Sinusitis

Sinusitis is an infection of the sinuses, the hollow spaces in your skull around the eyes and nose. When the sinuses are infected, they cause pain and pressure in your head and face. Sinusitis may get better on its own, but it is often treated with antibiotics.

Education Topics

Complications and Comorbidities

What other health problems can happen when you have sinusitis?

Complications of sinusitis (such as meningitis or an infection of the facial bones called osteomyelitis) are rare. But when complications occur, they may be life-threatening and often require extensive medical or surgical treatment.

Course

What happens when you have sinusitis?

Sinusitis often develops after a cold or viral infection. Most sinus infections improve on their own, but sometimes they develop into a bacterial infection. Swelling, inflammation, and mucus production caused by the cold can lead to blockage in the nasal passages, which may encourage the growth of bacteria.

There are two types of sinusitis: acute (sudden onset) and chronic (long-term). Acute sinusitis, whether it is viral or bacterial, may develop into chronic inflammation or infections that may last 12 weeks or longer. Chronic sinusitis can lead to permanent changes in the mucous membranes that line the sinuses. As a result of these changes, you may become prone to having more sinus infections that may become harder to treat.

What happens when you have sinusitis?

Most of the time sinusitis improves on its own. But sometimes it develops into a bacterial infection. This happens when swelling, inflammation, and mucus production cause blocked nasal passages. Acute (sudden) sinusitis may develop into chronic (long-term) inflammation or infections that may last 12 weeks or longer.

Definition

Sinusitis

Sinusitis is an infection of the sinuses, the hollow spaces in your skull around the eyes and nose. When the sinuses are infected, they cause pain and pressure in your head and face. Sinusitis may get better on its own, but it is often treated with antibiotics.

Diagnostics

How is sinusitis diagnosed?

Your doctor can tell if you have sinusitis by asking questions about your past health and doing a physical exam. You probably won't need any other tests. But you may need more tests if treatment doesn't help or if you have complications.

Medication Therapy

How are antibiotics used to treat sinusitis?

Antibiotics are used to treat sinusitis caused by bacteria. Examples are amoxicillin with clavulanate and cefdinir.

This treatment is successful in most cases of short-term (acute) sinusitis that are caused by bacteria. You should start to feel better within 3 to 4 days after you start to take an antibiotic.

Chronic sinusitis may last 12 weeks or longer. It usually requires 3 to 4 weeks of antibiotic treatment. Symptoms may continue or return even with treatment. You may need to try a different antibiotic.

You may need to see an ear, nose, and throat (ENT) specialist if your symptoms don't go away with long-term antibiotic treatment.

Do not stop taking the antibiotics early just because you feel better. Take all the antibiotics your doctor prescribed. If you don't, the infection may not go away.

How are medicines used to treat sinusitis?

Medicines may be needed when symptoms of sinusitis are severe or don't improve. The goals of treatment with medicine are to:

  • Treat the infection. It is usually caused by bacteria if your symptoms have lasted more than 7 to 10 days.
  • Relieve pressure and pain caused by poor sinus drainage.
  • Reduce inflammation of the nose and sinuses.

Medicine choices

You may use more than one medicine. Choices include:

  • Antibiotics. They kill bacteria. Examples are amoxicillin with clavulanate and cefdinir.
  • Decongestants. They reduce the swelling of the mucous membranes in the nose. Examples include oxymetazoline (such as Afrin) and phenylephrine (such as Neo-Synephrine).
  • Analgesics. They relieve pain. Some examples are acetaminophen (such as Tylenol) and ibuprofen (such as Advil).
  • Corticosteroids. They reduce inflammation in the nasal passages. They include beclomethasone (Beconase) and mometasone (Nasonex). Most of the time, they are used as a nasal spray.
  • Mucolytics. These thin mucus. One example is guaifenesin (such as Robitussin).

Overview

Sinusitis: Overview

Sinusitis is an infection of the lining of the sinus cavities in your head. Sinusitis often follows a cold. It causes pain and pressure in your head and face.

In most cases, sinusitis gets better on its own in 1 to 2 weeks. But some mild symptoms may last for several weeks. Sometimes antibiotics are needed.

Sinusitis in teens: Overview

Sinusitis is an infection of the lining of the sinus cavities in your head. Sinusitis often follows a cold. It causes pain and pressure in your head and face.

In most cases, sinusitis gets better on its own in 1 to 2 weeks. But some mild symptoms may last for several weeks. Sometimes antibiotics are needed.

Sinusitis in children: Overview

Sinusitis is an infection of the lining of the sinus cavities in your child’s head. Sinusitis often follows a cold and causes pain and pressure in the head and face.

In most cases, sinusitis gets better on its own in 1 to 2 weeks. But some mild symptoms may last for several weeks. Sometimes antibiotics are needed.

Prevention

Preventing sinusitis

There are several ways you may reduce your chance of getting sinusitis.

  • Treat stuffiness (nasal congestion) caused by colds or allergies promptly.

    This can help you prevent a bacterial infection from developing in your sinuses.

  • Avoid contact with people who have colds and other viral upper respiratory infections.
  • Wash your hands often if you have contact with people who have colds or infections.
  • Avoid cigarette, cigar, and pipe smoke in your home and workplace.

    Smoke causes and further irritates inflamed membranes in your nose and sinuses.

  • Avoid the things that trigger your allergy attacks if you have allergies.

    Consider talking to your doctor about immunotherapy, such as allergy shots.

  • Avoid breathing dry air.

    Consider using a humidifier at home and work to increase the moisture in the air.

Providers

Who can diagnose and treat sinusitis?

Sinusitis may be diagnosed and treated by any of the following health professionals:

  • Family medicine physician
  • Pediatrician
  • Internist
  • Nurse practitioner (NP)
  • Physician assistant (PA)

Your doctor may refer you to an ear, nose, and throat (ENT) specialist (also called an otolaryngologist) who can provide a more specialized examination of the nasal passages and upper throat. Referral to an ENT specialist may be beneficial for people in whom nasal polyps or other conditions causing blockage of the nasal cavity are suspected. Diagnosis and surgical treatment of chronic or complicated cases of sinusitis may be done by an ENT specialist.

An infectious disease specialist may be needed when sinusitis is caused by something unusual or when rare complications (such as an infection of the facial bones) occur. An allergist (immunologist) may be needed when allergies are suspected to be causing or contributing to sinus problems.

Risk Factors

What increases your risk for sinusitis?

Your risk of sinusitis increases if you have recently had a cold, another viral or bacterial infection, or an upper respiratory tract infection. Also, chronic nasal allergies (allergic rhinitis) can lead to sinusitis.

Sometimes a deviated septum, broken nose, or growths such as nasal polyps can make you more susceptible to sinus infections. Problems with nasal structure can prevent the proper flow of mucus from the sinuses into the nose.

Other factors that increase your risk for getting sinus infections include having asthma, smoking, air pollution, overuse of decongestant sprays, cold weather, rapid air pressure changes (such as from flying or scuba diving), and swimming in contaminated water. Also, using continuous positive airway pressure (CPAP) to treat sleep apnea may increase the risk of sinusitis.

Self-care Treatment

Treating sinusitis at home

Home treatment may relieve symptoms of pain and pressure linked with short-term (acute) sinusitis. Home treatment may improve drainage of mucus from the sinuses and prevent the need for antibiotics.

  • Drink plenty of fluids to help keep your mucus thin.
  • Apply moist heat (using a hot, damp towel or gel pack) to your face for 5 to 10 minutes, several times a day.
  • Breathe warm, moist air from a steamy shower, a hot bath, or a sink filled with hot water.

    Avoid extremely cool, dry air. Consider using a humidifier to increase the moisture in the air in your home.

  • Use saltwater nasal washes (saline lavage or irrigation).

    This helps keep the nasal passages open and wash out mucus and bacteria. You can purchase saline nose drops or sprays at a pharmacy or make your own saline solution at home. If you make saline at home, use distilled water or water that has been boiled and then cooled.

