Sinusitis

What is Sinusitis?

Sinusitis is one of the top reasons people go to a doctor in the United States and a leading reason for prescribing antibiotics. In just one year, it resulted in roughly 73 million days where people had to limit their activities due to symptoms, and it cost about $2.4 billion for treatment, and this doesn’t even include the costs of surgery or special imaging tests. Also, in a health survey, around 14.7% of people reported they had sinusitis during the previous year. Nowadays, you might hear it referred to as rhinosinusitis because it’s rare to have severe sinus disease without also having a similar condition involving the nose (rhinitis).

There are four types of sinusitis which depend on how long the symptoms last and how often they occur:

Acute rhinosinusitis: This is when the symptoms start suddenly and last for less than 4 weeks and then go away completely.
Subacute rhinosinusitis: It’s similar to acute rhinosinusitis, but the symptoms last for less than 12 weeks.
Recurrent acute rhinosinusitis: This refers to when a person has four or more episodes of acute rhinosinusitis, with each episode lasting at least 7 days, within one year.
Chronic rhinosinusitis: This is when a person’s signs and symptoms of rhinosinusitis last for 12 weeks or longer.

What Causes Sinusitis?

What causes sudden or “acute” sinusitis – the inflammation or swelling of your sinuses – is usually a mix of things in your environment and in your body. Most of the time, it can be traced back to viruses and goes away on its own. To paint a clearer picture, think about the fact that almost 90% of people with common colds also have some form of sinus inflammation which is caused by viruses.

People prone to allergies, also known as atopy, often get sinusitis. It can be triggered by various things that you might inhale, such as allergens from pets, pollution, smoke, dust, viruses, and even bacteria and fungi.

Risk Factors and Frequency for Sinusitis

Higher rates of sinusitis are seen in the South and Midwest regions and among women. It mainly affects children under 15 years of age and adults between 25 to 64 years.

There are also a bunch of risk factors that increase the chances of getting sinusitis:

Physical deformities, like a deviated septum, polyps, and trauma or fractures effecting the sinuses or surrounding facial area.
Diseases that affect mucus transportation, such as cystic fibrosis and ciliary dyskinesia.
Conditions that weaken your immune system, such as chemotherapy, HIV, and diabetes.
Being in positions that affect mucus clearance, like patients in intensive care units who stay laying down for prolonged periods.
Problems like medication-induced rhinitis, toxic rhinitis, nasal cocaine abuse, pressure-related injuries, and foreign bodies in the nose.
Prolonged oxygen use which can dry out the mucus lining.
Patients with nasogastric or nasotracheal tubes.

Signs and Symptoms of Sinusitis

Sinusitis, or sinus infection, is characterized by a variety of symptoms. There are major and minor factors that play into the diagnosis, and while minor factors alone don’t necessarily mean you have sinusitis, they become significant when coupled with some of the major factors.

The major symptoms of sinusitis include:

Facial pain or pressure
Feeling of fullness or congestion in the face
Difficulty breathing through the nose
Nasal or post-nasal discharge that is often thick and yellow or greenish (pus-like)
Decreased sense of smell
Fever

Minor sinusitis symptoms, when combined with at least one major symptom, include:

Headache
Bad breath
Fatigue
Feeling unwell (malaise)
Tooth pain
Cough
Ear pain

When performing a physical examination, physicians look for additional signs such as facial swelling, redness, edema (swelling) usually around the eyes, cervical adenopathy (swollen lymph nodes in the neck), postnasal drainage, or a sore throat. A nasal examination may reveal several abnormalities like mucosal swelling, crusting, frank pus, polyps, or other anatomical defects. Examining your sinus through a light source may also be helpful. Factors that predict the existence of sinusitis include pain in the upper teeth, abnormal sinus examination, the poor response to nasal decongestants or antihistamines, colored nasal discharge, and mucopurulent (a mix of mucus and pus) seen on the examination. The presence of four or more of these symptoms is highly suggestive of sinusitis. The overall impression of the quiz by the doctor may be more helpful than any single discovery.

