflammation.

People with allergies or allergic rhinitis have higher rates of sinusitis than people without allergies. Constant exposure to allergens can thicken mucus and make your sinuses vulnerable to inflammation.

Allergens known to trigger allergic rhinitis and chronic sinusitis include:

  • Dust mites
  • Fungal spores (mold)
  • Animal dander
  • Cockroaches
  • Grass, tree, and weed pollen

Air pollution and environmental toxins may also trigger chronic sinusitis. Pollutants include cigarette smoke and secondhand smoke, carbon monoxide, nitrous dioxide, formaldehyde, and sulfur dioxide.

Additionally, anatomic variations in the nose, such as a deviated septum, can increase your risk for sinus obstruction and chronic sinusitis.

Narrow nasal passages caused by facial injury, tumors, foreign bodies in the nose, or polyps can also block the openings into your sinuses. (Polyps are small, grape-like growths that protrude into the sinuses and nasal passages, making it difficult for your sinuses to drain and for air to pass through your nose.)

Gastroesophageal reflux disease (GERD) is also linked to chronic sinusitis. According to the American Academy of Otolaryngology, when gastric fluids flow up out of the stomach into the esophagus and throat during acid reflux, acid can collect at the back of the nasal airway and in the sinuses. This acid can cause sinus inflammation.

Many other factors can increase the risk of developing chronic sinusitis, including:

  • Sensitivity to aspirin
  • Immune deficiencies (e.g., HIV infection)
  • Pregnancy
  • Genetic disorders that impair the cilia (such as cystic fibrosis)
  • Bacteria
  • Viruses
  • Asthma and other lung disorders

Viral and Bacterial Sinus Infections

Although a sinus infection (acute sinusitis) can be viral or bacterial, it is usually triggered by a viral upper respiratory infection (such as a cold or flu). Rhinovirus, influenza, and parainfluenza are the most common viruses that cause acute sinusitis.

Dental problems involving infections can also cause acute sinusitis (odontogenic sinusitis). The roots of your upper back teeth are close to the maxillary sinus, and if they become infected, the infection can travel into your sinuses.

The following bacteria cause a small percentage (0.5 to 2 percent) of acute sinusitis:

  • Streptococcus pneumonia
  • Staphylococcus aureus
  • Haemophilus influenza
  • Moraxella catarrhalis

These bacteria are normally present in the nasopharynx (the uppermost part of your throat). If you have a cold, the flu, or an acute viral sinusitis, nose blowing can jolt bacteria from your nose into your sinuses. If mucus in the sinuses is slow moving or blocked, it provides a rich environment for bacteria to grow, which can lead to a sinus infection.

Fungal Sinusitis

Although fungal sinusitis is rare, fungal spores (i.e., mold) are often present in the sinuses. In fact, we breathe these spores in and out all the time. Fungus is more likely to be present in the warm, moist environment of the sinuses when the immune system is damaged or depressed, or in people with nasal polyps.

Some of the most common fungi that cause sinusitis include:

  • Aspergillus species
  • Cryptococcus neoformans
  • Candida species
  • Sporothrix schenckii
  • Altenaria species
  • Curvularia species.

Allergic fungal sinusitis is more common in southern than in northern states, and its symptoms are similar to viral and bacterial sinusitis. Fungal sinusitis does not respond to antibiotic treatment and can be difficult to treat - some types of fungal sinusitis may require surgical treatment to remove spores.

On rare occasions - especially among people who have uncontrolled diabetes, immune system problems, or hematological cancers such as leukemia - fungal sinusitis can become invasive and extend beyond sinus tissue and bone, eventually moving into the brain and eyes.

Sources:

  • Ah-See et al. Sinusitis and its management. BMJ. 2007.
  • Fokkens et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinology. 2012.
  • Hamilos DL. Chronic rhinosinusitis: epidemiology and medical management. Journal of Allergy and Clinical Immunology. 2011.
  • Lal, Devyani. Fungal Sinusitis. American Rhinologic Society. 2011.

Symptoms of Sinus Infections

The signs of sinusitis can resemble those of a cold, the flu, or other conditions.

Rhinosinusitis — commonly known as sinusitis — is a common condition affecting 1 in 7 adults in the United States. Sinusitis occurs when the lining of the sinuses and nose becomes inflamed. This condition can cause considerable discomfort and pain.

