Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. Normally, sinuses are filled with air. But when sinuses become blocked and filled with fluid, bacteria can grow and cause an infection.

Conditions that cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in the lining of the nose), or deviated septum (a shift in the nasal cavity). Allergies (such as hay fever) can also cause swelling and poor drainage of the sinuses.

There are two types of sinusitis, including:

Acute sinusitis: A sudden onset of cold-like symptoms such as runny nose, stuffy nose and facial pain that does not go away after 7-10 days. It responds well to antibiotics and decongestants.
Chronic sinusitis: A condition characterized by at least four recurrences of sinusitis or infection that last 12 weeks or longer.
Who Gets Sinusitis?

About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis:

Nasal mucous membrane swelling as from a common cold
Blockage of drainage ducts
Structure differences that narrow the drainage ducts
Conditions that result in an increased risk of infection
In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, pacifiers, bottle drinking while lying on one's back, and smoke in the environment.

In adults, the contributing factors are most frequently infections and smoking.

What Are the Signs and Symptoms of Acute Sinusitis?

The primary symptoms of acute sinusitis include:

Facial pain/pressure
Nasal stuffiness
Nasal discharge
Loss of smell
Cough/congestion
Additional symptoms may include:

Fever
Bad breath
Fatigue
Dental pain
Acute sinusitis can last four weeks or more. This condition may be diagnosed when a person has two or more symptoms and/or the presence of thick, green, or yellow nasal discharge.

What Are the Signs and Symptoms of Chronic Sinusitis?

People with chronic sinusitis may have the following symptoms for 12 weeks or more:

Facial congestion/fullness
A nasal obstruction/blockage
Pus in the nasal cavity
Fever
Nasal discharge/discolored postnasal drainage
Additional symptoms may include:

Headaches
Bad breath
Fatigue
Dental pain
Thick nasal discharge
How Is Sinusitis Diagnosed?

To diagnose sinusitis, your doctor will examine your face for swelling and redness over the cheekbone area.

Facial swelling and redness are generally more prominent in the morning. As you remain upright, the symptoms gradually improve. The exam may include the doctor feeling and pressing your sinuses for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.

Other diagnostic tests may include a study of the mucus culture, nasal endoscopy (see below), X-rays, allergy testing, or CT scan of the sinuses.

What Is Nasal Endoscopy?

An endoscope is a special tube-like instrument equipped with tiny lights and cameras used to examine the interior of the nose and sinus drainage areas.

A nasal endoscopy allows your doctor to view the accessible areas of the sinus drainage pathways. First your nasal cavity is numbed using a local anesthetic. A rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity.

The procedure is used to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the doctor also looks for pus, polyp formation, and any structural abnormalities that would cause you to suffer from recurrent sinusitis.

How Is Sinusitis Treated?

Acute sinusitis. If you have a simple sinusitis infection, your health care provider may recommend treatment with decongestants like Sudafed and steam inhalations alone. Antibiotics are generally needed for more seriously ill patients.

If antibiotics are administered, they are given for 10 to 14 days. With treatment, the symptoms usually disappear and antibiotics are no longer required. Oral and topical decongestants may be prescribed to alleviate the symptoms. Use of nonprescription drops or sprays might be effective in controlling symptoms. However, nonprescription drops should not be used beyond their recommended use, usually four to five days, or they may actually increase congestion.

Chronic sinusitis. Warm moist air may alleviate sinus congestion. A vaporizer or inhaling steam from a pan of boiling water (removed from heat) may also help. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use. Use of nonprescription drops or sprays might be effective in controlling symptoms, however, they should not be used beyond their recommended use. Antibiotics may also be prescribed.

Other Treatment Options

To reduce congestion, your doctor may prescribe nasal sprays (some may contain steroid sprays), nose drops, or oral decongestant medicine. If you suffer from severe chronic sinusitis, oral steroids might be prescribed to reduce inflammation -- usually only when other medications have not worked. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for treatment for any fungal infection.

Will I Need to Make Lifestyle Changes?

Smoking is never recommended, but if you do smoke, you should refrain during treatment for sinus problems. No special diet is required, but drinking extra fluids helps to thin secretions.

Is Sinus Surgery Necessary?

Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus by millions of cilia (a hair-like extension of a cell). Irritation and swelling from an allergy can narrow the opening of the sinus and block mucus movement. If antibiotics and other medicines are not effective in opening the sinus, surgery may be necessary. Also, if there is a structural abnormality of the sinus such as nasal polyps, which obstruct sinus drainage, surgery may be needed.

Surgery is performed under local or general anesthesia using an endoscope. Most people can return to normal activities within five to seven days following surgery; full recovery usually takes about four to six weeks.

A procedure called a "turbinectomy" may also be performed to permanently shrink the swollen membranes of the nose. This is done in the office and takes a few minutes. The anesthetic used is very similar to that used in routine dental procedures.

What Happens if Sinusitis Is Not Treated?

Delaying treatment for sinusitis will result in suffering from unnecessary pain and discomfort. In rare circumstances, untreated sinusitis can lead to meningitis or brain abscess, and infection of the bone.

Reviewed by the doctors at The Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine.

Edited by Charlotte E. Grayson, MD, Feb. 2004, WebMD.

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