Testing for Sinusitis

For a straightforward case of sinusitis, the doctor usually makes the diagnosis based on your symptoms and a physical examination, so there is no need for lab tests in the emergency department. An X-ray might be used to look at the condition of your maxillary, frontal, or sphenoid sinuses, but it’s not effective for assessing the ethmoid cells or the ostiomeatal complex, where most sinus disease starts. Symptoms that might show up on an X-ray include fluid buildup, sinonasal opacity, or a thickening of the mucus membrane of 6mm or more.

If the doctor wants a more detailed look at your sinuses, they might use a special kind of X-ray called a coronal CT scan. Features on a CT scan that suggest sinusitis include a thickening of the mucosal (mucus-producing) layer of 4mm or more, displacement of the sinus wall, fluid levels within the sinus, or a blockage of the sinus.

If you have chronic bacterial or fungal sinusitis, the doctor may need to take a culture or a biopsy, which involves taking a small sample of tissue for testing. This can help determine the exact cause of the infection, and guide the doctor in selecting the most effective treatment.

Treatment Options for Sinusitis

For treating a congested nose or sinuses, you might use humidification methods, a nasal wash, or decongestants like pseudoephedrine. However, be aware that using oxymetazoline, another type of decongestant, for more than three days can cause your congestion to come back worse than before. People with high blood pressure should be careful when using oral decongestants. Antihistamines, drugs usually used for allergies, are not very helpful for clearing sinuses and can sometimes make drainage worse. They could be beneficial in the early stages of sinusitis (sinus inflammation) if it’s caused by an allergy. Topical steroids, which reduce swelling in your nose, can also be used. They’re more effective in cases of chronic and allergic sinusitis. Doctors usually only prescribe antibiotics if they believe the sinusitis is caused by bacteria.

In terms of antibiotics, the choice is usually made based on what bacteria are common in your community. You might get a 10-14 day course of amoxicillin or amoxicillin-clavulanate as the first line of treatment. However, in some areas, amoxicillin might not be very effective. Another antibiotic, trimethoprim-sulfamethoxazole, works for some people but resistance to it is quite high. If your symptoms don’t improve after a week on antibiotics, your doctor might switch you to a broader-spectrum drug. These could include a longer course of amoxicillin-clavulanate, cefuroxime axetil, other second or third-generation cephalosporins, clindamycin alone or with ciprofloxacin, sulfamethoxazole, a macrolide, or one of the fluoroquinolones. Metronidazole can be added to these treatments to fight a wider range of bacteria. For chronic sinusitis, your antibiotic should be effective against bacteria called S. aureus and be able to target other common bacteria that produce beta-lactamase, an enzyme that makes them resistant to many other antibiotics. If your condition doesn’t improve after 5-7 days on antibiotics, your doctor might add metronidazole or clindamycin. Typically, adults who respond well to treatment take antibiotics for 5-7 days, while children require a longer course of 10-14 days.

The condition that is most frequently confused with sinusitis is rhinitis or an upper respiratory infection. A toothache in the upper jaw can also seem like the pain associated with sinusitis in the same area. There are also other conditions that can be mistaken for sinusitis. These include:

Tension headaches
Vascular headaches
Presence of foreign bodies
Brain abscesses
Epidural abscesses
Meningitis
Subdural empyema (a collection of pus between the brain and its outermost cover)

What to expect with Sinusitis

In general, simple cases of acute bacterial sinusitis can be treated outside of the hospital and patients are likely to recover well. However, if you have this condition in your frontal or sphenoid sinuses (two different areas of your sinuses) and tests show fluid, it might be necessary for you to be hospitalized and treated with antibiotics delivered directly into your veins. If you have a weak immune system or appear seriously ill, you will need to be admitted to the hospital. It should be noted that sinusitis caused by fungus is quite serious, often leading to severe illness and even death.

Frequently asked questions

The prognosis for sinusitis is generally good, especially for simple cases of acute bacterial sinusitis. Most patients are likely to recover well with treatment outside of the hospital. However, sinusitis caused by fungus can be quite serious and may lead to severe illness and even death.

