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Sinusitis

Alternate Names

  • sinus infection
  • Sinuses
  • Inflammation of the ethmoid sinuses

Definition

Sinusitis is an inflammation or infection of the linings of the sinuses - the cavities in the bones behind the eyes, nose, and forehead. There are three major types of sinusitis:
  • acute sinusitis, which involves less than 3 weeks of symptoms
  • subacute sinusitis, with symptoms lasting 3 weeks to 3 months
  • chronic sinusitis, in which symptoms last longer than 3 months
  • What is going on in the body?

    There are four pairs of sinuses that connect to the nose and throat. The sinuses are normally filled with air. They moisten, cleanse, and warm the air after it leaves the nose on the way to the lungs. The normal nose is created to be a wonderful filter. It removes 80% of all tiny particles.
    Acute allergic sinusitis occurs when the lining of the nose and sinuses becomes inflamed. Common causes include pollens, animal dander, and other allergens. These allergens set off an inflammatory response. Histamine and other chemicals are released, causing the symptoms of acute allergic sinusitis.
    Viral sinusitis can occur together with an upper respiratory infection (URI). Viruses attack the lining of the sinuses and cause swelling of the nasal tissues, which leads to symptoms.
    Bacterial sinusitis can follow a viral infection if bacteria grow inside the sinuses. About 5 out of every 1,000 viral URIs are complicated by a bacterial sinus infection. Bacterial forms of sinusitis also occur when the drainage opening is blocked by swelling or narrowing. Then the normal bacteria in the sinus and nasal tracts overgrow and cause an infection.
    Cold air sinusitis produces symptoms when the person is exposed to cold air.
    Aspirin sensitivity sinusitis may occur in some individuals when they take medicines containing aspirin.

    Risks

    What are the causes and risks of the condition?

    Sinusitis may be caused by a virus, bacteria, allergen, or other factors as outlined above. People with immunodeficiency disorders are at higher risk for some types of sinusitis.

    Prevention

    What can be done to prevent the condition?

    Many cases of sinusitis can be avoided by preventing an upper respiratory infection. Avoiding crowded places and infected people can lessen the risk of catching a virus. Influenza or flu vaccination can help prevent infection by the influenza virus. Careful hand washing and disposal of tissues can help prevent the spread of sinusitis. Individuals should follow the healthcare provider's recommendation for good control of nasal allergies.

    Diagnosed

    How is the condition diagnosed?

    Diagnosis of sinusitis begins with a medical history and physical exam. The healthcare provider may order additional tests, such as:
    • blood and urine tests
    • allergy testing
    • cultures of nasal secretions
    • CT scan

    Long Term Effects

    What are the long-term effects of the condition?

    If sinusitis is untreated, the individual may have serious long-term effects, including:
    • infection of the eye socket
    • meningitis, or infection of the brain linings
    • chronic facial pain
    • loss of smell
    • chronic headaches

    Other Risks

    What are the risks to others?

    The viruses and bacteria involved in those forms of sinusitis are contagious from person to person. However, if infected, a close contact of a person with sinusitis might develop sinusitis, another respiratory illness, or no symptoms at all.

    Treatments

    What are the treatments for the condition?

    Treatment varies, depending on the cause and type of sinusitis. Some common treatments include:
    • avoiding triggers, such as cold air or allergens
    • saline nasal spray or rinses
    • warm compresses on the face humidifiers (to keep room humidity at about 40% relative humidity)
    • increased oral fluids
    • pain medicine such as ibuprofen (i.e., Advil, Motrin), aspirin or acetaminophen (i.e., Tylenol)
    • oral decongestant medicines such as pseudoephedrine and phenylephrine
    • decongestant nasal sprays such as oxymetazoline (i.e., Afrin) or phenylephrine (i.e., Neo-Synephrine). However, these sprays should not be use for more than three to five days prescription non-steroid nasal sprays such as azelastine (i.e., Astelin), cromolyn (i.e., NasalCrom), ipratropium (i.e., Atrovent Nasal) or any number of nasal steroid sprays.
    • prescription steroid nasal sprays such as beclomethasoneq (i.e., Beconase), fluticasone (i.e., Flonase), flunisolide (i.e., Nasarel), triamcinolone (i.e., Nasacort), mometasone (i.e., Nasonex) or budesonide (i.e., Rhinocort)
    • oral corticosteroids such as prednisone
    • antibiotics are used much less frequently than they used to be. The reason is that a number of recent randomized controlled trials and meta-analyses (research that combines a number of studies together) have show that antibiotics have little advantage over no treatment - with most patients improving without antibiotics.

    Side Effects

    What are the side effects of the treatments?

    Side effects depend on the medicines used. Brief use of topical decongestants has few side effects. Long-term use of topical decongestants (more than 3-5 days) can cause progressive inflammation in the nose.

    After Treatment

    What happens after treatment for the condition?

    Most cases of sinusitis go away on their own or with treatment. Some individuals may develop chronic sinusitis.

    Monitor

    How is the condition monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.

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