Causes and Risk Factors
- Sinusitis is often caused by a viral infection, such as the common cold.
- Underlying conditions like allergies or structural problems in the nose can increase the risk of sinusitis.
- People with lesser immunity against bacteria by birth are more prone to sinusitis.
- Recurrent episodes are more likely in individuals with asthma, cystic fibrosis, and poor immune function.
- Most cases of sinusitis are caused by a viral infection, not bacteria.
- Acute sinusitis is usually caused by viral infections, such as rhinoviruses, coronaviruses, and influenza viruses.
- Bacterial infections can also cause acute sinusitis, with Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis being common culprits.
- Fungal invasion can lead to acute sinusitis, especially in individuals with diabetes or immune deficiencies.
- Chronic sinusitis can be caused by various diseases, including anatomic derangements, allergic rhinitis, asthma, cystic fibrosis, and dental infections.
- Smoking and secondhand smoke are associated with chronic sinusitis.
Signs and Symptoms
- Common symptoms of sinusitis include thick nasal mucus, a plugged nose, and facial pain.
- Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, and frequent coughing.
- Acute sinusitis may be accompanied by a green nasal discharge that may contain pus or blood.
- Chronic sinusitis can lead to nasal congestion, facial pain, headache, night-time coughing, and an increase in asthma symptoms.
- Anosmia, the loss of the sense of smell, is often associated with chronic sinusitis.
Diagnosis
- In early stages, an ENT doctor can confirm sinusitis using nasal endoscopy.
- Diagnostic imaging is usually not needed in the acute stage unless complications are suspected.
- In chronic cases, confirmatory testing is recommended through direct visualization or computed tomography.
- The unnecessary and ineffective treatment of viral sinusitis with antibiotics is common.
- Sinusitis is classified into several categories based on the duration of symptoms, including acute, recurrent acute, subacute, chronic, and acute exacerbation of chronic sinusitis.
- Roughly 90% of adults have had sinusitis at some point in their lives.
- Bacterial and viral sinusitis can be distinguished through watchful waiting.
- Diagnostic methods include noting local tenderness and dull pain, CT and nuclear isotope scanning, and microbial culture.
- Chronic sinusitis can be part of a spectrum of diseases affecting the respiratory tract and is often linked to asthma.
Treatment
- Initial treatment for acute sinusitis is watchful waiting.
- If symptoms do not improve in 7-10 days or get worse, an antibiotic may be used.
- Pain killers such as naproxen, nasal steroids, and nasal irrigation can help with symptoms.
- Amoxicillin or amoxicillin/clavulanate is recommended as the first-line antibiotic treatment.
- Surgery may be used in people with chronic sinusitis or those who do not respond to medications.
- Treatment for sinusitis includes surgical drainage and administration of antimicrobial therapy.
- Surgical debridement is rarely required after an extended course of parenteral antimicrobial therapy.
- Chronic sinusitis is managed by controlling inflammation and reducing the incidence of infections.
- Medications are the first line of treatment, but surgery may be necessary if medications are ineffective.
- Antifungal treatments have had mixed results in treating chronic sinusitis associated with fungi.
Complications and Prognosis
- Complications of sinusitis are rare but can be life-threatening.
- Infection of the brain is the most dangerous complication, particularly in the frontal and sphenoid sinuses.
- Sinus infection can spread to the orbit, causing periorbital cellulitis, abscesses, and orbital cellulitis.
- Sinusitis may extend to the central nervous system, causing cavernous sinus thrombosis, meningitis, and brain abscesses.
- Other complications include sinobronchitis, maxillary osteomyelitis, and frontal bone osteomyelitis.
- Odontogenic sinusitis (ODS) can occur when an infection or complication of a dentistry procedure involves the maxillary sinus.
- Sinus infections can spread to other sinuses, including the ethmoid, frontal, and sphenoid sinus.
- Infections may involve the orbit, causing orbital cellulitis and potentially leading to blindness.
- Sinus infections can also result in central nervous system complications such as meningitis, brain abscess, and cavernous sinus thrombosis.
- Ethmoid sinusitis can lead to infection of the eye socket, resulting in the loss of sight and accompanied by fever and severe illness.
- 46% of sinusitis cases without antibiotics are cured after one week.
- 64% of sinusitis cases without antibiotics are cured after two weeks.
- 24 to 31 million sinusitis cases occur annually in the United States.
- Chronic sinusitis affects approximately 12.5% of people.
Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, a feeling that phlegm is oozing out from the back of the nose to the throat along with a necessity to clear the throat frequently and frequent attacks of cough.
| Sinusitis | |
|---|---|
| Other names | Sinus infection, rhinosinusitis |
 | |
| A CT scan showing sinusitis of the ethmoid sinus | |
| Specialty | Otorhinolaryngology |
| Symptoms | Thick nasal mucus, plugged nose, pain in the face, fever, sore throat, frequent attacks of cough |
| Causes | Infection (bacterial, fungal, viral), allergies, air pollution, structural problems in the nose |
| Risk factors | Asthma, cystic fibrosis, poor immune function, otitis media, laryngitis, bronchitis, orbital cellulitis, meningitis and encephalitis |
| Diagnostic method | Usually based on symptoms |
| Differential diagnosis | Migraine |
| Prevention | Handwashing, avoiding smoking |
| Treatment | Pain medications, nasal steroids, nasal irrigation, antibiotic |
| Frequency | 10–30% each year (developed world) |
Generally sinusitis starts off as a common viral infection like common cold. This infection generally subsides within 5 to 7 days. During this time the nasal structures can swell and facilitate the stagnation of fluids in sinuses that leads to acute sinusitis which lasts from 6th day of the infection to the 15th day. From the 15th day to 45th day of the infection comes the subacute stage followed by chronic stage. Whenever a chronic stage patient's immunity takes a hit the infection moves to "acute on sinusitis" stage and moves back to chronic when the immunity rises again.
Sinusitis usually occurs in individuals with underlying conditions like allergies, or structural problems in the nose and in people with lesser immunity against bacteria by birth. Most cases are caused by a viral infection. Recurrent episodes are more likely in persons with asthma, cystic fibrosis, and poor immune function. In early stages an ENT doctor confirms sinusitis using nasal endoscopy. Diagnostic imaging is not usually needed in acute stage unless complications are suspected. In chronic cases, confirmatory testing is recommended by either direct visualization or computed tomography.
Some cases may be prevented by hand washing, immunization, and avoiding smoking. Pain killers such as naproxen, nasal steroids, and nasal irrigation may be used to help with symptoms. Recommended initial treatment for acute sinusitis is watchful waiting. If symptoms do not improve in 7–10 days or get worse, then an antibiotic may be used or changed. In those in whom antibiotics are used, either amoxicillin or amoxicillin/clavulanate is recommended first line, with amoxicillin/clavulanate being superior to amoxicillin alone but with more side effects. Surgery may occasionally be used in people with chronic disease or in someone who is not responding to medicines as per doctor's expectation.
Sinusitis is a common condition. It affects between about 10 and 30 percent of people each year in the United States and Europe. Chronic sinusitis affects about 12.5% of people. Treatment of sinusitis in the United States results in more than US$11 billion in costs. The unnecessary and ineffective treatment of viral sinusitis with antibiotics is common.