Many medical and environmental factors can trigger sinusitis, including the following:

  • Environmental toxins (such as cigarette smoking or secondhand smoke)
  • Anatomic abnormalities (a deviated septum or nasal polyps)
  • Tumors
  • Foreign bodies
  • Allergic rhinitis, asthma, or hay fever
  • Changes in temperature or air pressure (e.g., from swimming, diving, or flying)
  • Viral, bacterial, or fungal infection

So how do you know if you have sinusitis?

Sinusitis Symptoms in Adults

According to the Infectious Diseases Society of America and the American Association of Otolaryngology-Head and Neck Surgery, the 3 most common acute and chronic sinusitis symptoms in adults are:

  • Nasal congestion, blockage, or stuffiness
  • Nasal discharge (which can be clear, yellow, green, or blood-tinged)
  • Facial pain pressure or fullness, which can be above, below, or behind the eyes

Sinusitis Symptoms in Children

The symptoms of sinus infection in children are similar to symptoms in adults. Children with acute viral sinusitis may also have a cough as well as thick, yellow-green nasal discharge.

Types of Sinusitis

Sinusitis can be acute (sudden onset) or chronic (long-lasting), infectious or non-infectious. Most cases of acute sinusitis are caused by viruses and may be triggered by an upper respiratory tract infection (such as the common cold or the flu).

In fact, up to 90 percent of people with colds also have symptoms of sinusitis. In sinusitis and the common cold, symptoms often develop suddenly, but usually disappear after 7 to 10 days.

The hallmark signs and symptoms of sinusitis — facial pain or pressure, frontal headache, or upper toothache — can be more severe in acute sinusitis than in chronic sinusitis, and sometimes fever is present.

Symptoms that last for more than 12 weeks without any improvement are defined as chronic sinusitis. Unlike acute sinusitis, chronic sinusitis is usually not infectious, and symptoms of chronic sinusitis are often less severe than the symptoms of acute sinusitis.

However, a wider range of symptoms of sinusitis is often present in chronic sinusitis than in acute sinusitis, including:

  • Fatigue
  • Little or no smell (hyposmia/anosmia)
  • Ear fullness or pressure
  • Upper toothache
  • Speech that sounds nasal
  • Swelling over cheekbone or around eye, cheek or upper teeth tender to touch
  • Bad breath (halitosis)

Chronic sinusitis can lead to long-term damage that might require surgery.

Bacterial Sinus Infection

In a small number of cases, bacteria that are normally present in the nose can move into the sinuses (from nose blowing or from a dental abscess). The moist, warm sinus spaces provide a great place for bacteria to grow, leading to acute bacterial sinus infection.

The signs and symptoms of acute bacterial sinusitis and viral upper respiratory infection are very similar. But the severity and duration of these symptoms provide clues about whether a virus or bacteria are responsible for sinus infection.

Acute bacterial sinusitis symptoms typically last longer than 10 days, or start to improve, and then get worse after 5 to 7 days (often called “double sickening”).

Sources:

  • Meltzer et al. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clinic Proceedings. 2011.
  • Settipane et al. Chronic rhinosinusitis. American Journal of Rhinology & Allergy. 2013.
  • Rosenfeld et al. Clinical practice guideline: adult sinusitis. Otolaryngology. 2007.
  • Sinusitis. Merck Manuals. 2013.

Chronic Sinus Infections

What causes chronic sinusitis, and how can it be treated?

If chronic sinus problems are making you miserable, you're not alone: According to the U.S. Centers for Disease Control and Prevention, over 29 million American adults have been diagnosed with sinusitis, an inflammation of the sinuses due to a viral, bacterial, or fungal infection.

Sinus problems usually start with a viral head cold. Congestion in your nose blocks the drainage of your sinuses, and that can lead to acute sinusitis. "Both your nose and your sinuses are lined by moisturizing mucous membranes," explains Toribio Flores, MD, an ear, nose, and throat (ENT) specialist at the Cleveland Clinic. "When mucus can't get out of the sinuses, bacteria start to grow, and that causes a sinus infection."

Sinusitis symptoms that last for more than 12 weeks could be chronic sinusitis. In addition to frequent head colds, your risk for chronic sinusitis also goes up if you have allergies. "Chronic sinusitis can be caused by an allergy, virus, fungus, or bacteria and can go on for months or even years," says Dr. Flores.

Know the Chronic Sinusitis Symptoms

Symptoms of chronic sinusitis are not very different from acute sinusitis symptoms — they just last longer. Whether sinusitis symptoms are the result of infection or allergy, the actual cause of the symptoms is the blocked drainage of mucus from the sinuses into the nose.

