Sinusitis

Overview

Sinusitis is an inflammation or infection of the sinus passages. It is a very common condition affecting more than 4 million Canadians every year.

Causes

Most cases of acute sinusitis start with a common cold. Your nose reacts to the virus that causes the cold by producing mucus and sending white blood cells to the lining of the nose which congest and swell the nasal passages. This prevents proper drainage which contributes to a growth in bacteria and eventually sinusitis.

Sometimes fungal infections can cause acute sinusitis. Some fungi can cause serious illness in people with a weakened immune system.

Chronic inflammation of the nasal passages also causes sinusitis. If you have allergic rhinitis or hay fever you may develop acute sinusitis.

Symptoms

The classic symptoms of acute sinusitis usually follow a cold that does not improve or one that worsens after 5 to 7 days of symptoms. They include:

  • Nasal congestion and discharge
  • Sore throat and postnasal drip (fluid dripping down the back of your throat especially at night or when lying down)
  • Headache -- pressure-like pain pain behind the eyes toothache or facial tenderness
  • Cough often worse at night
  • Fever (may be present)
  • Bad breath or loss of smell
  • Fatigue and generally not feeling well

Symptoms of chronic sinusitis are the same as acute sinusitis but tend to be milder and last longer than 8 weeks.

People more likely to get frequent sinusitis include those with cystic fibrosis or a weakened immune system (such as people with HIV and those receiving chemotherapy).

Other risks for developing sinusitis include:

  • Having asthma
  • Overuse of nasal decongestants (rather than continuing to relieve congestion the problem gets worse when these are used too often or for too long)
  • Having a deviated nasal septum nasal bone spur or polyp
  • Presence of a foreign body in your nose
  • Frequent swimming or diving
  • Dental work
  • Pregnancy
  • Changes in altitude (flying or climbing)
  • Air pollution and smoke
  • Gastroesophageal reflux disease (GERD)
  • Hospitalization especially if the reason you are in the hospital is related to a head injury or you needed a tube inserted into the nose (for example a nasogastric tube from your nose to your stomach)

Your doctor will assess your symptoms and perform a physical examination to determine whether you have sinusitis. If necessary he may also order an X-ray or other diagnostic test.

Treatment

Treatment of sinusitis is usually very straight forward.

Try the following to help reduce congestion in your sinuses:
  • Use a humidifier.
  • Spray with nasal saline several times per day.
  • Inhale steam 2 to 4 times per day (for example sitting in the bathroom with the shower running).
  • Drink plenty of fluids to thin the mucus.
  • Apply a warm moist wash cloth to your face several times per day.

Remember to be careful with over-the-counter nasal decongestants. They can help initially but using them beyond 3-5 days can actually worsen nasal congestion.

Also for sinus pain or pressure:

  • Avoid temperature extremes sudden changes in temperature and bending forward with your head down.
  • Try acetaminophen or ibuprofen.
  • Avoid flying when you are congested.

See your doctor if:

  • Your symptoms last longer than 10 to 14 days or you have a cold that gets worse after 7 days.
  • You have a severe headache unrelieved by over-the-counter pain medicine.
  • You have a fever.

If you have a bacterial infection your doctor may prescribe an antibiotic to kill the bacteria and/or steroid nasal spray to reduce inflammation. You must take the entire course of antibiotics even if it seems as if your infection has cleared otherwise it could come back.

If you have severe chronic sinusitis your doctor may prescribe oral steroids. Because they can have significant side effects you should take them only when other medicines have failed to clear up the problem. When medical treatment fails surgery may be the only alternative.

Prevention

Just as there is no way to prevent all colds there is no sure fire way to prevent sinusitis. However you may be able to limit the number of infections by:

  • Getting a flu shot each year
  • Washing your hands frequently
  • Eating plenty of fruits and vegetables which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection
  • Reducing stress
  • Avoiding smoke and pollutants
  • Using a humidifier to increase moisture in your nose and sinus areas
  • Drinking plenty of fluids to increase moisture within your body
  • Taking decongestants during an upper respiratory infection
  • Treating allergies promptly and appropriately