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Sinusitis
You're coughing and sneezing and tired and achy. You think that you might
be getting a cold. Later, when the medicines you've been taking to relieve
the symptoms of the common cold are not working and you've now got a terrible
headache, you finally drag yourself to the doctor. After listening to
your history of symptoms and perhaps doing a sinus X-ray, the doctor says
you have sinusitis. Sinusitis simply means inflammation of the sinuses,
but this gives little indication of the misery and pain this condition
can cause. Chronic sinusitis, sinusitis that recurs frequently, affects
an estimated 32 million people in the United States. Americans spend millions
of dollars each year for medications that promise relief from their sinus
symptoms.
Sinuses are hollow air spaces, of which there are many in the human body.
When people say, "I'm having a sinus attack," they usually are
referring to symptoms in one or more of four pairs of cavities, or spaces,
known as paranasal sinuses. These cavities, located within the skull or
bones of the head surrounding the nose, include the frontal sinuses over
the eyes in the brow area, the maxillary sinuses inside each cheekbone,
the ethmoids just behind the bridge of the nose and between the eyes,
and behind them, the sphenoids in the upper region of the nose and behind
the eyes. Each sinus has an opening into the nose for the free exchange
of air and mucus, and each is joined with the nasal passages by a continuous
mucous membrane lining. Therefore, anything that causes a swelling in
the nose-an infection or an allergic reaction-also can affect the sinuses.
Air trapped within an obstructed sinus, along with pus or other secretions,
may cause pressure on the sinus wall. The result is the sometimes intense
pain of a sinus attack. Similarly, when air is prevented from entering
a paranasal sinus by a swollen membrane at the opening, a vacuum can be
created that also causes pain.
Symptoms
Sinusitis has its own localized pain signals, depending upon the particular
sinus affected. Headache upon awakening in the morning is characteristic
of sinus involvement. Pain when the forehead over the frontal sinuses
is touched may indicate inflammation of the frontal sinuses. Infection
in the maxillary sinuses can cause the upper jaw and teeth to ache and
the cheeks to become tender to the touch. Since the ethmoid sinuses are
near the tear ducts in the corner of the eyes, inflammation of these cavities
often causes swelling of the eyelids and tissues around the eyes and pain
between the eyes. Ethmoid inflammation also can cause tenderness when
the sides of the nose are touched, a loss of smell, and a stuffy nose.
Although the sphenoid sinuses are less frequently affected, infection
in this area can cause earaches, neck pain, and deep aching at the top
of the head. Other symptoms of sinusitis can include fever, weakness,
tiredness, a cough that may be more severe at night, and runny nose or
nasal congestion. In addition, drainage of mucus from the sphenoids down
the back of the throat (postnasal drip) can cause a sore throat and can
irritate the membranes lining the larynx (upper windpipe).
Causes
Most cases of acute sinusitis are caused by viruses and will clear up
without treatment within two weeks. Viruses can enter the body through
the nasal passages and set off a chain reaction resulting in sinusitis.
For example, the nose reacts to an invasion by viruses that cause infections
such as the common cold, flu, or measles by producing mucus and sending
white blood cells to the lining of the nose, which congest and swell the
nasal passages. When this swelling involves the adjacent mucous membranes
of the sinuses, air and mucus are trapped behind the narrowed openings
of the sinuses. If the sinus openings become too narrow to permit drainage
of the mucus, then bacteria, which normally are present in the respiratory
tract, begin to multiply. Most apparently healthy people harbor bacteria,
such as Streptococcus pneumoniae and Haemophilus influenzae, in their
upper respiratory tracts with no ill effects until the body's defenses
are weakened or drainage from the sinuses is blocked by a cold or other
viral infection. The bacteria that may have been living harmlessly in
the nose, throat, or sinus area can multiply and cause an acute sinus
infection. Medicines, too, can set off a nasal reaction with accompanying
sinusitis. For example, intolerance to aspirin and other related non-steroidal
anti-inflammatory medications, such as ibuprofen, can be associated with
sinusitis in patients with asthma or nasal polyps (small growths on the
mucous membrane lining of the sinuses). Sometimes, fungal infections can
cause acute sinusitis. Although these organisms are abundant in the environment,
they usually are harmless to healthy people, indicating that the human
body has a natural resistance to them. Fungi, such as Aspergillus and
Curvularia, can cause serious illness, in people whose immune systems
are not functioning properly. Some people with fungal sinusitis have an
allergic-type reaction to the fungi. Chronic inflammation of the nasal
passages (rhinitis) also can lead to sinusitis. Allergic rhinitis or hay
fever (discussed below) is the most common cause of chronic sinusitis
and is a frequent cause of acute sinusitis. Vasomotor rhinitis, caused
by humidity, cold air, alcohol, perfumes, and other environmental conditions,
also can result in a sinus infection.
Chronic Sinusitis
Chronic sinusitis refers to inflammation of the sinuses that continues
for weeks, months, or even years. As noted above, allergies are the most
common cause of chronic sinusitis. Inhalation of airborne allergens (foreign
substances that provoke an allergic reaction), such as dust, mold, and
pollen, often set off allergic reactions (allergic rhinitis) that, in
turn, may contribute to sinusitis. People who are allergic to fungi can
develop a condition called "allergic fungal sinusitis." As body
cells react against these inhaled substances, they release chemical compounds,
such as histamine, at the mucosal surface. These chemicals then cause
the nasal passages to swell and block drainage from the sinuses, resulting
in sinusitis. Damp weather, especially in northern temperate climates,
or pollutants in the air and in buildings also can affect people subject
to chronic sinusitis. Chronic sinusitis can be caused by structural abnormalities
of the nose, such as a deviated septum (the bony partition separating
the two nasal passages), or by small growths called nasal polyps, both
of which can trap mucus in the sinuses.