Sinusitis symptoms you might experience include:

  • Nasal congestion with thick nasal discharge
  • Pain over the upper teeth
  • Headache
  • Post nasal drip and cough that is worse at night
  • Bad breath
  • Loss of smell
  • Fatigue
  • Fever

Treating Chronic Sinus Problems

"Acute bacterial sinusitis that occurs after a head cold usually responds to antibiotics, but chronic sinusitis may require anti-inflammatory medications, irrigation, and sometimes surgery to 'open up traffic' between the sinuses and the nasal passages," Flores says.

Options for treating chronic sinusitis include:

  • Antibiotics for four weeks or more
  • Antifungal medication
  • Steroid nasal sprays to fight nasal and sinus inflammation
  • Antihistamines or allergy shots for allergic sinusitis
  • Surgery to open and drain sinuses or to remove nasal obstructions that block sinus drainage

"Allergic fungal sinusitis is difficult to treat and often requires surgery," Flores says. "It is more common in people who have diabetes or a weakened immune system from other causes."

Managing Your Chronic Sinusitis Symptoms

If you have chronic sinusitis, your doctor may ask you to see an allergist, an ENT, or both. They can help you get started with treatment, but there is a lot you can do to manage sinus problems on your own:

  • Drink plenty of fluids to keep your mucus thin and flowing
  • Use steam or hot compresses to loosen up thick mucus secretions
  • Keep you environment moist by using a clean humidifier
  • Use over-the-counter saline nasal sprays or irrigations to open nasal and sinus passages
  • Avoid overuse of over-the-counter decongestant sprays that can cause rebound congestion

Remember that sinusitis symptoms could be due to a sinus infection, but they also might be the result of an allergy or fungus. Your doctor can help you find out the true cause and get you to the right specialist for treatment.

Treatments for Sinus Infections

Are antibiotics or decongestants recommended for sinusitis?

Sinusitis causes a painful inflammation of the lining of your nose and your sinuses.

Chronic sinusitis can be triggered by allergens, anatomical problems, and pre-existing medical conditions. Acute sinusitis is usually caused by a viral infection, and in a small number of cases, a bacterial infection.

There are no known cures for sinusitis. The aim of treatment in sinusitis is generally to relieve symptoms by reducing inflammation and improving sinus drainage. For some people, effective symptom relief during acute sinusitis, or when symptoms of chronic sinusitis become more severe, can prevent further bouts of sinusitis.

Sinusitis Relief

Medications used to treat sinusitis and sinus infections include analgesics for pain, decongestants, saline nasal irrigation, and intranasal corticosteroids.

Pain relief may be especially necessary in acute sinusitis. Oral over-the-counter (OTC) painkillers such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Aleve) or ibuprofen (Advil) can be effective in relieving pain.

Inhaled corticosteroids improve symptoms and can speed recovery in both acute and chronic sinusitis by reducing inflammation and swelling. Most inhaled corticosteroids are available by prescription only, in metered-dose inhalers or spray pumps, such as fluticasone (Flonase) or mometasone furoate (Nasonex).

Nasacort (triamcinolone acetonide) is a corticosteroid that’s available from pharmacies as an OTC nasal spray, and oral steroids are sometimes prescribed for sinusitis. Side effects from oral steroids include behavioral changes, increased appetite, high blood sugar, and weight gain.

Neti Pots and Sinus Infections

Nasal irrigation with saline solutions or salt water offer a safe and inexpensive treatment option for sinusitis symptom relief in both adults and children, especially in chronic or frequent sinusitis. Rinsing the nose with a solution of salt water can soften nasal secretions and clear out mucus.

Neti pots are available at most pharmacies and health food stores. You can use a neti pot to rinse your nasal passages 2 to 4 times a day. Before using a neti pot, make sure it’s clean by washing it with soap and water.

Decongestants and Sinusitis

Although there is very little research to confirm whether decongestants are effective in relieving the symptoms of sinusitis, many people find decongestants such as pseudoephedrine (Sudafed) helpful in reducing pressure and pain. Decongestants reduce sinus swelling and encourage mucus to drain into the nose.

Nasal spray decongestants usually contain oxymetazoline, phenylephrine, and naphazoline, (e.g. Afrin, Duramist, Neosynephrine, Vicks Sinex) and are available at pharmacies.

Topical decongestants should not be used for longer than 3 days because they can cause rebound congestion (rhinitis medicamentosa). If you have high blood pressure or heart disease you should avoid decongestants.

