Sinusitis

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Sinusitis is an infection or inflammation of the sinuses. A typical case of acute sinusitis begins with a cold or "flu" or an allergy attack that causes swelling of the nasal membranes and increased watery mucous production. The membranes can become so swollen that the tiny openings from the sinuses become blocked. When mucus and air cannot flow easily between the nose and sinuses, abnormal pressures occur in the sinuses, and mucus can build up in them. This creates a pressure-pain in the forehead or face, between and behind the eyes, or in the cheeks and upper teeth, depending on which sinuses are involved.

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A blocked sinus cavity filled with mucus becomes a fine place for bacteria to grow. When a person's "cold" lasts more than the typical week or so, and when his mucus turns yellow-green or develops a bad odor or taste, then a bacterial infection has probably taken over. The pressure and pain in the face and forehead can be quite severe in acute bacterial sinusitis.

Chronic sinusitis occurs when the sinus opening is blocked for an extended period. Headaches are less prominent in chronic sinusitis, but congestion and unpleasant nasal secretions usually persist. Also, fleshy growths known as polyps can develop as an exaggerated form of inflammatory swelling of the membranes. Some cases of sinusitis come from infections in the upper teeth that extend into the sinuses.

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How is Sinusitis Treated?

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Most of the time, antibiotics are not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time it takes for the infection to go away.

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Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

At some point, your doctor will consider further testing or other prescription medications.​

Other treatments for sinusitis include allergy shots (immunotherapy), avoiding allergy triggers, nasal corticosteroid sprays and antihistamines. ​​ Surgery to enlarge the sinus opening and drain the sinuses may also be needed. You mayo consider this procedure if your symptoms do not go away after 3 months of treatment and you have more than 2 or 3 episodes of acute sinusitis each year.​ Most fungal sinus infections need surgery. 

 

Chronic sinusitis is much more difficult to treat than acute bacterial sinusitis.  You may have been sick for months and may have received several courses of antibiotics.  Over time, the bacteria become immune to the antibiotics, and you may become allergic to certain antibiotics.  Steroids tend to be the most helpful medicine for chronic sinusitis, as they reduce the swelling that causes nasal and sinus blockage.  Despite aggressive medical management, many patients with chronic sinusitis require surgical cleaning of their sinuses.  New techniques such as balloon sinuplasty make it possible to wash out the sinuses under local anesthesia in the office. Most patients have very little pain and return to work the day after this procedure.

 

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