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Sinusitis Slideshow: Symptoms, Diagnosis, Treatment

Sinus Attack!

Pain in the forehead or between the eyes? Upper teeth ache? Face feeling full, nose stuffy and congested? You may have a common complaint that sends many people to a doctor's office: sinus trouble.

Sinuses: Air Spaces in Your Head

Sinuses are air spaces in your skull lined with mucous membranes. Most people have four sets of nasal sinuses:

  • Two frontal sinuses in the forehead above the eyes
  • Two maxillary sinuses, one inside each cheek bone (dark triangles seen in this CAT scan)
  • Ethmoid sinuses: a group of cavities behind the bridge of the nose
  • Sphenoid sinuses, behind the nose and underneath the brain

Sinuses are like fingerprints; everybody's are different. Some people have no frontal sinuses or just one.

What Is Sinusitis?

Tiny, hair-like structures called cilia (magnified here) help move mucus across sinus membranes and toward an exit. All of your sinus cavities connect to your nose to allow a free exchange of air and mucus. Infections or allergies make sinus tissues inflamed, red, and swollen. That's called sinusitis.

Just a Cold … at First

Sinusitis usually starts with inflammation triggered by a cold, allergy attack, or irritant. But it may not end there. Colds, allergies, and irritants make sinus tissues swell.

Stuffy, Puffy, and Sore

Sinusitis causes many symptoms. Most people have a stuffy nose and pain or pressure in several locations around the face or teeth. There's usually a nasal discharge that may be yellow, green, or clear. Other symptoms may include fatigue, decreased sense of smell and/or taste, cough, sore throat, bad breath, headache, pain on bending forward, and fever.

Chronic Sinusitis

The blue areas in this color-enhanced MRI show thickened mucosal surfaces on both maxillary sinuses. Inflammation of the sinus cavity that lasts for more than three months is chronic sinusitis. Although bacteria often colonize obstructed sinuses, bacterial infections are not the only cause of chronic sinusitis. Anatomy, allergies, polyps, immune deficiencies, and dental diseases may also cause chronic sinus problems.

Nasal Polyps

When sinuses remain inflamed, sinus membranes may thicken and swell. The swelling can be significant enough to cause grape-like masses called polyps (shown here). Polyps may protrude from the sinus into the nasal passage and partially or completely block the nasal airway.

Nasal Decongestants: Relief, at a Cost

These sprays open swollen nasal passages and allow your sinuses to drain. That can be helpful, especially during the worst days of a cold or during air travel. But you should use these drugs only for a few days. After that, there's a kick-back effect, making your nasal passages swell shut again. Decongestants are not indicated for chronic use. Oral decongestants may help, but also have side effects. Better solutions for acute sinus symptoms: nasal steroid sprays or saline sprays or washes. If symptoms persist, see your doctor. Chronic sinus symptoms may be caused by a deviated septum or another treatable condition.

Antibiotics Usually Not Needed

The common cold is a viral infection. Colds can lead to sinusitis symptoms, but these usually clear by themselves. Antibiotics do not treat viruses, so they won't help the sinus symptoms of a cold. Cold symptoms end in seven to 14 days. Usually, cold-related sinusitis goes away then, too.

Shown here is a magnified, color-enhanced image of a rhinovirus pathogen responsible for the common cold.

Treating Allergy-Related Sinusitis

What can help allergy-related sinus symptoms is irrigation with saline solution, either with a neti pot or squeeze bottle. Although there's no evidence they help with sinus infections, nasal steroid sprays may help some people suffering sinus symptoms from allergies. Antihistamines may help, too, especially for symptoms of sneezing and runny nose.

When to See the Doctor

Yellow or green mucus can mean a bacterial infection. Even then, acute bacterial sinusitis usually clears up in seven to 14 days -- without antibiotic treatment. But if you keep feeling worse and symptoms are persistent and severe, or if you get a fever, it's time to see a doctor.

Chronic Sinusitis Treatment Still a Puzzle

Chronic sinusitis is very difficult to treat. A first step is controlling predisposing factors such as eliminating environmental irritants. For symptom relief, doctors often prescribe nasal steroid sprays or antibiotics, but neither is proven to work in comprehensive studies. Surgery -- functional endoscopic sinus surgery or FESS -- offers at least moderate relief -- but this is not intended as first-line treatment for chronic sinusitis.

Sinusitis Complications: Worst-Case Scenarios

Only a layer of bone separates your sinuses from your brain. If a sinus infection passes through the bone, it can infect the lining of the brain -- meningitis -- or even the brain itself. Both problems are life threatening. A sinus infection can also spread into the orbit of the eye, causing an infection around the eye and possibly blindness. Less severe complications include asthma attacks and loss of smell or taste.

Preventing Sinusitis

There's no sure way to avoid either acute or chronic sinusitis. But here are some things that can help:

  • Keep sinuses moist -- use saline sprays, nasal lubricant sprays, or nasal irrigation often.
  • Avoid very dry indoor environments.
  • Avoid exposure to irritants, such as cigarette smoke or strong chemical odors.

 

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An Overview of Sinusitis

(continued)

What Are the Signs and Symptoms of Chronic Sinusitis?

People with chronic sinusitis may have the following symptoms for 8 weeks or more:

  • Facial congestion/fullness
  • A nasal obstruction/blockage
  • Pus in the nasal cavity
  • Fever
  • Nasal discharge/discolored postnasal drainage

Additional symptoms of chronic sinusitis may include:

  • Headaches
  • Bad breath
  • Fatigue
  • Dental pain

 

How Is Sinusitis Diagnosed?

To diagnose sinusitis, your doctor will review your symptoms and give you a physical examination.

The exam may include the doctor feeling and pressing your sinuses for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.

Other diagnostic tests to assess the potential causes for sinusitis may include a mucus culture, nasal endoscopy (see below), X-rays, allergy testing, CT scan of the sinuses, or blood work.

What Is Nasal Endoscopy?

A nasal endoscope is a special tube-like instrument equipped with tiny lights and cameras used to examine the interior of the nose and sinus drainage areas.

A nasal endoscopy allows your doctor to view the accessible areas of the sinus drainage pathways. Your nasal cavity may first be numbed using a local anesthetic (some cases do not require any anesthetic). A rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity.

The procedure is used to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal exam. During the endoscopic exam, the doctor also looks for any structural abnormalities that would cause you to suffer from recurrent sinusitis.

How Is Sinusitis Treated?

 Treatment for sinusitis depends on its severity.

  •  Acute sinusitis. If you have a simple sinus infection, your health care provider may recommend treatment with decongestants like Sudafed and steam inhalations alone. Use of nonprescription decongestant nasal drops or sprays may also be effective in controlling symptoms. However, these medicines should not be used beyond their recommended use, usually four to five days, or they may actually increase congestion. If antibiotics are given, they are usually given for 10 to 14 days. With treatment, the symptoms usually disappear and antibiotics are no longer required.
  • Chronic sinusitis. Warm moist air may alleviate sinus congestion. A vaporizer or inhaling steam from a pan of boiling water (removed from heat) may also help. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use. Use of nonprescription decongestant nasal drops or sprays might be effective in controlling symptoms, however, they should not be used beyond their recommended use. Antibiotics or oral steroids may also be prescribed.

 

Reviewed by Brunilda Nazario, MD on December 08, 2014

Sources: Sources

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