Antihistamines such as diphenhydramine (Benadryl) are not usually recommended for symptom relief in sinusitis. The Infectious Diseases Society of America (IDSA) recommends that people with bacterial or viral sinus infections avoid antihistamines because they can dry out the lining of the nose and sinuses and increase congestion. Antihistamines, however, can sometimes improve symptoms in people with allergies who have chronic sinusitis.

Antibiotics for Sinusitis

In the past, antibiotics were often routinely prescribed to treat sinusitis and sinus infections. Because most cases of viral sinusitis resolve without treatment, and bacterial infection occurs in only a very small number of cases, guidelines developed by medical experts recommend that antibiotics only be used to treat acute bacterial sinusitis in adults and children with sinusitis symptoms that last for more than 10 days.

The IDSA recommends a 5 to 7 day course of amoxicillin or amoxicillin-clavulanate (broad-spectrum antibiotics) for adults, and 10 to 14 days for children, when they are diagnosed with acute bacterial sinusitis.

Surgery for Sinusitis

Surgery is sometimes used to treat chronic sinusitis that persists, recurrent acute sinusitis, or when acute bacterial sinusitis does not respond to antibiotic treatment. The goals of surgery are to improve drainage and the passage of air through the sinuses, and to remove unwanted debris.

Functional endoscopic sinus surgery (FESS) is the main type of sinusitis surgery. Facial ultrasound can also be effective for relieving pain and congestion associated with acute bacterial sinusitis. Adenoidectomy (removal of the adenoids) or adenotonsillectomy (removal of the adenoids and the tonsils) is sometimes used in children to improve symptoms of chronic sinusitis.

Other surgical treatments may include:

  • Balloon dilation of sinus ostia, which is used with FESS
  • Balloon catheter sinuplasty
  • Repair of a deviated septum
  • Removal of nasal polyps

Sources:

  • Hayward et al. Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis. Annals of Family Medicine. 2012.
  • Meltzer et al. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clinic Proceedings. 2011.
  • Rosenfeld et al. Clinical practice guideline: adult sinusitis. Otolaryngology. 2007.

Home Remedies for Sinus Infections

Which home treatments are best for easing the pain of sinusitis?

Treatment for sinusitis depends on the underlying cause. The main goals of treatment for sinus infections are to relieve the painful symptoms and to prevent recurrence.

The treatment of sinusitis usually includes over-the-counter (OTC) painkillers to ease headache, pain, and fever if needed, and corticosteroids that you inhale into your nose via a pump or spray.

If symptoms don’t resolve in 7 to 10 days, are severe, or get worse after 10 days, your health care provider might prescribe antibiotics.

But most of the time, you’ll be able to manage the symptoms of sinusitis and sinus infections on your own. There are several practical measures you can take at home to relieve pain, reduce fever, and minimize congestion.

Nasal Irrigation

Cleansing the nasal cavity with a saline solution or salt water has been used for many years to treat chronic sinus and nasal disorders.

Rinsing the nose and sinuses with salt water keeps your nasal passages moist, flushes out thick secretions like mucus, reduces swelling in the nasal passages, and gets rid of infectious debris and allergens.

There are different devices to deliver nasal rinses, including saline sprays (such as Ocean Nasal Spray), douches (Sterimar, Sinus Rinse), drops (with a bulb syringe), or neti pots. The American Academy of of Otolarynology-Head and Neck Surgery recommends using drops or gentle spray for children.

Neti pots are available at most pharmacies and health food stores. You can use one to rinse your nasal passages 2 to 4 times a day. Make sure your neti pot is clean before each use by scrubbing it with soap and water.

Saline Solutions for Sinus Infections

You can buy concentrated saline solution (hypertonic) at pharmacies to use with a neti pot or bulb syringe. Use a concentration of 2 to 3.5 percent hypertonic saline, 0.05 percent sodium hypochlorite, or Xylitol in water. You can also make salt water at home with the following recipe:

  • Mix 3 heaped teaspoons of iodine-free pickling or canning salt with 1 rounded teaspoon of baking soda.
  • Store the mixture for ongoing use.
  • Each time you need to rinse your sinuses, add 1 teaspoon of the mixture to 1 cup (8 ounces) of lukewarm distilled, boiled, or filtered water. For children, use ½ teaspoon in 4 ounces of water.

If you are using a bulb syringe and drops, draw the salt water into the syringe. Tilt your head down and to the left over a sink or in the shower. Squeeze 4 ounces of solution into the top (right) nostril and breathe through your mouth. The solution will drip out from your left nostril. Tilt your head to the right and repeat in the other nostril.

