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Have you ever had a cold or allergy attack that wouldn't go
away? If so, there's a good chance you actually had sinusitis.
Experts estimate that 37 million people are afflicted with sinusitis
each year, making it one of the most common health conditions
in America. That number may be significantly higher, since the
symptoms of bacterial sinusitis often mimic those of colds or
allergies, and many sufferers never see a doctor for proper diagnosis
and treatment with an antibiotic.
Acute bacterial sinusitis is an infection of the sinus cavities
caused by bacteria. It usually is preceded by a cold, allergy
attack, or irritation by environmental pollutants. Unlike a cold,
or allergy, bacterial sinusitis requires a physician's diagnosis
and treatment with an antibiotic to cure the infection and prevent
future complications.
Normally, mucus collecting in the sinuses drains into the nasal
passages. When you have a cold or allergy attack, your sinuses
become inflamed and are unable to drain. This can lead to congestion
and infection. Diagnosis of acute sinusitis usually is based
on a physical examination and a discussion of your symptoms.
Your doctor also may use x-rays of your sinuses or obtain a sample
of your nasal discharge to test for bacteria.
When you have frequent sinusitis, or the infection lasts three
months or more, it could be chronic sinusitis. Symptoms of chronic
sinusitis may be less severe than those of acute; however, untreated
chronic sinusitis can cause damage to the sinuses and cheekbones
that sometimes requires surgery to repair.
Therapy for bacterial sinusitis should
include an appropriate antibiotic. If you have three or more
symptoms of sinusitis (see chart), be sure to see your doctor
for diagnosis. In addition to an antibiotic, an oral or nasal
spray or drop decongestant may be recommended to relieve congestion,
although you should avoid prolonged use of nonprescription nasal
sprays or drops. Inhaling steam or using saline nasal sprays
or drops can help relieve sinus discomfort.
Antibiotic resistance means that some infection-causing bacteria
are immune to the effects of certain antibiotics prescribed by
your doctor. Antibiotic resistance is making even common infections,
such as sinusitis, challenging to treat. You can help prevent
antibiotic resistance. If the doctor prescribes an antibiotic,
it is important that you take all of the medication just as your
doctor instructs, even if your symptoms are gone before the medicine
runs out.
If your doctor thinks you have chronic sinusitis, intensive
antibiotic therapy may be prescribed. Surgery is sometimes necessary
to remove physical obstructions that may contribute to sinusitis.
Surgery should be considered only if medical treatment fails
or if there is a nasal obstruction that cannot be corrected with
medications. The type of surgery is chosen to best suit the patient
and the disease. Surgery can be performed under the upper lip,
behind the eyebrow, next to the nose or scalp, or inside the
nose itself.
Functional endoscopic sinus surgery (FESS) is recommended for
certain types of sinus disease. With the endoscope, the surgeon
can look directly into the nose, while at the same time, removing
diseased tissue and polyps and clearing the narrow channels between
the sinuses. The decision whether to use local or general anesthesia
will be made between you and your doctor, depending on your individual
circumstances.
Before surgery, be sure that you have realistic expectations
for the results, recovery, and postoperative care. Good results
require not only good surgical techniques, but a cooperative
effort between the patient and physician throughout the healing
process. It is equally important for patients to follow pre-
and postoperative instructions.
As always, an ounce of prevention is worth a pound of cure.
To avoid developing sinusitis during a cold or allergy attack,
keep your sinuses clear by:
- using an oral decongestant or a short course of nasal spray
decongestant
- gently blowing your nose, blocking one nostril
while blowing through the other
- drinking plenty of fluids
to keep nasal discharge thin
- avoiding air travel. If you
must fly, use a nasal spray decongestant before take-off
to prevent blockage of the sinuses allowing mucus to drain
- If you have allergies, try to avoid contact with things
that trigger attacks. If you cannot, use over-the-counter or
prescription antihistamines and/or a prescription nasal spray
to control allergy attacks
Allergy testing, followed by appropriate allergy treatments,
may increase your tolerance of allergy-causing substances. If
you believe you may have sinusitis, see our tips for sinusitis
sufferers.
Because the symptoms of sinusitis sometimes mimic those of colds
and allergies, you may not realize you need to see a doctor.
If you suspect you have sinusitis, review these signs and symptoms.
If you suffer from three or more, you should see your doctor.
| Facial Pressure/Pain |
Yes |
Sometimes |
Sometimes |
| Duration of Illness |
Over 10-14 Days |
Varies |
Under 10 Days |
| Nasal Discharge |
Thick, yellow-green |
Clear, thin, watery |
Thick, whitish or thin |
| Fever |
Sometimes |
No |
Sometimes |
| Headache |
Sometimes |
Sometimes |
Sometimes |
| Pain in Upper Teeth |
Sometimes |
No |
No |
| Bad Breath |
Sometimes |
No |
No |
| Coughing |
Sometimes |
Sometimes |
Yes |
| Nasal Congestion |
Yes |
Sometimes |
Yes |
| Sneezing |
No |
Sometimes |
Yes |
Your child's sinuses are not fully developed until age 20. However,
children can still suffer from sinus infection. Although small,
the maxillary (behind the cheek) and ethmoid (between the eyes)
sinuses are present at birth. Sinusitis is difficult to diagnose
in children because respiratory infections are more frequent,
and symptoms can be subtle. Unlike a cold or allergy, bacterial
sinusitis requires a physician's diagnosis and treatment with
an antibiotic to prevent future complications.
The following symptoms may indicate a sinus infection in your
child:
- a "cold" lasting more than 10 to 14 days, sometimes
with low-grade fever
- thick yellow-green nasal drainage
- post-nasal drip, sometimes
leading to or exhibited as sore throat, cough, bad breath,
nausea and/or vomiting
- headache, usually not before age 6
- irritability or fatigue
- swelling around the eyes
If despite appropriate medical therapy these symptoms persist,
care should be taken to seek an underlying cause. The role of
allergy and frequent upper respiratory infections should be considered.
Learn your sinusitis
score and review 20 questions and
answers about your sinuses.
© 2004 AAO-HNS/AAO-HNSF
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Sinus Facts