  • Try gargling with warm salt water.

    This can help prevent a sore throat for people who have postnasal drip and are around age 8 and older.

  • If you need to blow your nose, do it gently.

    Forceful blowing may force thick mucus back into your sinuses and block them. Keep both nostrils open when blowing your nose.

  • Avoid alcohol.

    It causes swelling of the tissue lining the nose and sinuses.

  • Try over-the-counter medicines to relieve pain or stuffy nose.

    Be safe with medicines. Read and follow all instructions on the label. Do not use the medicine longer than the label says.

If you have chronic sinusitis, you'll probably need to continue the above home treatment measures for a long period of time to keep your sinuses clear.

Teens: How can you care for sinusitis?

  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label. No one younger than 20 should take aspirin. It has been linked to Reye syndrome, a serious illness.
  • If the doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Be careful when taking over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not taking more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
  • Use a nasal spray medicine that relieves a stuffy nose. Do not use the medicine longer than the label says.
  • Breathe warm, moist air from a steamy shower, a hot bath, or a sink filled with hot water. Avoid cold, dry air. Using a humidifier in your home may help. Follow the directions for cleaning the machine.
  • Use saline (saltwater) nasal washes to help keep your nasal passages open and wash out mucus and bacteria. You can buy saline nose drops at a grocery store or drugstore. Or you can make your own at home by adding 1 teaspoon of salt and 1 teaspoon of baking soda to 2 cups of distilled water. If you make your own, fill a bulb syringe with the solution, insert the tip into your nostril, and squeeze gently. Blow your nose.
  • Put a hot, wet towel or a warm gel pack on your face 3 or 4 times a day for 5 to 10 minutes each time.

Self-care Treatment Options

How can you care for yourself when you have sinusitis?

  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
  • If the doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • Be careful when taking over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not taking more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
  • Breathe warm, moist air from a steamy shower, a hot bath, or a sink filled with hot water. Avoid cold, dry air. Using a humidifier in your home may help. Follow the directions for cleaning the machine.
  • Use saline (saltwater) nasal washes. This can help keep your nasal passages open and wash out mucus and bacteria. You can buy saline nose drops at a grocery store or drugstore. Or you can make your own at home by adding 1 teaspoon of salt and 1 teaspoon of baking soda to 2 cups of distilled water. If you make your own, fill a bulb syringe with the solution, insert the tip into your nostril, and squeeze gently. Blow your nose.
  • Put a hot, wet towel or a warm gel pack on your face 3 or 4 times a day for 5 to 10 minutes each time.
  • Try a decongestant nasal spray like oxymetazoline (Afrin). Do not use it for more than 3 days in a row. Using it for more than 3 days can make your congestion worse.

How can you care for your child who has sinusitis?

  • Give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever, pain, or fussiness. Read and follow all instructions on the label. Do not give aspirin to anyone younger than 20. It has been linked to Reye syndrome, a serious illness.
  • If the doctor prescribed antibiotics for your child, give them as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of antibiotics.
  • Be careful with cough and cold medicines. Don’t give them to children younger than 6, because they don’t work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included.
  • Be careful when giving your child over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not giving your child more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
  • Make sure your child rests. Keep your child home if he or she has a fever.
  • If your child has problems breathing because of a stuffy nose, squirt a few saline (saltwater) nasal drops in one nostril. For older children, have your child blow his or her nose. Repeat for the other nostril. For infants, put a drop or two in one nostril. Using a soft rubber suction bulb, squeeze air out of the bulb, and gently place the tip of the bulb inside the baby’s nose. Relax your hand to suck the mucus from the nose. Repeat in the other nostril.
  • Place a humidifier by your child’s bed or close to your child. This may make it easier for your child to breathe. Follow the directions for cleaning the machine.
  • Put a hot, wet towel or a warm gel pack on your child’s face 3 or 4 times a day for 5 to 10 minutes each time. Always check the pack to make sure it is not too hot before you place it on your child’s face.
  • Keep your child away from smoke. Do not smoke or let anyone else smoke around your child or in your house.
  • Ask your doctor about using nasal sprays, decongestants, or antihistamines.