Sinusitis can be caused by a mix of factors in your environment and in your body, including viruses, allergens, bacteria, fungi, physical deformities, diseases affecting mucus transportation, weakened immune system, positions affecting mucus clearance, medication-induced rhinitis, toxic rhinitis, nasal cocaine abuse, pressure-related injuries, foreign bodies in the nose, prolonged oxygen use, and patients with nasogastric or nasotracheal tubes.

The signs and symptoms of sinusitis include both major and minor factors. The major symptoms of sinusitis are: - Facial pain or pressure - Feeling of fullness or congestion in the face - Difficulty breathing through the nose - Nasal or post-nasal discharge that is often thick and yellow or greenish (pus-like) - Decreased sense of smell - Fever The minor symptoms of sinusitis, when combined with at least one major symptom, include: - Headache - Bad breath - Fatigue - Feeling unwell (malaise) - Tooth pain - Cough - Ear pain In addition to these symptoms, physicians also look for additional signs during a physical examination. These signs may include facial swelling, redness, edema (swelling) usually around the eyes, cervical adenopathy (swollen lymph nodes in the neck), postnasal drainage, or a sore throat. A nasal examination may reveal abnormalities such as mucosal swelling, crusting, frank pus, polyps, or other anatomical defects. Factors that predict the existence of sinusitis include pain in the upper teeth, abnormal sinus examination, poor response to nasal decongestants or antihistamines, colored nasal discharge, and mucopurulent (a mix of mucus and pus) seen on the examination. It is important to note that the presence of four or more of these symptoms is highly suggestive of sinusitis, and the overall impression of the doctor may be more helpful than any single discovery.

The types of tests that may be needed for sinusitis include: - X-ray: This can be used to assess the condition of the maxillary, frontal, or sphenoid sinuses, but it may not be effective for assessing the ethmoid cells or ostiomeatal complex. - Coronal CT scan: This special kind of X-ray provides a more detailed look at the sinuses and can help identify features suggestive of sinusitis. - Culture or biopsy: In cases of chronic bacterial or fungal sinusitis, a culture or biopsy may be necessary to determine the exact cause of the infection and guide treatment decisions.

Tension headaches, vascular headaches, presence of foreign bodies, brain abscesses, epidural abscesses, meningitis, subdural empyema (a collection of pus between the brain and its outermost cover).

When treating sinusitis, there can be several side effects depending on the method of treatment used. Here are some potential side effects: - Using oxymetazoline, a decongestant, for more than three days can cause congestion to come back worse than before. - Oral decongestants, such as pseudoephedrine, should be used with caution by people with high blood pressure. - Antihistamines, commonly used for allergies, are not very helpful for clearing sinuses and can sometimes make drainage worse. - Topical steroids, which reduce swelling in the nose, can be used but may have side effects. - Antibiotics may be prescribed if the sinusitis is caused by bacteria, but they can have side effects and may not always be effective. - The choice of antibiotic depends on what bacteria are common in the community, and resistance to certain antibiotics can be high. - If symptoms don't improve after a week on antibiotics, a broader-spectrum drug may be prescribed. - For chronic sinusitis, the antibiotic should be effective against specific bacteria and may require the addition of other medications. - The duration of antibiotic treatment varies, with adults typically taking them for 5-7 days and children requiring a longer course of 10-14 days.

You should see an ENT (Ear, Nose, and Throat) doctor for sinusitis.

Sinusitis mainly affects children under 15 years of age and adults between 25 to 64 years.

Sinusitis can be treated using various methods. These include humidification methods, nasal wash, decongestants like pseudoephedrine, and topical steroids to reduce swelling in the nose. Antihistamines may be beneficial in the early stages of sinusitis caused by allergies. Doctors usually prescribe antibiotics if they believe the sinusitis is caused by bacteria. The choice of antibiotics depends on the bacteria common in the community. Amoxicillin or amoxicillin-clavulanate is often the first line of treatment, but other antibiotics may be used if symptoms don't improve. The duration of antibiotic treatment is typically 5-7 days for adults and 10-14 days for children.

Sinusitis is a condition characterized by inflammation of the sinuses, which is a common reason for doctor visits and antibiotic prescriptions in the United States. It can cause symptoms that limit daily activities and result in significant treatment costs.