Definition

Sinusitis refers to an inflammation of the sinuses, airspaces within the bones of the face. Sinusitis is most
often due to an infection within these spaces.

Description

The sinuses are paired air pockets located within the bones of the face. They are:

• the frontal sinuses; located above the eyes, in the center region of each eyebrow
• the maxillary sinuses; located within the cheekbones, just to either side of the nose
• the ethmoid sinuses; located between the eyes, just behind the bridge of the nose
• the sphenoid sinuses; located just behind the ethmoid sinuses, and behind the eyes

The sinuses are connected with the nose. They are lined with the same kind of skin found
elsewhere within the respiratory tract. This skin has tiny little hairs projecting from it,
called cilia. The cilia beat constantly, to help move the mucus produced in the sinuses
into the respiratory tract. The beating cilia sweeping the mucus along the respiratory tract
helps to clear the respiratory tract of any debris, or any organisms which may be present.
When the lining of the sinuses is at all swollen, the swelling interferes with the normal
flow of mucus. Trapped mucus can then fill the sinuses, causing an uncomfortable
sensation of pressure and providing an excellent environment for the growth of infection-
causing bacteria

What and where are the sinuses?

The sinuses are hollow cavities in the facial bones that connect to the nasal cavity through narrow channels
called ostia. The frontal, maxillary and anterior ethmoid sinuses drain through a common channel called the
middle meatus. The posterior ethmoid and sphenoid sinuses drain into the sphenoethmoid recess.

What is the purpose of sinuses?

The reason is unknown but there are a number of theories as to why the sinuses developed:

• Humidification and filtration of inhaled air

• Lightens the weight of the skull
• Affect vocal resonance/enhance voice
• Absorb energy of an impact therefore helping to prevent brain injury (much like the body of a car
does in a crash)

What are cilia?

The sinuses in their normal state are empty since mucous is constantly swept out by cilia. The cilia work in
unison to sweep the mucous through the ostia. The mucous is swept into the nasal cavity where it then
drains out of the nose (runny nose) or into the back of the throat (post nasal drip). When cilia do not
function properly either due to an inborn problem (rare), infection or smoking, mucous is not properly
cleared. This becomes self-perpetuating process where the infected mucous interferes with the normal
sweeping process of the cilia and this in turn prevents proper clearance of the mucous.
Definition of sinusitis:

Sinusitis is defined as inflammation within the sinus cavities. Acute sinusitis often occurs in the common
cold and in the first ten days of symptoms there is reason to wait since things often improve on their own.
In fact, a recent study suggests that treatment with a nasal steroid spray is as good as antibiotics in acute
sinusitis. Beyond 10 days, it’s likely that things have evolved into a bacterial sinusitis. Anyone can get a
bacterial sinusitis but it’s more likely if you have allergies, smoke cigarettes (or smoke anything for that
matter), have some certain anatomic variances within your sinuses (such as a deviated nasal septum) or if
you have an immune deficiency. Bacterial sinusitis can relapse and require more than one round of
antibiotics.

Chronic sinusitis is potentially much more complicated than acute sinusitis depending upon the cause.
Some patients with chronic sinusitis have localized areas of infection due to their sinus anatomy that might
respond well to surgery alone. For others there is widespread swelling of the sinus membranes and though
surgery may help some of these patients, they also need careful close monitoring and medications to keep
the sinus swelling in check. Go to the chronic sinusitis page.
How long does a typical cold last? Symptoms can linger up to 2 weeks. If things are gradually improving
each day, there is reason to wait rather than take antibiotics. Upper respiratory infections may be routine
viral infections but may be the flu. Follow this link to see the difference between the flu and a the common
cold.

Diagnosis

A thorough medical history, physical examination and diagnostic testing help to differentiate between the
many causes of sinus pain. Testing for sinus disease usually consists of allergy skin testing to determine
sensitivities to airborne allergens with an emphasis on mold. Evaluation of the upper airway requires a
visual examination (endoscopy) with a small camera attached to a thin flexible endoscope. Our office uses
the D-Scope™ VCCU (Video Capture and Compression Utility) a PC Based digital video system
developed by Dr. Chandler. This enables us to review the images immediately with the patient, to share
findings with other physicians as necessary and to compare findings over time. Lastly since many patients
with sinus disease have asthma, a pulmonary function test is often done at the time of the first visit. By the
time the patient has left the office after the initial consultation they often know their allergic sensitivities,
the status of their sinus disease and their lower airway function (as applicable).

Treatment

Treating acute bacterial sinusitis can be as easy as taking antibiotics. Treating chronic sinusitis is another
matter entirely since it is a fairly complex problem. Please see chronic sinusitis treatment.

What are the side effects of the treatments?