Signs and Symptoms

What are the symptoms of sinusitis?

The main symptoms of sinusitis are a runny or stuffy nose and pain and pressure in your head and face. You may also have a yellow or green drainage or drip from your nose or down the back of your throat. Symptoms in children include coughing, nasal discharge, headache, and face pain.

Surgical Treatment

When is surgery used to treat sinusitis?

Very few people need surgery to treat sinusitis. But you may need surgery if all of these are true:

  • Your doctor says that you have long-term (chronic) sinusitis.
  • You've taken medicines and followed home treatment for at least 4 to 6 weeks. This treatment includes antibiotics, a steroid nasal spray, and other prescription medicines. This is called "maximum medical treatment."
  • You've had a CT scan of your sinuses after the 4 to 6 weeks of treatment. It's very important to have the CT scan done after this treatment. Reducing the swelling and infection as much as you can will lets your doctor see what could be causing your infections.
  • The CT scan shows that something, such as nasal polyps, is keeping your sinuses from draining as they should.

You also may need surgery if:

  • You have a sinus infection caused by a fungus. Fungal infections can't be cleared up with antibiotics.
  • You have a serious problem such as an infection that spreads beyond your sinuses. This is rare.

What happens during surgery depends on how bad your blockage is and what other sinus problems you have. Surgery may just involve removing infected tissue or small growths (polyps) inside the nose. More extensive surgery involves removing pieces of bone to create a wider opening to allow a sinus to drain.

Sinus surgery is always performed by an ear, nose, and throat (ENT) specialist (also called an otolaryngologist).

How is surgery used to treat sinusitis?

Very few people need surgery to treat sinusitis. In general, it's used only for severe cases of chronic sinusitis that don't get better with medicines.

The goal of surgery is to make the sinuses drain better. This is usually done by removing the blockage and draining the mucus. This may mean removing:

  • Infected, swollen, or damaged tissue.
  • Bone. This creates a wider opening for mucus to drain from the sinuses.
  • Growths (polyps) inside the nose or sinuses.
  • A foreign object that is blocking a nasal or sinus passage. This usually occurs in children.

Surgery may be the only way to get a badly blocked sinus to drain as it should. But surgery doesn't always cure sinusitis. Some people may need a second surgery.

Surgery works best when it's used along with medicine and home treatment to prevent future sinusitis. You may be able to prevent a second surgery and future sinusitis if you take antibiotics to prevent a new infection.

Surgery choices

Endoscopic surgery is preferred over traditional surgery for most cases of chronic sinusitis that require surgery. It is less invasive, costs less, and has a lower rate of problems after surgery. The options are:

  • Endoscopic surgery. This may be done to remove small amounts of bone or other material blocking the sinus openings or to remove growths (polyps). In most cases, a thin, lighted tool called an endoscope is inserted through the nose. This lets the doctor see and remove the blockage.
  • Sinus surgery. This may be done when complications of sinusitis have occurred. Complications include pus in a sinus, infection of the facial bones, or a brain abscess. The doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

Treatment Options

How is sinusitis treated?

You may not need treatment for sinusitis. But over-the-counter medicine can help with pain and pressure. If you don't get better, your doctor may suggest a steroid nose spray or antibiotics. Surgery is sometimes needed when sinusitis is severe and doesn't get better with medicines.

What Causes It

What causes sinusitis?

Sinusitis can be caused by viruses, bacteria, or fungi. When the lining of the sinus cavities gets inflamed from a virus like a cold, it swells. The swelling can block the normal drainage of the sinuses, leading to a buildup of fluid. Bacteria or fungi may start to grow, causing more swelling and pain.

What It Is

What is sinusitis?

Sinusitis is an infection of the lining of the sinus cavities in your head. It often happens after a cold. It causes pain and pressure in your head and face. Sinusitis can be either acute (sudden) or chronic (long-term). Sinusitis is chronic when it lasts 12 weeks or more.

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