What triggers sinusitis?
 Hypothyroidism (underactive thyroid gland) causes
But if sinus drainage is blocked, glands in the sinuses
continue to produce mucus, and the resulting pool of
backed-up mucus provides what Dr. Metson calls "the
perfect culture medium."
Sinus blockage can have a variety of environmental,
anatomical, and genetic causes, but the main culprit is
swelling of the nasal passages produced by the common
cold or allergies. More serious sinusitis can result from
structural problems, such as a deviated septum (a crook in
the partition that separates the right from left nasal
cavities) or nasal polyps (small, grapelike growths in the
lining of the sinus cavity).
Risk Factors
Sinusitis is one of the most common diseases in the
United States, affecting about 30 million Americans each
year.
Young Children and Sinusitis
Before the immune system matures, all infants are
susceptible to respiratory infections. Babies catch a cold
about every 1 - 2 months. Young children are prone to
colds and may have 8 - 12 bouts every year. Smaller
nasal and sinus passages make children more vulnerable
to upper respiratory tract infections than older children and
adults. Ear infections such as otitis media are also
associated with sinusitis. Nevertheless, true sinusitis is
very rare in children under 9 years of age.
The Elderly and Sinusitis
The elderly are at specific risk for sinusitis. Their nasal
passages tend to dry out with age. In addition, the
cartilage supporting the nasal passages weakens, causing
airflow changes. They also have diminished cough and
gag reflexes and weakened immune systems and are at
greater risk for serious respiratory infections than are
young and middle-aged adults.
People with Asthma or Allergies
People with asthma or allergies are at higher risk for non-
infectious inflammation in the sinuses. The risk for sinusitis
is higher in patients with severe asthma. People with a
combination of polyps in the nose, asthma, and sensitivity
to aspirin (called Samter's, or ASA, triad) are at very high
risk for chronic or recurrent acute sinusitis.
Hospitalization
Some hospitalized patients are at higher risk for sinusitis,
particularly those with:
 Head injuries
 Conditions requiring insertion of tubes through the
nose
 Breathing aided by mechanical ventilators
 Weakened immune system (immunocompromised)
Other Medical Conditions Affecting the Sinuses
A number of medical conditions put people at risk for
chronic sinusitis. They include:
 Diabetes
 Gastroesophageal reflux disease
 Nasal polyps or septal deviation
 AIDS and other disorders of the immune system
 Oral or intravenous steroid treatment
congestion that clears up when the condition is treated
 Cystic fibrosis is a genetic disorder in which the mucus
is very thick and builds up
 Kartagener's syndrome, a genetic disorder that
impairs function of cilia, the hair-like structures that
normally move mucus through the respiratory tract
Miscellaneous Risk Factors
Dental Problems. Bacteria associated with infections from
dental problems or procedures can trigger cases of
maxillary sinusitis.
Changes in Atmospheric Pressure. People who
experience changes in atmospheric pressure, such as
while flying, climbing to high altitudes, or swimming, risk
sinus blockage and therefore an increased risk of
developing sinusitis. (Swimming increases the risk for
sinusitis for other reasons, as well.)
Cigarette Smoke and Other Air Pollutants. Air pollution
from industrial chemicals, cigarette smoke, or other
pollutants can damage the cilia responsible for moving
mucus through the sinuses. Whether air pollution is an
important cause of sinusitis and, if so, which pollutants are
critical factors, is still not clear. Cigarette smoke, for
example, poses a small but increased risk for sinusitis in
adults. Second-hand smoke does not appear to have any
significant effect on adult sinuses, although it may pose a
risk for sinusitis in children.
Other Causes of Sinusitis Symptoms
Allergies. Symptoms of both sinusitis and allergic rhinitis
include nasal obstruction and congestion. The conditions
often occur together. People with allergies and no sinus
infection may have:
 Thin, clear, and runny nasal discharge
 Itchy nose, eyes, or throat (do not occur with bacterial
sinusitis)
 Recurrent sneezing
 Symptoms of allergies appear only during exposure to
allergens
Migraine and Other Headaches. Many primary headaches,
particularly migraine or cluster, may closely resemble
sinus headache. Migraine and sinus headaches may even
coexist in many cases. Sinus headaches are usually more
generalized than migraines, but it is often difficult to tell
them apart, particularly if headache is the only symptom of
sinusitis.
