Acute Sinusitis

In recent months, I have seen many complaints of sinus infections. The typical patient will come to the office and complain of facial pain around the cheeks with a fever and nasal drainage. Acute sinusitis is a very common illness in the primary care setting, accounting for about 16 million office visits per year.

Acute sinusitis is inflammation of the sinuses or cavities around the nasal passages. Sinuses are air chambers that make mucus to clear particles and organisms in the air. Cilia, or tiny hairs, clears out the mucus from the sinuses and helps it drain through the nasal canals. The swelling from sinusitis interferes with drainage and mucus builds up in the cavities. The mucus then becomes a breeding ground for infection.

The most commonly affected area in adults is the maxillary sinus. In children, it is the ethmoid sinus.

The causes of sinusitis include:

1. Viral (Rhinovirua, Influenza, Adenovirus, Parainfluenza)

2. Bacteria (Streptococcus, Haemophillus, Moraxella)

3. Fungal (Aspergillus, Mucormycosis) in immunocompromised patients (Diabetics, HIV, cancer patients)

Risk factors include:

1. Allergies

2. Nasal passage abnormalities (deviated septum, polyps)

3. Trauma

4. Dental infections

5. Recurrent upper respiratory infections

6. Nasal dryness

7. Inhaled irritants (tobacco smoke)

8. Immune disorder

9. Inflammatory disorder

10. Hormones

Signs and symptoms (up to 4 weeks) include:

1. Pain/pressure in the cheeks, between the eyes, forehead, or nose (worse when leaning forward)

2. Upper teeth pain

3. Headache

4. Fever

5. Bad breath

6. Nasal drainage (yellow/green)

7. Trouble breathing through the nose

8. Reduced ability to taste or smell

9. Cough at night

10. Nausea

11. Fatigue

12. "Double sickening" (Patient begins with a cold, gets better, then gets worse again)

Treatment includes:

1. Saline nasal spray (Ayr or Ocean spray)

2. Short term decongestant (Sudafed)

3. Anti-inflammatory (ibuprofen)

4. Fluids

5. Rest

6. Moist heat on the sinuses (warm compresses)

7. Humidifier

8. Avoid anti-histamines

If the symptoms do not improve after several days, contact your health care professional.

Typically viral sinus infections will improve after 5-7 days. Acute bacterial sinus infections usually require antibiotics.

If the symptoms do not improve after sufficient treatments, diagnostic imaging such as a CT may be taken to confirm diagnosis. Specialist referral to an ENT usually are reserved to persistent sinusitis, mental status changes, severe facial or dental pain, severe swelling or redness around the eyes, visual complaints, high fever, and sinusitis refractory to medical management.

Major complications are extremely rare.

Contact your health care professional for more information.

Thank you and have a nice day.