Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU
What are sinuses?
Sinuses are empty cavities within your cheek bones, around your eyes and behind your nose. You have 4 sinuses on each side of your head. There is a large sinus under your eye and another above your eye on each side. If you drop a line between your ears and another line down the center of your face, where those lines intersect is another sinus (sphenoid sinus). Then, connecting all three of these sinuses is what is called the ethmoid sinus, which is more of a labyrinth - like an egg-cartonlike group of sinuses.
What is sinusitis?
If your stuffy nose and cough last longer than 10 days, you may have more than a cold. Rhinosinusitis is a swelling of your nasal sinuses. It is often called sinusitis or a sinus infection.
How do I know if I have sinusitis?
You may experience any of the following:
- pressure around your nose, eyes or forehead
- stuffy nose
- thick, yellow or green drainage from your nose
- bad-tasting post-nasal drip
- head congestion, ear fullness or a headache
- toothache, tiredness and, occasionally, fever
Types and Causes of Sinusitis
Acute sinusitis refers to sinusitis symptoms that last less than 4 weeks. Most acute sinusitis starts as a regular cold from the common cold viruses and then becomes a bacterial infection.
Chronic sinusitis is when symptoms last 3 months or longer (more than 12 weeks). The cause of chronic sinusitis is a combination of swelling and infection. A CT scan can help to see if you have sinusitis or not.
Recurrent sinusitis occurs when 3 or more acute episodes happen in a year.
What are the risk factors for chronic sinusitis?
Allergic rhinitis puts you at risk for developing sinusitis because allergies can cause swelling of the nasal mucosa and blockage of the sinuses. This blockage prevents the sinuses from draining, and increases the risk of developing infection (bacterial sinusitis).
If your skin test is positive for allergies, your allergist can prescribe medications to control the swelling such as nose spray This can reduce your risk of developing an infection.
Immune problems may decrease your ability to fight infections. Such problems include low levels of immunoglobulins (IgG, IgM, IgA), also called antibodies. Some patients have low level of antibodies to a common bacteria called Pneumococcus. This may lead to chronic or recurrent sinusitis.
A board-certified allergist can test quickly and reliably for both allergies and immunodeficiency.
Problems with the structure of your nose - such as narrow nasal or sinus passages, tumors or a shifted (deviated) nasal septum can also cause sinusitis. A CT scan can show such anatomocal problems. Surgery is sometimes needed to correct them.
Many patients with recurring or chronic sinusitis have more than one factor that puts them at risk of infection.
Diagnosis of sinusitis
To diagnose sinusitis, an allergist may order the following tests:
- allergy skin testing (blood testing is an alternative)
- antibody levels for IgG, IgM, IgA, and pneumococcal serotypes, complete blood count
- CT scan of the sinuses
Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia.
Treatment of sinusitis
Sinusitis requires a mix of treatments. You may need a medication to reduce nasal blockage and control allergies, which helps keep the sinus passages open such as steroid nasal spray.
If bacterial sinusitis is present, you will need an antibiotic.
For people with allergies, long-term treatment such as allergy shots can control allergic symptoms and prevent sinusitis.
Several non-drug treatments can also be helpful. These includes sinus rinses with distilled salty water.
Some patients may need surgery to correct the structure of your nose by an otorhinolaryngologist, or an ear-nose-throat physician (ENT).
Experts Discuss the Causes of Sinusitis. NYTimes, 2012.