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Sinusitis

Sinusitis

Definition

Sinusitis is inflammation of the sinus cavities. The sinus cavities are air-filled spaces in the skull. It is usually associated with infection.

Sinusitis is called acute if it lasts for less than 4 weeks, subacute if it lasts 4-12 weeks, and chronic if symptoms last for more than 3 months. You may have recurrent sinusitis if you have repeated bouts of acute sinusitis.

Sinus Infection
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Causes

Infectious sinusitis is caused by a viral, bacterial, or (rarely) fungal infection of fluid in the sinus cavities. Infections are usually associated with acute sinusitis more than chronic.

Risk Factors

Factors that may increase your chance of sinusitis include:

  • Recent viral infection
  • Smoking or exposure to second-hand smoke
  • Other sources of indoor or outdoor air pollution
  • Allergies or asthma
  • Abnormalities of the facial bones, sinuses, or nasal passages, such as:
    • Deviated septum
    • Nasal polyps
    • Cleft palate
    • Large adenoids
  • Certain chronic illnesses, including:
    • Cystic fibrosis
    • Kartagener’s syndrome (a chronic lung disease) and immotile cilia syndrome
    • Wegener granulomatosis—rare disease that causes blood vessel walls to become inflamed
    • Sarcoidosis
  • HIV infection and other disorders of the immune system
  • Diabetes
  • Head injury or a medical condition requiring a tube to be inserted into the nose
  • Cocaine and other drugs inhaled through the nose

Symptoms

Sinusitis may cause:

  • Facial congestion or fullness
  • Facial pain or pressure that increases when you bend over or press on the area
  • Headache
  • Cough, which is often worse at night
  • Nasal congestion not responding well to either decongestants or antihistamines
  • Runny nose or postnasal drip
  • Thick, yellow, or green mucus
  • Bad breath
  • Ear pain, pressure, or fullness
  • Fever
  • Fatigue
  • Dental pain
  • Initial improvement with sudden worsening of symptoms over the course of a few weeks

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Sinusitis is diagnosed based on its symptoms and tenderness of the sinuses when pressed.

Tests may include:

  • Holding a flashlight up to the sinuses to see if they light up
  • CT scan or x-ray of the sinuses to look for fluid in the sinus
  • Endoscopic examination of the sinuses—threading a tiny, lighted tube into the nasal cavities to view the sinus opening
  • Removing sinus fluid through a needle for testing (rare)

You have may acute sinusitis when the following occurs:

  • History of 10 or more days of colored mucous, or visibly infected mucus
  • Tenderness over the sinuses
  • Fever
  • Difficulty smelling

Treatment

Most sinus infections are caused by a virus and will pass on their own in 7-10 days. Home care and medications can help manage symptoms.

Infections that last longer or keep coming back may need more care.

Prevention

To help reduce your chance of sinusitis:

  • Have allergy testing to find out what things you are allergic to and to learn how to treat your allergies.
    • Avoid substances you know you are allergic to
    • Stick with your allergy treatment plan
  • If you get a cold, drink lots of fluids and use a decongestant.
  • Use sinus washes as directed.
  • Blow your nose gently, while pressing one nostril closed.
  • If you must travel by air, use a nasal spray decongestant to decrease inflammation prior to takeoff and landing.
  • Use a humidifier when you have a cold, allergic symptoms, or sinusitis.
  • Use HEPA filters for your furnace and vacuum cleaner to remove allergens from the air.
  • Avoid cigarette smoke.
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