Trigeminal Neuralgia. In some cases, headache that
persists after successful treatment of chronic sinusitis may
be due to neuralgia (nerve-related pain) in the face.
Other Conditions. A number of other conditions can mimic
sinusitis. They include:
 Dental problems
 A foreign object in the nasal passage
 Temporal arteritis (headache caused by inflamed
arteries in the head)
 Persistent upper respiratory tract infections
 Temporomandibular disorders (problems in the joints
and muscles of the jaw hinges)
 Vasomotor rhinitis, a condition in which the nasal
passages become congested in response to irritants
or stress. It often occurs in pregnant women.
Complications
Bacterial sinusitis is nearly always harmless (although
uncomfortable and sometimes even very painful). If an
episode becomes severe, antibiotics generally eliminate
 further problems. In rare cases, however, sinusitis can be
very serious.
Osteomyelitis. Adolescent males with acute frontal
sinusitis are at particular risk for severe problems. One
important complication is infection of the bones
(osteomyelitis) of the forehead and other facial bones. In
such cases, the patient usually experiences headache,
fever, and a soft swelling over the bone known as Pott's
puffy tumor.
Infection of the Eye Socket. Infection of the eye socket,
or orbital infection, which causes swelling and subsequent
drooping of the eyelid, is a rare but serious complication of
ethmoid sinusitis. In these cases, the patient loses
movement in the eye, and pressure on the optic nerve can
lead to vision loss, which is sometimes permanent. Fever
and severe illness are usually present.
Blood Clot. Blood clots are another danger, although rare,
from ethmoid or frontal sinusitis. If a blood clot forms in the
sinus area around the front and top of the face, symptoms
are similar to orbital infection. In addition, the pupil may be
fixed and dilated. Although symptoms usually begin on
one side of the head, the process usually spreads to both
sides.
Brain Infection. The most dangerous complication of
sinusitis, particularly frontal and sphenoid sinusitis, is the
spread of infection by anaerobic bacteria to the brain,
either through the bones or blood vessels. Abscesses,
meningitis, and other life-threatening conditions may
result. In such cases, the patient may experience mild
personality changes, headache, altered consciousness,
visual problems, and, finally, seizures, coma, and death.
First line of defense against sinusitis: Nasal irrigation
One of the simplest, cheapest, and most effective ways to
prevent and treat sinus problems is nasal irrigation. Using
a homemade solution, you can often relieve sinusitis
symptoms, reduce reliance on nasal sprays and
antibiotics, and improve your quality of life. At least once a
day, follow these steps:
1. Stir ½ teaspoon of non-iodized salt and ½ teaspoon of
baking soda into 2 cups of lukewarm distilled or previously
boiled water (as recommended by the American Academy
of Otolaryngology).
2. Fill a small bulb syringe with the saltwater solution. (If you
prefer, you can use a small pitcher called a neti pot to
stream the solution through your nose.)
3. Lean over your bathroom or kitchen sink, insert the tip of
the syringe just inside one nostril, and gently squeeze the
bulb. The water will run back out the nostril (or possibly
the opposite nostril) and into the sink. Use at least one full
bulb of solution.
4. Repeat the procedure in the other nostril. (If the salt
solution stings your nose, use less salt.)
5. Thoroughly rinse (with distilled or cooled boiled water) and
dry the bulb syringe or neti pot after each use.
Hydration
Home remedies that open and hydrate sinuses are often
the only treatment necessary for mild sinusitis that is not
accompanied by signs of acute infection.
 Drinking plenty of fluids and getting lots of rest when
needed is still the best bit of advice to ease the
discomforts of the common cold. Water is the best
fluid and helps lubricate the mucus membranes.
(There is NO evidence that drinking milk will increase
or worsen mucus, although milk is a food and should
not serve as fluid replacement.)
