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.

Causes

Infectious sinusitis is caused by a bacterial, viral, or (rarely) fungal infection of fluid in the sinus cavities.

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’s 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

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

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.
• If you have allergies, stick with your 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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Calgary Allergy Network http://www.calgaryallergy.ca

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http://www.ebscohost.com/dynamed
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Accessed September 29, 2014.

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1/10/2008 DynaMed’s Systematic Literature Surveillance
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Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: A randomized controlled trial. JAMA. 2007;298(21):2487-2496.

12/11/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2009;(4):CD005149.