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Welcome to our health education library. The information shared below is provided to you as an educational and informational source only and is not intended to replace a medical examination or consultation, or medical advice given to you by a physician or medical professional.

Sinusitis

What is a sinus?

A sinus is a hollow, air-filled cavity. There are hollow cavities that are in the skull and connected to the nasal airway by a narrow hole in the bone (ostium). Normally, all are open to the nasal airway through an ostium. Humans have four pair of these cavities, each referred to as the:

  • Frontal sinus (in the forehead)
  • Maxillary sinus (behind the cheeks)
  • Ethmoid sinus (between the eyes)
  • Sphenoid sinus (deep behind the ethmoids)

What is a sinus infection?

A sinus infection occurs when a pathogenic organism (virus, bacterium or fungus) grows within a sinus and causes intermittent blockage of the sinus ostium. Drainage of mucus and pus often occurs when the blockage is relieved. Such infections also cause inflammation of one or more sinuses. This adds to blocking the openings of the sinuses and causes discomfort.

Inflammation of the air cavities within the passages of the nose (paranasal sinuses) is referred to as sinusitis. Sinusitis can be caused by infection but can also be caused by allergy and irritation of the sinuses.

What are the symptoms of sinusitis?

Commonly the symptoms of sinus infection are headache, facial tenderness, pressure or pain and fever. However, as few as 25 percent of patients may have fever associated with acute sinus infection. Other common symptoms include:

  • Cloudy, discolored nasal drainage
  • Feeling of nasal stuffiness
  • Sore throat
  • Cough
  • Headache
  • Sneezing

How is sinusitis diagnosed?

Sinus infection is most often diagnosed based on a history and examination made by a doctor. Because plain X-ray studies of the sinuses may be misleading and procedures such as CT and MRI scans, which are much more sensitive in their ability to diagnose sinus infection, are so expensive and not available in most doctors’ offices, most cases of sinus infection are initially diagnosed and treated based on clinical findings on examination. These physical findings may include:

  • Redness and swelling of the nasal passages
  • Purulent (pus-like) drainage from the nasal passages (the symptom most likely to clinically diagnose sinusitis)
  • Tenderness to percussion (tapping) over the cheeks or forehead region of the sinuses
  • Swelling around the eyes and cheeks

If sinus infection fails to respond to the initial treatment prescribed, then more in-depth studies such as CT or MRI scans may be performed. Ultrasound has been used to diagnose sinus infections in pregnant women, but it is not as accurate as CT or MRI. Rhinoscopy, a procedure for directly looking in the back of the nasal passages with a small flexible fiberoptic tube, may be used to directly look at the sinus openings (ostea) and check for obstruction of these openings by either swelling or growths.

How is sinusitis treated?

For sinusitis caused by viral infection, no antibiotic treatment is required. Frequently recommended treatments include pain and fever medications (such as acetaminophen), decongestants and mucolytics.

Bacterial infection of the sinuses is suspected when facial pain, nasal discharge resembling pus and symptoms persist for longer than a week and are not responding to OTC nasal medications. Acute sinus infection from bacteria is usually treated with antibiotic therapy aimed at treating the most common bacteria known to cause sinus infection, since it is unusual to be able to get a reliable culture without aspirating the sinuses.

Taking decongestants (pseudoephedrine) and mucolytics (guaifenesin) orally may be helpful in assisting drainage of sinus infection.

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