 Chicken soup does, indeed, help congestion and
aches. The hot steam from the soup may be its chief
advantage, although other ingredients in the soup may
have anti-inflammatory effects. In fact, any hot
beverage may have similar soothing effects from
steam. Ginger tea, fruit juice, and hot tea with honey
and lemon may all be helpful.
 Spicy foods that contain hot peppers or horseradish
may help clear sinuses.
Prevention
The best way to prevent sinusitis is to avoid colds and
influenza. If you are unable to avoid them, the next best
way to prevent sinusitis is to effectively treat colds and
influenza.
 Good Hygiene and Preventing Transmission
Colds and flu are spread primarily when an infected
person coughs or sneezes near someone else. A very
common method for transmitting a cold is by shaking
hands. Everyone should always wash their hands before
eating and after going outside. Ordinary soap is sufficient.
Waterless hand cleaners that contain an alcohol-based gel
are also effective for everyday use and may even kill cold
viruses. (They are less effective, however, if extreme
hygiene is required. In such cases, alcohol-based rinses
are needed.) Antibacterial soaps add little protection,
particularly against viruses. Wiping surfaces with a
solution that contains one part bleach to 10 parts water is
very effective in killing viruses.
 Vaccines
Influenza Vaccine. Because influenza viruses change from
year to year, influenza vaccines are redesigned annually
to match the anticipated viral strains. Doctors recommend
that people receive annual influenza vaccinations in
October or November.
Flu vaccines are now recommended for virtually everyone
over 6 months of age, except those allergic to eggs or
other vaccine compounds.
 Bathe your nasal passages daily. Run water gently into
the nasal passages to help clear excess mucus and
moisten membranes. (See "First line of defense: Nasal
irrigation.") Good times to do it are in the morning and at
night, when you brush your teeth. "Brush, then flush," is
Dr. Metson's motto. During the day, use nasal saline spray
to moisten nasal passages.
 Drink lots of water. Good hydration helps keep the
mucus thin and loose. Have a bottle of water at your desk
at work, or put a glass near the kitchen sink to remind you
to drink water throughout the day.
 Inhale steam. Linger in a hot shower. Or bring water to a
boil, and pour it into a pan; place a towel over your head,
and carefully bend over the pan to inhale the steam. To
avoid burns, keep your distance at first and move in
gradually to a comfortable zone.
 Avoid dry environments. A humidifier in your home (in
particular, by your bed) and where you work can help
prevent nasal passages from drying out. Keep humidifiers
clean and free of bacteria and mold.
 Sleep with your head elevated. Mucus pools in your
sinuses at night when your head is down, so have your
head propped up with pillows or a wedge during sleep.
 Be nice to your nose. Blow your nose gently, one nostril
at a time. Forceful blowing can irritate the nasal passages
and propel bacteria-laden mucus back up into your
sinuses.
 Avoid antihistamines unless prescribed. Antihistamines
make mucus thick and hard to drain. But if your sinusitis is
triggered by allergies, your clinician may still want you to
take an antihistamine along with other medications.
 Be careful with decongestants. Tablets containing
pseudoephedrine act on blood vessels to shrink
membranes and keep nasal passages open. Nasal sprays
containing phenylephrine or oxymetazoline also work well
— and quickly. But using topical nasal decongestants for
more than a day or two runs the risk of setting off a spiral
of dependency as a result of rebound — increased
swelling after the medication wears off. (According to Dr.
Metson, a shorter-acting spray, such as 0.25% or 0.5%
Neo-Synephrine, is less likely to cause rebound than
longer-acting ones like Afrin.) Oral decongestants can
cause jitters and increase blood pressure, so if you have
high blood pressure, don't use them without consulting a
clinician first.
Medications
Antibiotics
Antibiotic drugs are used to treat bacterial, not viral,
infections. Unfortunately, because of the overuse and
improper use of antibiotics, many types of bacteria no
longer respond to antibiotic treatment. The bacteria have
become “resistant” to these drugs. Due to the problem of
bacterial resistance, doctors have had to switch to
different or stronger types of antibiotics to treat bacterial
infections.
