"Sinusitis" refers to inflammation of the nasal sinus cavities, which
are moist, hollow spaces in the bones of the skull. There are four pairs of
sinuses: frontal, maxillary, ethmoid, and sphenoid. The sinuses are located
behind the eyebrows, cheekbones, and nose. The sinuses help moisten and warm
air that is filtered by the nose, serving to protect the lungs. The sinuses
also play a role in voice resonation.
The sinus cavities, nose, and lungs are lined with mucous membranes, which
protect the airways by trapping irritants that are inhaled. Tiny hair-like
filaments called cilia are in constant movement and sweep mucus and
the trapped irritants out of the airways and nasal passages. In the sinuses,
the mucus drains out of a tiny opening called the ostium.
The ostium of any sinus cavity can get plugged. When this blockage prevents
the flow of mucus, the pressure builds up, leading to sinusitis (inflammation
and pain). If the blocked sinus becomes infected with bacteria, the sinus becomes
even more inflamed and painful.
|There are four different pairs of sinuses -- the
frontal, ethmoid, maxillary, and sphenoid sinuses. In this illustration,
the sinuses on the right side are shown as inflamed and infected, although
any sinus can be affected. The sphenoid sinuses are not shown because they
are further back in the head.
Sinusitis often affects people who have a stuffy or runny nose due to allergies
(allergic rhinitis). Nasal discharge may be
either a symptom or a cause of sinusitis. Other symptoms of sinusitis can include:
- Facial pain or pressure
- Thick, discolored mucus (yellow or green)
- Diminished sense of smell
- Cough (worse when laying down)
- Bad breath
- Pressure in the ears
Acute vs. chronic sinusitis
Sinusitis can be acute or chronic. Acute sinusitis usually lasts for 3 weeks
but can persist for as long as 3 months. Acute sinusitis is often accompanied
by high fever in young children.
Chronic sinusitis lasts longer than 3 months and does not respond to conventional
antibiotic treatment. Symptoms of chronic sinusitis are less severe than those
of acute, but can last for years.
A distinguishing symptom of chronic sinusitis is a persistent cough -- with
sinusitis in children, cough may be the only symptom.
Acute sinusitis is usually caused by a viral respiratory infection. Chronic
sinusitis can also be caused by infection, but is more often caused by inflammation
and blockage due to allergies or a physical obstruction (deviated
septum, misformed bone or cartilage structures, nasal polyps, tumors, or foreign
|This view shows the bones and cartilage that surround
the sinuses, including the septum and the turbinates. The septum and turbinates
can block the sinuses, leading to pain and inflammation.
The septum separates the two sides of the nasal cavity. A "deviated
septum" is one that is crooked or misformed; in some cases a deviated septum
may actually block the opening to one of the sinuses.
The turbinates are bones that usually help protect the openings to
the sinuses. The ostium is a tiny canal between the turbinates that drains
a sinus cavity. Any structural problem in the turbinates (by birth or from
an accident) can block the canal.
A cyst or polyp is a harmless structure that can block the ostium,
depending on how big it gets and where it is located in the sinus.
Some people have structural problems that partially block the sinuses, and
their allergies just make the problem even worse.
Other factors that may contribute or cause sinusitis (both acute and chronic)
include a weakened immune system due to existing illness, cocaine abuse, overuse
of decongestant nasal sprays, and activities like swimming and diving.
If you suspect you have sinusitis, ask your primary care physician for a referral
to an Ear, Nose, and Throat (ENT) doctor (also called an otorhinolaryngologist).
If you have bad allergies and think they may be causing sinusitis, ask for
a referral to an allergist.
To make a diagnosis, your doctor will need to consider all of your symptoms.
Your doctor will examine your nasal and sinus passages with an endoscope to
see whether your sinuses are clear or inflamed with excess, cloudy mucus.
A computerized tomography (CT) scan of the sinuses (shown above) can
be considered the "gold standard" in diagnosing sinusitis. The CT scan allows
the doctor to clearly see where there are healthy pockets of air versus mucus
build-up, structural obstruction, and inflammation in your sinuses.
Treatment and management
Acute sinusitis may require aggressive treatment with antibiotics. If you
don't respond to the medication within 3 - 5 days, your doctor may change your
prescription for a stronger antibiotic. Chronic sinusitis may require as many
as 6 weeks of treatment with antibiotics.
Decongestant medications may relieve symptoms of stuffy, runny nose that accompany
sinusitis. Corticosteroid nasal sprays may help with inflammation.
If you don't respond to antibiotics and continue to experience symptoms, surgery
may be recommended. If you have nasal polyps, a deviated septum, or other obstructive
growths, surgery may be the only answer to relieve your symptoms.
Nasal irrigation with saline is often recommended for people with sinusitis,
particularly those having undergone surgery. It helps to clean out the sinuses
and nasal passageways after surgery.
If you suspect that you have allergies, determine what you may be allergic
to with allergy testing, so you can avoid them. If you can control your allergies,
you may find that your sinusitis symptoms clear up too.
Review Date: 5/16/2007
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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