Overview

If you have nasal congestion, facial pressure, cough and thick nasal discharge, you may have rhinosinusitis, commonly referred to as sinusitis.
Sinuses are hollow spaces in the bones around the nose that connect to the nose through small, narrow channels. The sinuses stay healthy when the channels are open, which allows air from the nose to enter the sinuses and mucus made in the sinuses to drain into the nose.
Sinusitis, also called rhinosinusitis, affects about 1 in 8 adults annually and generally occurs when viruses or bacteria infect the sinuses (often during a cold) and begin to multiply. Part of the body’s reaction to the infection causes the sinus lining to swell, blocking the channels that drain the sinuses. This causes mucus and pus to fill up the nose and sinus cavities.
Humans have four pair of these cavities each referred to as the:

• frontal sinus (in forehead),
• maxillary sinus (behind cheeks),
• ethmoid sinuses (between the eyes), and
• sphenoid sinus (deep behind the ethmoids).

What Causes It?

Lots of people. About 35 million Americans have sinusitis at least once each year. Conditions that can cause sinus blockage include:

• Nasal polyps: These tissue growths can block the nasal passages or sinuses.
• Deviated nasal septum: A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
• Other medical conditions: The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases can result in nasal blockage.
• Respiratory tract infections: Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
• Allergies such as hay fever: Inflammation that occurs with allergies can block your sinuses.
• Allergic rhinitis: which is swelling of the lining of the nose.
• Immune system deficiencies or medications that suppress the immune system, such as; Budesonide (Entocort EC), Cortisone (Cortone), Dexamethasone (Decadron), Hydrocortisone (Cortef), Methylprednisolone (Medrol), Prednisolone (Prelone), Prednisone (Deltasone), Triamcinolone and others.

For children, things that can cause sinusitis include:

• Allergies
• Illnesses from other kids at day care or school
• Pacifiers
• Bottle drinking while lying on the back
• Smoke in the environment

Types

• Acute sinusitis usually starts with cold-like symptoms such as a runny, stuffy nose and facial pain. It may start suddenly and last 2-4 weeks. Acute viral sinusitis is likely if you have been sick less than 10 days and are not getting worse. Acute bacterial sinusitis is likely when you do not improve at all within 10 days of getting sick or when you get worse within 10 days after beginning to get better.
• Subacute sinusitis inflammation usually lasts 4 to 12 weeks.
• Chronic sinusitis inflammation symptoms last 12 weeks or longer. People with allergic rhinitis or asthma are more likely to suffer from chronic sinusitis. This is because the airways are more likely to become inflamed when allergic rhinitis or asthma are present.
• Recurrent sinusitis happens several times a year.

Symptoms

At least two of the four primary signs and symptoms of chronic sinusitis must be present with confirmation of nasal inflammation for a diagnosis of the condition. They are:

• Thick, discolored discharge from the nose or drainage down the back of the throat (postnasal drainage) or
• Yellowish-greenish nasal discharge that may have an odor
• Nasal obstruction or congestion, causing difficulty breathing through your nose
• Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
• Reduced sense of smell and taste in adults or cough in children
• Post nasal drip is mucus overproduction from sinusitis that flows to the throat and irritates throat tissue

Other signs and symptoms can include:

• Ear pain
• Aching in your upper jaw and teeth
• Cough that might worsen at night
• Sore throat
• Bad breath (halitosis)
• Fatigue or irritability
• Nausea
• Tooth pain
• Itching eyes or sneezing

Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn’t a common sign of chronic sinusitis, but you might have one with acute sinusitis.

Is Chronic Sinusitis Treated Differently Than Acute Sinusitis?

Because chronic sinusitis is caused more by inflammation than infection, the treatments for chronic sinusitis are meant to control the inflammation. Salt water nasal irrigation and/or nasal steroid sprays are the main treatments for the symptoms of chronic sinusitis. It may help to look for other factors that can go along with chronic sinusitis and possibly make the problem worse, and have them treated too. Some of these factors are allergies, nasal polyps, asthma, and problems with the body’s ability to fight infections.

Do I Need Surgery For My Sinusitis?

Surgery for the sinuses is done when the symptoms can’t be controlled with medications and other treatments. The most common type of surgery for the sinuses is called endoscopic sinus surgery, because a pencil-sized scope (“endoscope”) is used to see inside the nose and sinuses and guide the surgery. The purpose of the surgery is to widen the natural drainage pathways between the sinuses and the nose, allowing mucus to get out of the sinuses and air to get in. Medications that are delivered to the surface of the nose and sinuses, like sprays and irrigations, can get into the sinuses better after surgery as well.

Risk Factors

You’re at increased risk of getting chronic or recurrent sinusitis if you have:

• A nasal passage abnormality, such as a deviated nasal septum or nasal polyps
• Asthma, which is highly connected to chronic sinusitis
• Aspirin sensitivity that causes respiratory symptoms
• An immune system disorder, such as HIV/AIDS or cystic fibrosis
• Hay fever or another allergic condition that affects your sinuses
• Regular exposure to pollutants such as cigarette smoke

Complications

Chronic sinusitis complications include:

• Meningitis: This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
• Other infections: Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
• Partial or complete loss of sense of smell: Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
• Vision problems: If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Prevention

Take these steps to reduce your risk of getting chronic sinusitis:

• Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before meals.
• Manage your allergies. Work with your doctor to keep symptoms under control.
• Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.
• Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.