Many over-the-counter antihistamines cause drowsiness and decreased mental

alertness. Decongestants can cause elevation of blood pressure, fast heart rate, and
difficulty sleeping. Nasal steroids may cause nosebleeds and nasal crusts. Chronic
steroid usage can cause bone thinning, predisposition to infection, diabetes, and
cataracts.
Chronic Sinusitis and Home Remedies

Sinus infection cannot be cured by home remedies. However, people can use home
remedies to lessen their discomfort. Inhaling steam from a vaporizer or a hot cup of
water can soothe inflamed sinus cavities. Another treatment is saline nasal spray,
which can be purchased in a pharmacy. A hot water bottle; hot, wet compresses; or
an electric heating pad applied over the inflamed area also can be comforting.

Prevent Chronic Sinus Infections

Simple changes in your lifestyle or home environment may help lower your risk for
sinusitis. Some common ways to lower your risk of developing an infection are:

1. In winter months, when the cold air outside and your heating system make
the air inside your home abnormally dry, use a humidifier to keep home
humidity at 45% to 50%. This will stop dry air from irritating the sinuses, and
make them less of a target for infection. (Don't forget to clean your humidifier
as directed to avoid growth of mold).
2. During summer months, if you swim, keep your head above water and avoid
deep dives and somersaults under water.
3. If you smoke, quit. Allergy management at all times of the year is very
important.

Contagious

No. Sinusitis (chronic and acute) is not contagious. However, the cold that frequently
precedes sinusitis may be spread to other family members.

What do the Sinuses do?

Sinuses are very important. They help warm, moisten and filter the air in the nasal
cavity and also add resonance to certain sounds.

Major Signs

The three major signs indicating sinusitis and/or a sinus infection are:

1. Your cold has lasted more than seven days and is accompanied by cough,
fever, headache, toothache, facial pain, green or gray nasal drainage, or
postnasal drip.
2. You have lost your sense of smell and taste and have bad breath
accompanied by chronic congestion.
3. In children, increased irritability and vomiting occurs with gagging on mucus
and/or a prolonged cough.

Tips on taking care of sinusitis

 1. Get plenty of rest. Lying down can make your sinuses feel more stopped-up,
so try lying on the side that lets you breathe the best.
2. Sip hot liquids and drink plenty of fluids.
3. Apply moist heat by holding a warm, wet towel against your face or breathing
in steam through a cloth or towel.
4. Talk with your doctor before using an over-the-counter cold medicine. Some
cold medicines can make your sinus infection worse or cause other problems.
5. Don’t use a nose spray with a decongestant in it for more than 3 days. If you
use it for more than 3 days, the swelling in your sinuses may get worse when
you stop the medicine.

Introduction

If you have sinusitis, you are not alone. Sinusitis is one of the most commonly diagnosed diseases in the
United States, affecting more than 30 million adults. Americans make nearly 800,000 emergency
department visits annually for sinusitis. Over $2 billion is spent each year in the U.S. for over the counter
medications for nasal and sinus disorders, and about $200 million on prescription medications.
Furthermore, people with sinus problems undergo more than 460,000 sinus surgeries each year in the U.S.,
making it one of the most commonly performed surgical procedures (1,2).

These numbers are up from a decade ago, and health experts expect further increases in the future. Possibly
due to pollution and other factors, the prevalence of all breathing-related ailments – not just sinusitis, but
also allergies and asthma – is rising and shows no signs of leveling off. And not only is sinusitis common,
it strikes people during their most productive years. It’s far more likely to occur between the ages of 20 and
65 than during childhood or teen years, or late in life.

Causes of sinusitis

The sinuses can become blocked by anything that leads to swelling inside the nose. A common
cold is the most frequent cause, but environmental allergies, such as hay fever, which cause the
membranes lining the nasal cavity to swell can also result in a sinus infection. Other causes
include dry indoor heat during the winter months or a deviated nasal septum. (The septum is the
partition that separates the right and left sides of the nasal cavity. If it is very crooked, it can
obstruct the sinus outflow passages and lead to sinusitis.)
Symptoms of sinusitis

The three most common symptoms of sinusitis are:

Facial pressure/headache: The dull, throbbing pain, ache, or pressure that is a hallmark of
sinusitis results from inflamed tissue putting pressure on nerve endings in the lining of your
sinuses. This pain's location is often specific to the infected sinus:

• Frontal sinusitis causes forehead pain or headache.

• Maxillary sinusitis causes cheek pain, which may radiate to the teeth in the upper jaw.

• Ethmoid sinusitis causes pain between the eyes or across the bridge of the nose.

sphenoid sinusitis causes pain behind the eyes, on the top of the scalp, or along the back of the
head.

If all four pairs of sinuses are infected (what's known as pan sinusitis), your pain and pressure is
usually more spread out and may encompass the entire face or head.

