There are 4 pairs of sinuses connected to the nasal cavity by small openings called (ostia). Nasal sinuses are small mucous-lined pockets within the facial bones surrounding the nose. Normally, these sinuses make mucus that drains from the sinuses into the nose while air passes freely in and out.

Sinusitis (inflammation of the sinuses) occurs when at least one of three conditions is manifest: (1) The small openings (ostia) from the sinuses to the nose are blocked; (2) small hairs (cilia) in the sinuses that help move the normally produced mucous out are not working; and (3) too much mucous is produced, often simply a result of inflammation. Any combination of these may cause sinusitis.

Sinusitis affects approximately 3 out of 1,000 people, and develops in approximately 31 million Americans alone each year. Some people never get sinusitis, and others develop sinusitis frequently (especially patients with cystic fibrosis). It usually follows respiratory infections, such as colds.

Sinusitis typically follows an upper respiratory infection or allergic reaction, which can cause inflammation and swelling that closes off the sinus ostia. This encourages mucous accumulation in the sinuses, and makes the sinus a great place for bacteria and fungus to live and grow rapidly. Individuals with weakened immune systems are at greatest risk, since their risk of any infection is high.

While the most frequent cause of sinusitis is upper respiratory tract infections (common colds) or allergic rhinitis, other risk factors include: history of asthma; overuse of nasal decongestants; deviated nasal septum; nasal bone spurs; nasal or facial tumors; nasal polyps; foreign bodies; frequent swimming and/or diving; and dental work. Typically, these all cause blockages of the sinus ostia, and are the result of problems that affect the nasal area only.

Diseases that are considered systemic (affecting the whole body) typically render individuals immunosuppressed and, in turn, at increased risk for infection. These include: HIV infection, cancer, and patients on immunosuppression or receiving chemotherapy.

People with one of a number of diseases that prevent the cilia (hair that helps move mucus out of the sinuses) from working are also at risk. These diseases include: Kartagener's syndrome, cystic fibrosis, and immotile cilia syndrome.

Remember, these diseases predispose individuals to develop sinusitis because they make the sinuses a better place for infectious organisms, especially bacteria, to grow. Not all individuals with the above conditions develop sinusitis, but they are at risk.

The classic symptoms of acute sinusitis are nasal congestion, greenish nasal phlegm (discharge), facial and/or dental pain, eye pain, headache, and a nighttime cough. Some patients also complain of fever, malaise (feeling ill), bad breath, and a sore throat. It is usually preceded by a URI (cold), which does not improve or worsens after 5-7 days of symptoms.

Chronic sinusitis is subtler, and can be difficult to diagnose. It manifests the symptoms listed above in a milder form, but usually persists for longer than 8 weeks. It is most common in patients with allergies.

The simplest way to test for sinusitis is through percussion (tapping) over a sinus area. Tenderness may indicate infection.

Transillumination (examination by shining a light against the sinus), endoscopy, ultrasonography, X-rays, or cultures of the material from the nose may indicate sinusitis in some people. However, some of these tests have been shown to be relatively insensitive tests for detecting sinusitis and are generally unnecessary.

When sinusitis is not clinically obvious, a CT scan of the sinuses is an outstanding test to help in diagnosing sinusitis. Finally, when the sinusitis is thought to involve tumor or fungal infections, MRI of the sinuses may be necessary and can prove even more helpful.

Individuals with chronic or recurrent sinusitis may need further laboratory evaluation. This may involve sweat chloride tests (cystic fibrosis), HIV tests, ciliary function tests, tests for immunodeficiency, and/or allergy testing with nasal cytology (checking the cells in the nasal secretions).

The goals of treatment are twofold: the relief of the symptoms and the cure of the infection. Symptoms can be relieved with a saline spray, a lavage, or with a humidifier. While nasal decongestants can also be helpful, the use of topical (spray) nasal decongestants beyond 3 to 5 days can actually worsen nasal congestion.

Nasal corticosteroid sprays may also be used to help decrease the swelling, especially in patients with swollen structures (such as nasal polyps) or allergies. These prescription medications include fluticasone (Flonase), mometasone (Nasonex), and triamcinolone (Nasacort AQ).

Antibiotic treatment aims at curing the disease. Common antibiotics include: Ampicillin, Amoxacillin, Bactrim (Trimethoprim with Sulfamethoxazole), Augmentin, Cefuroxime, or Cefprozil.

Other antibiotics may be used depending on the type of bacteria. Acute sinusitis should be treated for 10 to 14 days, while chronic sinusitis should be treated for 3 to 4 weeks.

Surgery to clean and drain the sinus may also be necessary, especially in patients with recurrent episodes of sinusitis despite medical treatment. A specialist called an ENT (Ears, Nose and Throat), also known as an otolaryngologist, can perform this surgery.

Most fungal sinus infections require surgical intervention. Finally, surgical repair of a deviated septum or nasal polyps may prevent the condition’s recurrence.

Sinus infections are usually curable with medical treatment. Those who have recurrent attacks should be evaluated for chronic sinusitis and other possible causes.

• Chronic sinusitis
• Spread of infection into the bones of the face (called osteomyelitis)
• Spread of infection into the brain (called meningitis)
• Spread of infection to the eye (called orbital cellulitis)
• Abscess formation
• Cavernous sinus thrombosis
• Resistance of the bacteria to certain commonly used antibiotics

Call for an appointment with your health care provider if symptoms indicate acute sinusitis.

• Appropriately treat allergies and upper respiratory tract infections, and avoid cigarette smoke and adverse environmental exposure (pollution).
• Avoid temperature extremes because sudden changes in temperature will increase sinus pain. Avoid bending with the head down because this usually increases the pain.
• Because moisture thins mucus and allows it to drain better, use a humidifier or steam to increase moisture in the nose and sinus area. Drink plenty of fluids to increase moisture within your body. Use of decongestants during upper respiratory infections may reduce the chances of developing sinusitis.