Overview

Sinusitis, often called a sinus infection, is swelling of the lining of the sinuses, the air-filled spaces behind the cheeks, forehead and eyes. When this lining swells, mucus cannot drain well, which causes a blocked nose, facial pressure and thick nasal discharge.

Acute sinusitis lasts less than 4 weeks and most cases are caused by a cold virus, so they usually get better on their own within 7 to 10 days. Chronic sinusitis lasts 12 weeks or longer and is often linked to allergies, nasal polyps or ongoing irritation from dust and smoke.

Symptoms

• Blocked or stuffy nose
• Thick yellow or green discharge from the nose or down the throat
• Pain or pressure in the cheeks, forehead or around the eyes, often worse when bending forward
• Reduced sense of smell or taste
• Headache, cough, bad breath or pain in the upper teeth
• Tiredness and sometimes a mild fever
• Warning signs that need urgent care: swelling or redness around the eye, double or blurred vision, severe headache, stiff neck, confusion or a high fever

Causes & Risk Factors

• Viral infections such as the common cold, the most common cause of acute sinusitis
• Bacterial infection, which is less common and usually follows a cold
• Allergies (allergic rhinitis), including reactions to dust, pollen and mold
• Dust storms and dry air-conditioned indoor air, which irritate and dry the nasal lining
• Smoking, shisha and secondhand smoke
• Nasal polyps, a deviated nasal septum or an upper tooth infection
• Asthma or a weakened immune system

Complications

• Chronic sinusitis with long-lasting blockage and loss of smell
• Worsening of asthma symptoms
• Infection spreading to the tissues around the eye (orbital cellulitis), which is rare but serious
• Very rarely, spread of infection to the brain lining (meningitis) or a brain abscess
• Repeated infections that affect sleep and work

Diagnosis

A doctor usually diagnoses acute sinusitis from the symptoms and a physical exam of the nose, face and throat. Imaging such as a CT scan is not needed for most simple cases. For chronic or repeated sinusitis, or when complications are suspected, the doctor may request a CT scan of the sinuses, a look inside the nose with a thin camera (nasal endoscopy) or allergy testing.

Treatment

• Saline nasal rinses or sprays to wash out mucus and irritants
• Steroid nasal sprays (intranasal corticosteroids) to reduce swelling, especially in allergy-related and chronic sinusitis
• Pain and fever relievers such as paracetamol or ibuprofen, with rest and fluids
• Decongestant nasal sprays only for a few days, since longer use can cause rebound blockage
• Antibiotics considered only when bacterial sinusitis is likely: symptoms lasting more than 10 days without improvement, symptoms that get worse after first getting better, or severe symptoms with high fever and facial pain
• Referral to an ear, nose and throat (ENT) specialist for chronic sinusitis that does not improve with medicines

Prevention

• Wash hands often and get the yearly flu vaccine
• Treat allergies and asthma as advised by a doctor
• Avoid smoking, shisha and secondhand smoke
• Stay indoors with windows closed during dust storms and wear a mask when outdoors
• Keep indoor air from getting too dry and clean air-conditioner filters regularly
• Use saline rinses during colds and allergy seasons

Patients with sinus symptoms are seen by the Internal Medicine Department at AlHayat Medical Center.

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