In order to rinse with a neti pot, lie on your back on a bed or couch and put the spout of the pot in the upper nostril. Hang your head over the side of the bed to help the saline move further into your nasal passages and out the other nostril. Repeat on the other side.

Regardless of which method you use, to avoid reinfection, don’t touch your nose with the dropper or spout.

Other Home Treatments for Sinusitis

Nasal irrigation is just one step you can take at home to relieve the symptoms of sinusitis and prevent sinus infections.

  • Drink plenty of fluids to thin out mucus.
  • Apply moist heat to your sinus areas by placing warm, wet towels, or gel packs against your face. Do this several times a day for 5 to 10 minutes.
  • Take a hot shower and breathe in the steam to keep mucus loose and the nasal and sinus passages open. This can help relieve pressure. Or fill a sink or bowl with hot water, place a towel over your head to trap the steam, and breathe it in.
  • Use a humidifier to keep dry air in your home more humid. (But not too humid, since moist air can also grow bacteria and fungi.)
  • Avoid alcohol, smoke, and dry air. These conditions can dry out your sinuses and nasal passages and increase mucus membrane irritation.

Sources:

  • Thornton et al. Are Saline Irrigations Effective in Relieving Chronic Rhinosinusitis Symptoms? A Review of the Evidence. Journal for Nurse Practitioners. 2011.
  • Achilles et al. Nasal saline irrigations for the symptoms of acute and chronic rhinosinusitis. Current Allergy And Asthma Reports. 2013.
  • Li, James TC. What is a neti pot? Mayo Clinic. 2012.

Antibiotics for Sinus Infections

There are a few cases in which antibiotics might be recommended for treating sinusitis.

The goals of treatment for sinusitis are to reduce inflammation, improve sinus drainage, and minimize the pain and discomfort of sinus infections.

Treatment for sinus symptoms depends on the underlying cause of the sinus infection and whether the condition is chronic sinusitis (lasting 12 weeks or longer) or acute (a rapid onset).

In adults, antibiotics are usually reserved for treating acute bacterial sinusitis. Therefore, it’s important to know if an infection is more likely to be bacterial, as opposed to viral.

What Kind of Sinusitis Do You Have?

The main test that can tell whether you have viral or bacterial sinusitis is a microbial culture of sinus secretions that are obtained from either a sinus puncture or endoscopy. Health care providers almost never use these tests, however, because they are invasive and it takes several days for results to be available.

Instead, your health care provider will usually diagnose sinusitis based on an overall impression of your symptoms.

Acute sinusitis is defined as 7 to 10 days of sinus inflammation that result in the following symptoms:

  • Clear or colored nasal discharge/post nasal drip
  • Nasal congestion
  • Facial or dental pain, or tenderness in the sinus area

In acute sinusitis caused by a viral infection (i.e., almost all cases of acute sinusitis), symptoms usually improve after 10 days.

In acute bacterial sinusitis, symptoms continue after 10 days, are often severe (such as a fever of 102 degrees F or higher), or get worse within 10 days after improving.

Are Antibiotics Safe for Sinus Infections?

Until recently, guidelines developed by experts at the Centers for Disease Control and Prevention (CDC) recommended antibiotics for people with acute sinusitis who had moderate to severe symptoms.

However, clinical trials testing the usefulness of antibiotics now show clearly that antibiotics are not a sinus infection cure. Antibiotics have little effect on the symptoms of acute viral sinusitis, and do not prevent complications from occurring.

Despite this evidence, antibiotics are often overused, for sinusitis and many other conditions. In the United States, antibiotics are prescribed for about 80 percent of children and adults with acute sinusitis. Health care providers sometimes prescribe antibiotics as a “just-in-case” measure, and because patients often demand antibiotics.

But the overuse of antibiotics encourages the growth of antibiotic-resistant bacteria. According to the Infectious Diseases Society of America (IDSA), these “superbugs” are tough to treat and present a real and immediate danger to public health.

The IDSA, the American Academy of Family Physicians, the American College of Physicians-American Society of Internal Medicine, the CDC, and the American Academy of Ontolaryngology-Head and Neck Surgery do not recommend antibiotics for treating sinus infections in first 7 days of infection.

In adults, antibiotics should be reserved to speed recovery and prevent serious complications only when there is a strong suspicion that the cause of acute sinusitis is bacterial (not viral).