Difficulty breathing through the nose/congestion: The combination of swollen nasal

membranes and excess mucus makes it difficult to breathe through your nose.

For some sinus sufferers, the term congestion refers not to blocked nasal breathing, but to a sense
of fullness or blockage of the face, particularly in the cheeks. This sensation is caused by blockage
of the sinuses themselves. When ostia swell shut, the mucous membranes in the sinuses absorb
oxygen, creating negative pressure (or a vacuum), which can produce this sense of facial
congestion, or even pain.

Nasal drainage/post-nasal drip: Mucus from the sinuses normally drains in minute
quantities into the nose and down the back of the throat before being swallowed. During an
infection, increased secretion by the nose and sinuses results in a larger volume of mucus, which is
often thick and yellow or green. This mucus, which may contain large quantities of bacteria and
white blood cells, flows down the back of the nose and throat. Some people blow a large amount
of mucus out the front of the nose as well.

Other symptoms of sinusitis include:

Loss of smell: The roof of the nasal cavity is lined with smell receptors. Swelling of the
membranes in the nose can block the odor molecules from reaching these receptors, leaving you
with a reduced sense of smell.

Loss of taste: A normal sense of taste, particularly the ability to perceive different flavors,
depends on an intact sense of smell. Consequently, many people who lose smell from sinusitis also
describe a corresponding decrease in their sense of taste.
Bad breath: The discolored mucus that drains from infected sinuses contains bacteria and debris
that emit foul-smelling odors. As a result, thick mucus that runs down the back of your throat may
produce bad breath (halitosis) when these odors are exhaled.

Cough: When mucus runs down the back of the throat, it may touch the vocal cords and trigger an
involuntary cough response. Coughing is often worst when lying down at night or upon awakening
in the morning.

Sore throat: The thick mucus that drains during a sinus infection is more acidic than normal
watery mucus, so it can irritate the membranes that line your throat.

Fatigue: Your body uses extra energy to mount an immune response. This shifting of calorie
reserves from normal daily activity to infection-fighting can leave you feeling tired. In addition,
poor nasal breathing and frequent coughing during the night can cause poor quality sleep, resulting
in less energy during the day.

Ear fullness: Inflammation and drainage from sinusitis may block the eustachian tubes,
passageways that connect your ears to the back of your nose. If these tubes become blocked, you
can develop an uncomfortable feeling of fullness or pressure in the ears.

Fever: Occasionally, the body may mount a fever in response to the marked
inflammation and the presence of a large quantity of bacteria during a sinus infection. Fever is
more common in acute, rather than chronic sinusitis. Acute sinusitis refers to a sinus infection
which lasts less than 4 weeks.

How do I know if I have sinusitis, a cold, or an allergy?

Unless you have prior experience with sinusitis, you may have trouble distinguishing it from other
ailments such as colds and allergies. People often mistakenly confuse the three because so many
of their symptoms are similar. But they are, in fact, three different entities, with three different
causes.
 Colds: Whereas sinusitis is often caused by bacteria, colds are caused by
viruses. These much smaller microorganisms invade the body's cells, where they
reproduce and are eventually released into the bloodstream to invade other cells.
The body's immune system is usually quite effective at controlling viral infections,
so most colds go away within a week. Colds can occur at any time but are most
common during winter ("cold season"). What can be confusing is that it's not
uncommon for a cold to precede a sinus infection.

Allergies: Allergies are usually caused by environmental irritants such as pollen,

dust mites, or pet dander, not bacteria or viruses. These irritants, known as
allergens, activate an immune response that is different from the immune response
to an infection. During allergic reactions, a powerful molecule called histamine
causes the membranes of the upper respiratory tract, including the nose and
sinuses, to swell and weep mucus. Histamine release can also trigger repeated
sneezing and make your nose and eyes itch.

Allergies can be either perennial, meaning they occur year-round, or seasonal.

Allergies to dust and pet dander are often perennial. Seasonal allergies tend to be
worst during the spring, when flowers and trees bloom, and the fall, when ragweed
is in the air. As with colds, allergies may precede and trigger sinusitis.

Table One: Telling Symptoms. The decision on how to treat sinusitis, cold, and
allergy symptoms depends on what’s causing them. Here’s how to tell them apart.
Symptom Sinusitis Cold Allergy
Facial pressure/pain Yes Sometimes Sometimes
Duration of illness More than 10 days Less than 10 days Varies
Nasal discharge Thick, yellow-green Thick and whitish or Clear, thin, watery
thin and watery
Itchy eyes No No Yes
Headache Yes Sometimes Sometimes
Bad breath Sometimes No No
Cough Sometimes Yes Sometimes
Nasal congestion Yes Yes Sometimes
Sneezing No Yes Yes
Fatigue/weakness Sometimes Yes Sometimes
Sore throat Sometimes Yes Sometimes
Anatomy of the sinuses