Statistics suggest that sinusitis, a common medical condition, affects one out of every eight adults each year. Children may also suffer from this infection; however, because their sinuses are not fully developed until they are in their late teens, it is sometimes difficult to distinguish their presenting symptoms from allergies, vs. colds or viruses.
Definition of Sinusitis and Facts:
While they vary in size, shape and development, humans have four pairs of mucous lined sinuses, which are located in their cheekbones, lower forehead, between the eyes and behind the nose. When they are infected by multiplying bacteria, fungi or viruses, sinuses react to the invaders through the swelling, inflammation and irritation of their mucosal linings, which leads to blockage of normal sinus drainage. The blockage can be manifested in the following manner:
- Acute: can last up to three weeks.
- Subacute: can last anywhere from three weeks to three months.
- Chronic: typically lasts longer than three months and can also present as a series of acute episodes on top of the chronic condition over time.
Sinusitis Symptoms and How Related to Allergies:
The symptoms and complaints of sinusitis are generally specific to their
type. They can be acquired during a hospital stay or nosocomial; triggered by allergies or a cold, viral, fungal or bacterial infections; or be linked to immunosuppression problems. According to Reuler, Lucas and Kumar (1995) and Caspersen, Walter, Walsh, Rosenfeld, and Piccirillo (2015), the following is a list of selected symptoms and complaints based on the type of sinusitis.
- Acute: Facial pain and fullness, pain around the eyes, headache, cloudy, green, yellow, clear or purulent nasal discharge, decreased sense of smell and fever. Also, may be difficult to distinguish from common cold or allergies.
- Allergic: Some resources refer to an “allergic” sinusitis, which is associated with “allergic rhinitis.” This is a nasal condition that occurs when individuals have an allergic reaction to something that they breathe in. The symptoms usually resolve when the offending allergen is removed or the particular allergy season ends.
- Subacute: Complaints similar to acute presentations, but last up to three months.
- Chronic: Similar complaints as acute sinusitis with the addition of nasal obstruction or polyps, postnasal drip, halitosis and lasting longer than three months. Pain may be absent in chronic sinusitis, except for those individuals with frontal sinus infections.
- Hospital Acquired or Nosocomial: Occurs after patients are hospitalized and is contracted either through something in the hospital’s environment or staff hygiene practices or illnesses. The infections usually affect the sinuses on both sides and are frequently seen in those patients with long-term ventilator needs; nasogastric and tracheal tubes; or with nasal packing due to injury or surgical procedures on their skulls and faces.
- Immunosuppression Problems: In addition to the symptoms reported in sinusitis, opportunistic fungi and other gram-negative microorganisms may be seen in individuals with HIV or other immune deficiencies. According to Lal, there are several types of fungal sinusitis, which may be invasive or non-invasive.
Causes of Sinusitis:
According to Caspersen, et al (2015), Reuler, et al (1995) and Lal (n.d.), sinusitis is an infection caused by bacteria, viruses or fungi, which are associated with respiratory illnesses, deficient immune systems, and other conditions. Acute sinusitis caused by bacteria is manifested when an individual has not improved at all after ten days of getting sick or if their condition worsens within ten days after they begin to get better. When the cause of the sinusitis is a virus, however, the individual is usually sick less than ten days and does not get worse. As for fungal sinusitis, most people in good health who have strong immune systems are not affected by the presence of fungi that they may inhale. The fungi may, however, cause infection and inflammation of the sinuses and nose in individuals with weakened immune systems. It may also occur in individuals who have been on long-term antibiotic therapy.
Sinusitis Diagnosis and Tests:
Sinusitis, in its many forms, cannot be diagnosed based on signs and symptoms alone because other conditions may mimic sinusitis. Additional information may be obtained through a physical exam and assessment; a medical history review; CT scans for severe or chronic sinusitis or complications; sinus x-rays; endoscopic sinus exams (ESM); allergies and immune functioning tests; needle aspiration and culture of sinus contents to identify the microorganisms causing the problem; or a Magnetic Resonance Imaging (MRI) to see where the infection has spread or if there are any growths or tumors in the sinuses or nose. Current guidelines advise health care providers to refrain from ordering expensive radiological diagnostic tests unless severe complications are suspected or if there is facial swelling or cranial nerve complications (WebMD; Potera, 2015).
Treatment and Therapy:
Following a correct diagnosis of sinusitis and before prescribing any treatments or therapies, healthcare providers must be aware of the current clinical practice guidelines from the American Academy of Otolaryngology Head and Neck Surgery Foundation. ENTNET’s latest directives suggest that antibiotics are not needed for viral or fungal sinus infections. Additionally, when the infection is bacterial, there should be “watchful waiting” or a seven-day waiting period without antibiotics to see if the individuals get better on their own. Over the counter treatments for both bacterial and viral sinusitis include nasal steroid sprays, nasal irrigations or rinses as well as pain relievers.
Prevention and Prophylaxis:
An effective strategy to help prevent sinusitis is the adoption of a healthy lifestyle, which promotes rest, stress reduction, good nutrition, strengthening of the immune system, annual flu shots, exercise and frequent hand washing.
Where to find help:
If you are suffering from any of these symptoms, you could make an appointment with one of our Arizona specialists to help determine the right course of action, and treatment plan. Patients and healthcare providers should always conduct specialized testing and meet in person to discuss the benefits and potential risks or harms of treatments based on your unique body.
Caspersen, L.A., Walter, L.M., Walsh, S.A., Rosenfeld, R.M., and Piccirillo, J.F. (2015). Plain language summary: Adult sinusitis (Sinus infection). Otolaryngology-Head and Neck Surgery, Vol. 153(2), Lal, D. (n.d.) Fungal sinusitis. care.american-rhinologic.org/fungal_sinusitis
American Academy of Otolaryngology-Head and Neck Surgery. (n.d.). Retrieved from entnet.org/
WebMD. Allergies Health Center. webmd.com/allergies/picture-of-the-sinuses