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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

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Other Treatment Options for Sinusitis

 Addressing potential triggers or contributing factors is a key first step in the management of sinusitis. To reduce congestion due to sinusitis, your doctor may prescribe nasal sprays (some may contain steroid sprays), nose drops, or oral decongestant medicine. If you suffer from severe chronic sinusitis, oral steroids might be prescribed to reduce inflammation -- usually only when other medications have not worked. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for a fungal sinus infection. Immunoglobulin (antibodies) may be given if you have certain immune deficiencies.

Will I Need to Make Lifestyle Changes?

Smoking is never recommended, but if you do smoke, you should refrain during treatment for sinus problems. No special diet is required, but drinking extra fluids helps to thin secretions.

Is Sinus Surgery Necessary?

Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus by millions of cilia (a hair-like extension of a cell). Irritation and swelling from an allergy can narrow the opening of the sinus and block mucus movement. If antibiotics and other medicines are not effective in opening the sinus, surgery may be necessary. Also, if there is a structural abnormality of the sinus such as nasal polyps, which can obstruct sinus drainage, surgery may be needed.

Surgery may be performed under local or general anesthesia using an endoscope. Most people can return to normal activities within five to seven days following surgery. Full recovery usually takes about four to six weeks.

A procedure called a "turbinectomy" may also be performed to shrink the swollen tissues of the nose. This can be done in your doctor's office and can take only a few minutes. The anesthetic used is very similar to that used in routine dental procedures.

Another treatment, called balloon sinusplasty, can also be done under local anesthesia in a doctor's office. With this procedure, a doctor can open up swollen, inflamed sinuses much like a heart surgeon opens blocked blood vessels to the heart with balloon angioplasty. The unblocked sinus can now drain mucus more freely.  

Reviewed by Brunilda Nazario, MD on December 08, 2014

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