Diagnosis
Although a stuffy nose can occur in other conditions, like the common
cold, many people confuse simple nasal congestion with sinusitis. A cold,
however, usually lasts about seven days and disappears without treatment.
Acute sinusitis often lasts longer than a week. A doctor can diagnose
sinusitis by medical history, physical examination, X-rays, and if necessary,
MRIs or CT scans (magnetic resonance imaging and computed tomography).
Treatment
After diagnosing sinusitis and identifying a possible cause, a doctor
can prescribe a course of treatment that will clear up the source of the
inflammation and relieve the symptoms. Sinusitis is treated by re-establishing
drainage of the nasal passages, controlling or eliminating the source
of the inflammation, and relieving the pain. Doctors generally recommend
decongestants to reduce the congestion, antibiotics to control a bacterial
infection, if present, and pain relievers to reduce the pain. Over-the-counter
and prescription decongestant nose drops and sprays, however, should not
be used for more than a few days. When used for longer periods, these
drugs can lead to even more congestion and swelling of the nasal passages.
If symptoms do not improve within 10 to 14 days, the cause of sinusitis
is likely to be bacterial. Most patients with sinusitis that is caused
by bacteria can be treated successfully with antibiotics used along with
a nasal or oral decongestant. A narrow-spectrum antibiotic -- one that
fights the most common bacteria -- is the initial treatment recommended.
For many years, the combination of allergic disease and infectious sinusitis
has been considered the most difficult form of sinus disease to treat.
The patient with uncontrolled nasal allergies frequently experiences a
lot of congestion, swelling, excess secretions, and discomfort in the
sinus areas. Therefore, the patient should work with a doctor who understands
the diagnosis and treatment of allergic diseases to pinpoint the cause
of the allergies and follow an allergy care program to help alleviate
sinusitis. Doctors often prescribe steroid nasal sprays, along with other
treatments, to reduce the congestion, swelling, and inflammation of sinusitis.
Because steroid nasal sprays have no serious side effects, they can be
used for long-term treatment. In some people, however, they irritate the
nasal passages. For patients with severe chronic sinusitis, a doctor may
prescribe oral steroids, such as prednisone. Because oral steroids can
have significant side effects, they are prescribed only when other medications
have not been effective.
Although sinus infection cannot be cured by home remedies, people can
use them to lessen their discomfort. Inhaling steam from a vaporizer or
a hot cup of water can soothe inflamed sinus cavities. Another treatment
is saline nasal spray, which can be purchased in a pharmacy. A hot water
bottle; hot, wet compresses; or an electric heating pad applied over the
inflamed area also can be comforting. In treating patients with severe
sinusitis, a physician may use special procedures. One technique requires
the patient to lie on his back with his head over the edge of the examining
table. A decongestant fluid is placed in the nose, and air is suctioned
out of the nose so that the decongestant fluid can shrink the sinus membranes
sufficiently to permit drainage. Or, a thin tube can be inserted into
the sinuses for washing out entrapped pus and mucus. Sometimes, however,
surgery is the only alternative for preventing chronic sinusitis. In children,
problems often are eliminated by removal of adenoids obstructing nasal-sinus
passages. Adults who have had allergic and infectious conditions over
the years sometimes develop polyps that interfere with proper drainage.
Removal of these polyps and/or repair of a deviated septum to ensure an
open airway often provides considerable relief from sinus symptoms. The
most common surgery done today is functional endoscopic sinus surgery,
in which the natural openings from the sinuses are enlarged to allow drainage.
Prevention
Although people cannot prevent all sinus disorders-any more than they
can avoid all colds or bacterial infections-they can take certain measures
to reduce the number and severity of the attacks and possibly prevent
sinusitis from becoming chronic. Appropriate amounts of rest, a well-balanced
diet, and exercise can help the body function at its most efficient level
and maintain a general resistance to infections. Eliminating environmental
factors, such as climate and pollutants, is not always possible, but they
can often be controlled. Many people with sinusitis find partial relief
from their symptoms when humidifiers are installed in their homes, particularly
if room air is heated by a dry forced-air system. Air conditioners help
to provide an even temperature, and electrostatic filters attached to
heating and air conditioning equipment are helpful in removing allergens
from the air. A person susceptible to sinus disorders, particularly one
who also is allergic, should avoid cigarette smoke and other air pollutants.
Inflammation in the nose caused by allergies predisposes a patient to
a strong reaction to all irritants. Drinking alcohol also causes the nasal-sinus
membranes to swell. Sinusitis-prone persons may be uncomfortable in swimming
pools treated with chlorine, since it irritates the lining of the nose
and sinuses. Divers often experience congestion with resulting infection
when water is forced into the sinuses from the nasal passages.
Air travel, too, poses a problem for the individual suffering from acute
or chronic sinusitis. A bubble of air trapped within the body expands
as air pressure in a plane is reduced. This expansion causes pressure
on surrounding tissues and can result in a blockage of the sinuses or
the eustachian tubes in the ears. The result may be discomfort in the
sinus or middle ear during the plane's ascent or descent. Doctors recommend
using decongestant nose drops or inhalers before the flight to avoid this
difficulty. People who suspect that their sinus inflammation may be related
to dust, mold, pollen, or food-or any of the hundreds of allergens that
can trigger a respiratory reaction-should consult a doctor. Various tests
can determine the cause of the allergy and also help the doctor recommend
steps to reduce or limit allergy symptoms.
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NIAID, a component of the National Institutes of Health, supports research
on AIDS, tuberculosis and other infectious diseases as well as allergies
and immunology.
Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
Public Health Service
U.S. Department of Health and Human Services
June 1998
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