In adults, the following signs and symptoms suggest the need for antibiotic treatment:

  • Moderate to severe symptoms that last for more than 10 days
  • High fever and pain that last for more than 3 to 4 days
  • Symptoms that improve, then worsen

The American Academy of Pediatrics recommends antibiotic treatment for children and adolescents only in the following situations:

  • Severe bacterial sinusitis with a fever of 102 degrees F or higher, and nasal discharge or facial pain lasting three days or longer
  • Worsening symptoms with a new onset fever or an increase in nasal discharge or cough after earlier improvement
  • Other conditions such as ear infections, pneumonia, swollen lymph nodes, or streptococcal pharyngitis (strep throat) occurring at the same time

Choice of Antibiotic

Although no single antibiotic has been shown to be better for treating acute bacterial sinus infection, most medical guidelines for adults and children recommend a short course of amoxicillin or amoxicillin-clavulanate.

Studies have shown that these antibiotics are effective against bacteria that are linked to acute bacterial sinusitis (Streptococcus pneumoniae, Haemophilus influenza, and, in children, Moraxella catarrhalis). Amoxicillin is also considered relatively safe and inexpensive.

Other antibiotics can also be prescribed (e.g., doxycycline, levofloxacin, or moxifloxacin). It isn’t clear what the ideal duration of these antibiotic treatments should be, but most experts recommend 5 to 7 days for adults and 10 to 14 days for children.

Sources:

  • Chow et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical Infectious Diseases. 2012.
  • Lemiengre et al. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database of Systematic Reviews. 2012.
  • Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngology. 2007.
  • Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013.

Are Sinus Infections Contagious?

Depending on the cause of sinusitis, it can sometimes spread from person to person.

Sinusitis and sinus infections can develop when the movement of mucus out of the sinuses is blocked. The three most common sinusitis symptoms in adults are:

  • Nasal congestion, blockage, or stuffiness
  • Nasal discharge (which can be clear, yellow, green, or blood-tinged)
  • Facial pain pressure or fullness above, below, or behind the eyes

Chronic sinusitis, in which symptoms last for 12 weeks or longer, can be triggered by many factors. Abnormalities that can narrow the nasal passages include nasal polyps, a deviated septum, or foreign bodies that have been placed in the nose and have become stuck.

Pollutants, allergens, and chemicals in the air (such as grass or weed pollen, carbon monoxide, formaldehyde, or tobacco smoke) also affect the movement of mucus and can trigger chronic sinusitis. Other risk factors for chronic sinusitis include immune deficiency diseases such as HIV, gastroesophageal reflux disease (GERD), and asthma.

In most cases, sinusitis is not contagious, but there are some causes of sinus infections that can spread from person-to-person.

Bacterial Sinus Infections

Bacterial sinusitis can sometimes develop following a viral upper respiratory infection (such as a cold or flu). Common bacteria that cause sinus infection include Streptococcus pneumonia, Heamophilus influenza, Staphylococcus aureus and Moraxella catarrhalis.

According to the Infectious Disease Society of America, bacterial sinus infection is more likely in adults and children if the symptoms are present for more than 10 days or are severe (e.g., nasal discharge or facial pain that lasts more than 3 to 4 days, fever of 102 degrees F or higher).

Viral Sinus Infections

The respiratory viruses that cause colds, flu, and sinusitis are spread mostly via hand-to-hand contact. Therefore, they are contagious.

Tiny air droplets that result from nose blowing or coughing are the main carriers of respiratory viruses. If you touch something or someone contaminated by a virus, then touch your own nose, eyes, or mouth, you can develop a cold or acute sinusitis.

Respiratory viruses spread especially fast among children in close proximity to each other, such as in school or day-care environments.

Common viruses that cause colds and sinusitis include rhinoviruses and influenza viruses A and B. Children younger than 2 years and adults older than 65 have the highest risks for getting the flu.

Preventing Contagious Sinusitis

There are many precautions you can take to reduce the spread of infection to the sinuses via respiratory viruses:

  • Hand hygiene: Hand washing with soap and water, or disinfecting hands with sanitizer, can reduce the chance of contagion from respiratory viruses.
  • Social distancing: If you or your child has a cold, flu, or sinusitis, consider staying home from work or school.
  • Masks: Wearing a face mask can reduce the spread of viruses that cause sinusitis. You can buy masks at most pharmacies.
  • Vaccination: Influenza and pneumococcal vaccine can help prevent viral and pneumococcal/bacterial infection and sinusitis.

