Sinusitis is inflammation of the sinuses in the face which fill with mucus and become painful. Sinusitis is called “chronic’ when it lasts longer than 8 weeks. The sinuses are spaces in the bones which are normally mostly empty except a little bit of tissue that can become swollen or inflamed. This inflammation generally begins with a common cold, bacteria, allergies or fungal infections. When the sinuses become inflamed, mucus cannot drain normally and becomes backed up. The sinuses that most often have inflammation and get sinusitis are called the paranasal sinuses and consist of the frontal sinus (which lies in the forehead region), the maxillary sinuses (which lie to either side of the nose in the cheekbone area) and the ethmoid and sphenoid sinuses (which lie further back in the bone between the face and the brain). The backup of mucus in the sinuses can cause a stuffy feeling or feeling of increased pressure and pain in the area of the sinuses or in the teeth. Risk factors for chronic sinusitis include allergies or hay fever, having nasal polyps or tumors a deviated nasal septum (or a crooked wall between the two nostrils of the nose), infections in the teeth, having enlarged or infected adenoids, prolonged exposure to environmental irritants like cigarette smoke, HIV, acid reflux (GERD), and aspirin sensitivity. These symptoms can come and go quickly (acute sinusitis) but if they last longer than eight weeks, they are called chronic sinusitis. Chronic sinusitis can have the more serious complications of causing exacerbations of asthma, meningitis, problems with vision (if infection spreads to the eye socket), aneurysms (dilated areas of the blood vessels), blood clots (especially in the veins surrounding the sinuses which can sometimes lead to a stroke), and ear infections.
Thick green or yellow drainage from nose, mucus draining in the back of the throat, feeling of fullness in sinuses, congestion, difficulty breathing from nose, pain in jaw or teeth, pain in sinuses or face, decreased smell, decreased taste, cough, pain in the ear, sore throat, fatigue, bad breath
The diagnosis of acute sinusitis is made after a thorough history and physical exam by your doctor. Your doctor will press over your sinuses to see if you have tenderness which is indicative of sinusitis. Your doctor will also look in your nose and mouth with a light. Sometimes, an ENT doctor (ear, nose and throat or otolaryngologist) will look further into your nasal passages with a thin tube with a camera at the end to see if there is anything causing the sinusitis in the nasal passages like polyps (small abnormal growths). This procedure is called nasal endoscopy. You may also have a CT scan done to take pictures of your sinuses and look for signs of deeper inflammation or other things that may be causing an obstruction in your nasal passages. Sometimes a swab of the nasal passages will be done to identify what may be causing your infection, especially with chronic sinusitis where the source of the sinusitis may be coming from. You may be referred to an allergist who can do a test with a series of small pinpricks on your skin to see if you may have allergies.
Acute sinusitis resolves on its own over time, but chronic sinusitis typically does not. For chronic sinusitis, the goals of treatment are to decrease flare-ups, allow sinuses to drain, and reduce the source of inflammation. To help relieve the symptoms of sinusitis, many treatment options are available including over-the-counter saline nasal sprays (which help clean out the nasal passages of allergens and bacteria), nasal corticosteroids (to help decrease inflammation in the nasal passages), decongestants (to help decrease secretions), and pain relievers like aspirin or Tylenol. Chronic sinusitis is sometimes treated with antibiotics though most of the time chronic sinusitis is not caused by bacteria, so antibiotics will not work. If you are given a prescription for antibiotics, it is important to finish the entire prescription even if your symptoms improve because the infection may not be totally gone and may come back. Depending on your particular case, you may need anti-fungal medication as well. For people with allergies (including to aspirin), and allergist may recommend allergy shots, or immunotherapy, to help decrease the likelihood that you will keep getting recurrent sinusitis. You may go to see an ENT doctor for minimally invasive endoscopic sinus surgery, as well as balloon sinuplasty which are used to open the sinuses and improve mucus drainage. After sinus surgery, patients typically experience fewer sinus infections, less severe sinus infections and improve much faster with medical treatment.