Amoxicillin, a type of penicillin, used to be the main
antibiotic used for sinusitis but it has become less
effective. Amoxicillin-clavulanate (Augmentin, generic) has
replaced amoxicillin as the antibiotic recommended for
treating acute bacterial sinusitis in both children and
adults. It is a type of penicillin that works against a wide
spectrum of bacteria.
Patients who have a history of penicillin allergy cannot
take amoxicillin-clavulanate:
 For adults with sinusitis and penicillin allergies,
doctors recommend either doxycycline or the
fluoroquinolones levofloxacin or moxifloxacin.
 Children should not take doxycycline because it can
cause tooth discoloration. Levofloxacin is the standard
alternative antibiotic for children with penicillin
allergies.
Other types of antibiotics, such as macrolides and
trimethoprim-sulfamethoxaole, have also become
ineffective for treating acute bacterial sinusitis and are no
longer recommended.
Side Effects. Side effects of antibiotics vary according to
the specific drug and the patient’s individual response.
Many patients experience few side effects, but they many
include:
 Upset stomach.
 Vaginal infections. (Taking supplements of acidophilus
or eating yogurt with active cultures may help restore
healthy bacteria that offset the risk for such infections.)
 Allergic reactions can occur with all antibiotics but are
most common with medications derived from penicillin
or sulfa. These reactions can range from mild skin
rashes to rare but severe, even life-threatening,
anaphylactic shock.
 Certain drugs, including some over-the-counter
medications, interact with antibiotics. Inform your
doctor of all medications you are taking and of any
drug allergies.
Corticosteroids
Nasal-spray corticosteroids, most commonly called
steroids, are effective drugs for treating allergic rhinitis.
Although they are not approved for treating sinusitis, they
may be helpful for patients with sinusitis (either chronic or
acute) who have a history of allergic rhinitis. Nasal spray
steroids can help reduce inflammation and mucus
production.
Corticosteroids available in nasal spray form approved for
treating nasal allergy symptoms include:
 Triamcinolone (Nasacort, generic). Approved for
children over age 6.
 Mometasone furoate (Nasonex). Approved for use in
patients as young as age 3.
 Fluticasone (Flonase, generic). Approved for children
over age 4.
 Beclomethasone (Beconase, Vancenase), flunisolide
(Nasalide, generic), and budesonide (Rhinocort).
Approved for children over age 6.
Side Effects. Corticosteroids are powerful anti-
inflammatory drugs. Although oral steroids can have many
side effects, the nasal-spray form affects only local areas,
and the risk for widespread side effects is very low unless
the drug is used excessively. Side effects of nasal
corticosteroids may include:
 Dryness, burning, stinging in the nasal passage
 Sneezing
 Headaches and nosebleed (these side effects are
uncommon but should be reported to your doctor
immediately)
Decongestants
Decongestants are drugs that help reduce nasal
congestion. They are available in both pill and nasal spray
forms. However, decongestants will not cure sinusitis.
Nasal decongestants may actually worsen sinusitis by
increasing sinus inflammation.
Due to the lack of evidence for the benefit of nasal
decongestants in treating sinusitis, the FDA ordered
manufacturers of over-the-counter (OTC) nasal
decongestant products to remove from their labeling all
references to sinusitis. The Infectious Diseases Society of
America does not recommend nasal or oral decongestants
for patients with acute bacterial sinusitis.
Your doctor may still recommend that you take either an
OTC or prescription nasal decongestant to help relieve
blockage symptoms associated with sinusitis. If you think
you have sinusitis, check with your doctor before taking a
decongestant. Do not try to treat sinusitis by yourself.
Decongestants should never be used in infants and
children under the age of 4 years, and some doctors
recommend not giving them to children under the age of
14. Children are at particular risk for central nervous
system side effects including convulsions, rapid heart
rates, loss of consciousness, and death.
Antihistamines
Antihistamines are included in many cold and allergy
medications. Because they dry and thicken nasal
secretions, they make sinus drainage difficult and may
worsen sinusitis. Patients with sinusitis should not take
antihistamines.
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