Sources:

  • Chow et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical Infectious Diseases. 2012.
  • Fokkens et al. European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology. 2012.
  • Jacobs et al. Human rhinoviruses. Clinical Microbiology Reviews. 2013.
  • Zoorob et al. Antibiotic use in acute upper respiratory tract infections. American Family Physician. 2012.

How to Prevent Sinus Infections

What are the avoidable factors that can trigger sinusitis?

The sinuses are four hollow, air-filled spaces in your skull behind your cheeks, eyebrows, and jaw. Sinusitis occurs when the mucus lining of your sinuses and nasal passages becomes inflamed.

Sinusitis is a very common condition that affects roughly 1 in 7 people in the United States. The most common symptoms in adults and children are nasal blockage and discharge, facial pain, and loss of the sense of smell.

Women are more likely to be diagnosed with sinusitis than men, and the condition is more common in the southern states than in other parts of the United States.

Sinusitis can be acute or chronic, and most cases are triggered by a viral upper respiratory tract infection, such as the flu or a cold. The following factors are also triggers for sinusitis:

  • Cigarette smoking and second-hand smoke
  • Air pollutants
  • Nasal obstruction (tumors, nasal polyps, foreign bodies, a deviated septum)
  • Gastroesophageal reflux disease (GERD)
  • Dental infections
  • Allergic rhinitis (e.g. hay fever)
  • Asthma
  • Fungal infection
  • Bacterial infection
  • Conditions that damage the hair-like cilia in the sinuses (such as cystic fibrosis)

Prevention of Sinus Infection

There are several practical measures you can take to prevent sinusitis and reduce the risk of sinus infections. These measures are especially important for people with chronic sinusitis or recurrent acute sinusitis.

First, you can reduce the likelihood of mold growth by keeping your home clean, dry, and well aired. Minimize your exposure to disease-producing agents such as bacteria, viruses, and fungi with good hand hygiene. Wash your hands regularly and thoroughly with soap and water or use an alcohol-based rub, especially during flu season and whenever family members have a contagious illness.

If you're prone to chronic sinusitis, or if you have acute sinusitis, nasal irrigation with a metered nasal spray, nebulizer, douche, neti pot, or bulb syringe will keep the inside of your nose moist.

Flushing your nasal passages with a store-bought or home-made solution of hypertonic saline (salt water) can improve mucus transport, reduce swelling in the nasal passages, and get rid of infectious debris and allergens. Flushing can relieve sinusitis symptoms and reduce the chance of recurrent infection.

Smoking increases the risk of developing sinusitis. If you smoke, get help to stop. (Inhaling second-hand smoke is also a risk factor for sinus infection, so consider making yours a smoke-free home).

Get tested for allergies — if you know what causes allergy attacks, you might be able to avoid these triggers and reduce the risk of sinusitis.

If you catch a cold, drink lots of fluids and use a nasal spray or oral decongestant to keep your sinuses clear. And when your nose is congested, blow your nose gently, one nostril at a time (forceful nose blowing may actually worsen sinusitis symptoms).

Changes in air pressure from swimming, diving, or air travel can trigger sinusitis. Consider using decongestants before travel and when swimming.

Influenza and pneumococcal infections can increase the risk of sinusitis, especially in children and in adults with certain conditions such as chronic heart disease, diabetes, and HIV. Remember to get your annual flu shots.

The Centers for Disease Control and Prevention also recommend vaccination against pneumococcus for children younger than 5 years, adults over 65 years, and people with certain risk factors including chronic heart disease, chronic lung disease, HIV infection, diabetes, sickle cell disease, and other conditions.

Finally, eating a healthy diet of foods that are rich in vitamins and minerals can reduce the risk of developing upper respiratory tract infections and sinusitis.

Sources:

  • Hamilos DL. Chronic rhinosinusitis: epidemiology and medical management. Journal of Allergy and Clinical Immunology. 2011.
  • Fokkens et al. European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology. 2012.
  • Meltzer et al. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clinic Proceedings. 2011.
  • Rosenfeld et al. Clinical practice guideline: adult sinusitis. Otolaryngology. 2007.

Sinus Infection Complications

Can you recognize the signs of a sinusitis complication?

Complications from sinus infections are relatively rare. However, when complications occur they can be serious.

Men typically have more sinusitis complications than women; complications occur more in the winter months that at other times of the year; and complications in children are almost always preceded by acute (rather than chronic) sinusitis.

