WHAT IS SINUSITIS?Sinusitis is an inflammation of the sinus membranes that can be infectious (caused by a virus, bacteria, or fungus) or non-infectious (often caused by allergies). People often visit my office worried about having glaucoma or another eye disease because they are feeling pain and pressure around their eyes. However, my examination reveals that most of these patients do not have any ocular pathology and instead are suffering from a sinus infection. The sinus infection treatment that I prescribe usually resolves the problem within 10-14 days. However, if left untreated, a sinus infection potentially can develop into more serious problems involving the inner ear, the eyes, and the meninges (membrane that covers the brain). For this reason, it is important to understand this disease, including its risk factors, causes, and treatment.
WHAT IS SINUSITIS?Sinusitis, also called rhinosinusitis, is an inflammation of the sinuses and nasal passages—the hollow air spaces around the nose. It most commonly is the result of a viral infection, but also can be caused by bacteria, fungus, allergy, or environmental irritants. Sinus infection symptoms include headache or pressure in the eyes, nose, cheek area, or on one side of the head. It also can be accompanied by cough, fever, bad breath, and nasal congestion with thick nasal discharge.
WHAT ARE THE SINUSES?The sinuses, also called paranasal sinuses, are the spaces between the bones of the face. Air passes in and out of these spaces, and mucus drains through them and out of the nose. The sinuses also reduce the weight of the skull and give our voices a nicer, more resonant sound.There are four main pairs of sinus openings, also called sinus cavities, in the face.
Our sinuses have defenses against foreign invaders and substances. If these are disrupted in some way, then viruses, bacteria, fungi, or other substances that typically are restricted to the nasal passages, may inappropriately enter into the sinus cavities. A mucus layer and cells that contain little hairs called cilia cover the surface of the sinuses. These help to trap and propel bacteria and pollutants outward. The ostiomeatal complex (OMC) connects the nasal passage to the paranasal sinuses.
WHO IS AT RISK?The following factors place you at greater risk for contracting a sinus infection.
SINUSITIS TYPESSinusitis is categorized as acute (sudden onset) or chronic (long term, the most common type). Proper treatment of rhinosinusitis is important and may help to prevent relapse. Generally, acute sinusitis either is a single episode lasting less than 8 weeks or multiple episodes occurring no more than 3 times per year, with each lasting no longer than 10 days. Medications usually are effective against acute sinusitis. Successful treatment of rhinosinusitis counteracts damage done to the mucous lining of the sinuses and surrounding bones of the skull, and reduces the patient's thick nasal discharge and congestion.Chronic sinusitis either is a single episode lasting longer than 8 weeks or multiple episodes occurring more than 4 times per year, each with sinus infection symptoms usually lasting more than 20 days. Acute bacterial sinusitis, or ABS, often follows a cold, allergy, or other condition that causes inflammation and accumulation of mucus leading to thick nasal discharge. Bacteria love mucus. They find congested sinuses a great place to grow and multiply. Sometimes our body is able to fight off a bacterial infection on its own. Other times, we need the help of an antibiotic sinus infection treatment prescribed by a physician. It is important to understand that antibiotics only treat bacterial infections. Therefore, if a doctor determines that your rhinosinusitis symptoms are caused by something else — a virus, for example — an antibiotic will not help. If your doctor does prescribe an antibiotic for treatment of rhinosinusitis, remember to take it exactly as directed. And always be sure to take the entire prescription (usually for 10-14 days), even if you are feeling better before the prescription is finished.
HOW DOES SINUSITIS DEVELOP?Rhinosinusitis often follows a viral infection in the upper respiratory tract, but allergens (allergy-causing substances) or pollutants also can trigger sinus infection symptoms. The following steps present a characteristic pattern for the development of sinusitis.
Allergens and pollutants follow a similar pathway and also produce rhinosinusitis symptoms. Bacteria associated with acute sinusitis include: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These bacteria, in addition to Staphylococcus aureus and certain anaerobic bacteria (live without oxygen), are involved in chronic rhinosinusitis. Fungal infections also can be a cause of chronic sinusitis, especially in people with diseases that weaken the immune system, such as HIV infection, leukemia, and diabetes.
SINUS INFECTION SYMPTOMSRhinosinusitis symptoms depend upon the paranasal sinuses that are affected. Ethmoid sinusitis (between the eye sockets)
Maxillary sinusitis (behind the cheek bones)
Frontal sinusitis (in the forehead and above the eyebrows)
Sphenoid sinusitis (deep in the head at the back of the nose)
In addition to the above list of sinus infection symptoms, chronic sinusitis can also can be accompanied by sore throat, bad breath, obstruction, and a history of trauma or damage to the sinuses due to recurrent infections.
TIPS FOR TREATING SINUS INFECTION SYMPTOMSThere are several things that you can do at home to help alleviate your sinus infection symptoms. These suggestions should be viewed as an adjunct to seeing a physician, not as a substitute for it.
Over-the-counter (OTC) medications for sinus infection treatment only should be taken as directed.
WHEN SHOULD YOU SEEK MEDICAL CARE?A person should call a doctor when experiencing pain or pressure in the upper face accompanied by nasal congestion or nasal discharge, postnasal drip, or ongoing bad breath that is unrelated to dental problems. Fever can be a symptom of a rhinosinusitis or a cold. A person experiencing simple congestion with a low-grade fever probably has a cold and may not need special medications or antibiotics. Those also experiencing facial pain or headaches may have a sinus infection.
REFERENCE:Goldman L and Schafer AI. Goldman's Cecil Medicine, 24th Ed. Philadelphia, PA: Saunders Elsevier, 2012:1622-1628.
A number of visitors have written to me asking for recommendations pertaining to eye-care products and books for obtaining more information. I have joined with Amazon.com to create a dependable resource for books and products. You can find these materials at the Eye-Care Store. My goal is to provide you with information, clear up misconceptions, and to explain options so that you can have an informed conversation with your doctor. However, under no circumstances should information found here be considered a substitute for ongoing consultation and examination with your doctor. Since I have not examined you, I only can speak in terms of generalities, whereas your doctor has sufficient clinical details to evaluate your case specifically.
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