Sinus infections or sinusitis may be caused by anything that interferes with airflow into the sinuses and the drainage of mucus out of the sinuses. The sinus openings (ostea) may be blocked by swelling of the tissue lining and adjacent nasal passage tissue, for example with
Other causes of sinus infections or sinusitis
Tumors or growths also can block the sinuses if they are near the sinus openings.
Dehydration, disease, drying medications, and lack of sufficient humidity can cause sinusitis or sinus infection.The drainage of mucous from the sinuses can also be impaired by thickening of the mucous secretions, by decrease in hydration (water content) of the mucous brought on by disease (for example, cystic fibrosis), drying medications (antihistamines), and lack of sufficient humidity in the air. The epithelial cells have small hair-like fibers, called cilia, which move back and forth to help the mucus move out of the sinuses. These small cilia may be damaged by many irritants, especially smoke. This can prevent them from assisting the mucus in draining from the sinuses, and thus results in sinus infections or sinusitis.
Stagnated mucus provides an environment for bacteria, viruses and in some circumstances, (for example, AIDS or immunodepressed people) fungus, to grow within the sinus cavities. In addition, the microbes themselves can initiate and exacerbate sinus blockage. The most commonly infected sinuses are the maxillary and ethmoid sinuses.
Rarely, immunodepressed or victims of multiple traumas in disasters such
as tsunamis, hurricanes, earthquakes, or tornadoes may breathe in fungi from
the soil or water. Eventually, in a few days to over a week, the fungi can grow
and cut off blood supply to almost any type of tissue, especially in the nose
and eyes. These infections, although rare, are serious and can be deadly and
require immediate medical and surgical care. Although the fungal infection may
resemble common bacterial sinusitis initially, it is a disease termed
zygomycosis or mucormycosis.
The following may increase a person's risk of developing sinusitis:
The septum is the bone and cartilage that divides the nose into two
nostrils. When this is bent to one side, either through injury or growth,
it can lead to repeated infections and inflammation.
Symptoms vary, depending on the length and severity of the infection.
If the patient has two or more of the following symptoms and thick, green or yellow nasal discharge, they may be diagnosed with acute sinusitis.
In more advanced cases, the following symptoms may also be present:
If these symptoms continue for 12 weeks or longer, the doctor may
diagnose chronic sinusitis.
A doctor will carry out a physical examination and ask the patient about their symptoms. This is usually enough to make a diagnosis.
The doctor may visually examine the nasal cavity with a light source, or a small, handheld device with a light attached called an otoscope, which can also be used to examine the ears.
If symptoms persist, a doctor may refer a person with sinusitis to an ear, nose, and throat specialist (ENT) for a more in-depth examination. They may insert an endoscope into the nose, a small, thin, flexible tube with a light and camera attached. This can provide more detailed images.
In cases of persistent or severe sinusitis, a CT scan may be
Treatment options depend on how long the condition lasts.
Acute and subacute sinusitis
Most acute cases will resolve without treatment.
However, sinusitis can be uncomfortable, so people often use home remedies and over-the-counter (OTC) medications to relieve symptoms.
In the following cases, the person should see a doctor:
If the sinusitis has a bacterial cause, a doctor may prescribe antibiotics. If symptoms remain after the course of medication is finished, the individual should return to the doctor.
Chronic sinusitis is not usually bacterial in nature, so antibiotics are unlikely to resolve symptoms. A fungal infection can be treated with antifungal drugs.
Corticosteroid sprays can help in recurrent cases, but these need a prescription and medical supervision.
In allergic sinusitis, treating allergies with shots or reducing and avoiding exposure to allergens like animal dander or mold can lessen the occurrence of chronic sinusitis.
Structural issues, such as a deviated septum, may need surgery. Surgery may also be advised if there are polyps, or if the sinusitis has resisted all other treatments.
Functional endoscopic sinus surgery (FESS) is the main procedure used for treatment, but other surgeries may be required as other parts of the nose are often affected. If a deviated septum is causing recurrent infections, for example, a septoplasty will be used to straighten out this bone and cartilage.
Treatment may still be required following surgery to prevent the return of sinusitis.
Surgery should always be the last resort on sinusitis in children, and obtaining a second opinion is recommended before proceeding.
Insurers may require patients to provide in-depth evidence to ensure that
the surgery is for sinusitis and not for cosmetic surgery, to improve the
appearance of the nose.
The following may help prevent sinusitis: