Sinusitis

Causes and Symptoms

Is sinusitis the same thing as a sinus infection?

We often use the term sinus infection synonymously with sinusitis. However, one can also have inflammation of the sinuses without having an infection. This is more rare than an infection, and often referred to as chronic sinusitis.

What are the symptoms of sinusitis?

Most people have experienced the classic symptoms of sinusitis at some point: nasal congestion, nasal drainage or postnasal drip, throbbing pressure around the face and head especially when bending forward, and even tooth pain. Other symptoms can include fever, earache, dizziness, fatigue, and (rarely) loss of taste and smell.

What causes sinusitis?

Viral infections, including the common cold and flu, are the most common cause of sinusitis. Bacterial infections that require antibiotic treatment account for less than 1% of all sinuses infections. Most often, bacterial infections are preceded by viral infections or inflammation of the nasal passage caused by environmental or seasonal allergies. This inflammation alters the normal cleaning and clearing ability of the mucous membranes and allows for bacteria to infect the sinuses.  

What is the difference between bacterial and viral sinusitis? Are there other types of sinusitis?

Viral sinusitis is caused by viruses such as the common cold or flu. Bacterial sinusitis is caused by bacteria such as Streptococcus or Staphylococcus. Generally, symptoms of viral and bacterial sinus infections are the same.

Viral sinus infections typically spontaneously resolve on their own, usually within 10 days of the onset of symptoms. For bacterial sinus infections, symptoms last longer (>10 days). Worsening of sinusitis symptoms after an initial period of improvement also suggests a bacterial cause. Sinusitis can be classified based on the duration of symptoms:

• Acute rhinosinusitis – Symptoms lasting for less than 4 weeks
• Subacute rhinosinusitis – Symptoms lasting for 4-to-12 weeks
• Chronic rhinosinusitis – Symptoms persisting longer than 12 weeks
• Recurrent acute rhinosinusitis – Four or more episodes of acute sinusitis per year, with interim symptom resolution

Treatment

What’s the best treatment for sinusitis?

Symptomatic treatment aimed to help improve nasal inflammation, drainage, and sinus pressure is the recommended treatment for sinusitis.  

• Nasal irrigation to clear blocked sinus passages is the cornerstone of a self-care approach. Rinses with an over-the-counter NeliMed or Neti Pot two-to-three times a day will help clear sinuses and reduce inflammation. Steam inhalation is another effective option to help open the sinus passages. Simply boil some water in a pot and put a towel over your head as you inhale the hot steam. You can do this with plain boiling water or boiling water with some drops of essential oil, like eucalyptus.
• In addition to nasal irrigation, decongestants will help provide relief from sinus pressure and pain. Decongestants—among them, Afrin nasal (oxymetazoline) or Sudafed (pseudoephedrine)—help reduce the swelling caused by inflamed sinuses. Afrin should not be used for more than three to four days in a row. Increased sinus swelling as the medication wears off (called a rebound effect) necessitates the continued use of the spray and eventual dependency.  
• Over-the-counter nasal steroid sprays such as Flonase (Fluticasone) or Nasacort (Triamcinolone acetonide) help reduce sinus inflammation.  
• Motrin/Advil (Ibuprofen) or Tylenol (Acetaminophen) will help reduce fever and sinus pain/pressure.    
• Umcka (Pelargonium sidoides), Andrographis paniculata, and Elderberry (Sambucus nigra) are over-the-counter herbs that have shown some benefit in reducing the duration of sinusitis symptoms.  
• If you have viral upper respiratory symptoms, avoid dairy products. They can contribute to increased mucus production.
• If symptoms exceed 10-14 days or if there is a worsening of symptoms after a period of improvement, antibiotics may be used. Antibiotics are only needed when a bacterial infection is known or suspected by your provider. When antibiotics aren’t needed, they won’t help you, and their side effects could cause harm. Side effects can range from minor issues, like a rash, to very serious health problems, such as antibiotic-resistant infections.

When should you see a doctor?

You should contact your doctor if you have sinusitis symptoms lasting longer than 10 days, persistent fever above 102 not improving with Tylenol or Ibuprofen, swelling or redness around your nose or eyes, visual changes, a severe headache, or neck stiffness.

Prevention

Is sinusitis preventable?

The best way to prevent sinusitis is through good hand hygiene. We know viruses are the most common cause of sinusitis and proper hand washing and/or use of hand sanitizers have been shown to prevent the spread of respiratory viruses.  To boost your immune system and decrease your risk of sinusitis you can follow these general rules:

• Eat nutrient rich, non-processed foods.
• Prioritize sleep, at least 7 hours nightly, ideally 8-9.
• Stay physically active.
• Limit your use of alcohol, which suppresses your immune system.
• Stay well-hydrated.
• Try vitamin C. There is some evidence that vitamin C used as daily prophylaxis at doses of 0.2 grams a day has an effect at reducing the incidence of viruses that cause sinusitis.

Are there any special considerations for recurrent sinusitis?

Recurrent sinusitis is defined as four or more episodes of sinusitis per year, with interim symptom resolution. If you have recurrent sinusitis, your provider may order further testing to evaluate for an underlying cause.

A CT scan of your sinuses can help show nasal blockage or polyps that may require other treatments. Polyps are soft growths inside your nose that can block your sinus passages and contribute to sinus inflammation. We don’t always know why people develop nasal polyps. However, they can be a result of recurrent sinusitis. Your provider may need to refer you to an ear, nose and throat specialist who can determine if you need endoscopic surgery and/or removal of nasal polyps.

Useful Links

A comprehensive list of sinusitis information with diagrams (ENT Health)

An outline of key high-level sinusitis information (CDC)

A deep dive into chronic sinusitis (Cleveland Clinic)

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