The three main kinds of complications from sinusitis are orbital, intracranial, and bone.

Orbital Complications of Sinusitis

The orbits — sometimes called the eye sockets — are the cavities in your skull that hold your eyes in place.

Orbital complications of sinusitis are the most common type, and often occur with swelling of the eyelids, bulging eyes, impaired eye movement, and vision symptoms such as double vision (diplopia).

The symptoms of orbital cellulitis — an infection of the tissue in the back of the orbits — include protruding eyeballs, limited motion of the eyes, and tenderness around the eyes. Preseptal cellulitis (a related condition involving the eyelid or conjunctiva) typically shows up with orbital pain, eyelid swelling, fever, and erythema.

Treatment for orbital cellulitis includes intravenous (IV) antibiotics. Children with these symptoms usually need a computerized tomography (CT) scan of the sinuses to rule out abscesses.

A subperiosteal abscess of the orbital area often involves swelling of the eyelids and conjunctiva. Other symptoms include redness of the eyelids, protruding eyeball, limited ocular motion, reduced sharpness of vision (visual acuity), and high fever.

Treatment involves 24 to 48 hours of IV antibiotics. If the abscess remains on CT scan after treatment, surgical exploration of the orbital area and drainage of the sinuses and abscess are often necessary.

The following ‘red flag’ symptoms during a sinusitis infection are reasons to seek immediate medical help:

  • Vision symptoms (double vision, decreased visual acuity, difficulty opening the eye)
  • Severe headache
  • Swelling or redness around one or both eyes
  • Impaired function of the muscles of and around the eyes
  • Neck stiffness
  • Confusion or difficulty thinking clearly
  • Sleepiness
  • High fever

Your health care provider may recommend a CT scan and/or referral to an otolaryngologist, also called an ENT or ear, nose, and throat specialist.

Intracranial Complications of Sinusitis

The main intracranial complications of sinusitis — those that occur inside the skull — are abscess, meningitis, cerebritis (an inflammation of the brain), and cavernous sinus thrombosis (an infection in the veins around the sinuses).

Symptoms associated with these conditions include high fever, severe headache, nausea and vomiting, neck stiffness, altered mental state, and difficulty walking. In cavernous vein thrombosis, signs and symptoms include both eyelids dropping, pain around the eyes, headache, and fever.

Intracranial complications are mostly linked to an infection of the ethmoid or sphenoid sinuses, and high-dose IV antibiotics are often used as treatment.

Bone Complications of Sinusitis

Bone complications of sinusitis include an infection (osteomyelitis) of the frontal bone in the head, or Pott’s puffy tumor — a doughy swelling in the skin of the frontal bone.

Symptoms include swelling of the eyelids, high fever, severe headache, nausea and vomiting, diplopia, and photophobia (avoiding light). A CT scan is usually needed to confirm bone complications. Treatments may include antibiotics, surgical removal of damaged bone, and sinus drainage.

Complications from Chronic Sinusitis

Complications from chronic sinusitis that affect the surrounding area can include:

  • Mucoceles: sacs in the sinuses that block the sinuses
  • Osteitis: inflammation of the bone
  • Bone erosion/expansion: bone thinning or thickening

Sinusitis in Pregnancy

Changes that occur during pregnancy can result in sinusitis. Antibiotic treatment with amoxicillin can be used to treat acute bacterial sinus infection in pregnancy, but other antibiotics that are sometimes used in the treatment of sinusitis, such as sulfonamides, may cause harm to the developing fetus.

If you are pregnant, most doctors suggest you avoid using oral corticosteroids and decongestants in the first trimester.

Sinusitis Complications in Children

As with adults, orbital complications from sinusitis are most common in children, including orbital cellulitis, abscess, and cavernous thrombosis. In children, infection can spread easily in the sinuses, and orbital complications can occur with or without pain. Intracranial complications include abscess, venous thrombosis, and meningitis.

If your child has any of the following symptoms you should seek treatment:

  • Impaired function of the muscles around the eyes
  • Neck stiffness
  • Confusion or difficulty thinking clearly
  • Severe headache

Sources:

  • Aring et al. Acute rhinosinusitis in adults. American Family Physician. 2011.
  • Foden et al. A guide to the management of acute rhinosinusitis in primary care: management strategy based on best evidence and recent European guidelines. British Journal Of General Practice. 2013.
  • Wald et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013.
  • Goldstein et al. Rhinologic issues in pregnancy. Allergy & Rhinology. 2012.

Source: http://www.everydayhealth.com

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