More than 20 million Americans will have at least one bout of sinusitis this year. If you understand sinusitis, you can reduce your chances of developing the problem — and if sinusitis strikes, you'll know how to speed your recovery and lower your risk of complications.
Your sinuses are air-filled chambers located in the bones of your face. Each of us has four pairs of sinuses.
Each of the sinuses is lined by a membrane that produces mucus. When you're healthy, the mucus is a thin, watery fluid that flows freely from your sinuses into the upper part of your nose. But when your sinuses become inflamed, the mucus gets thick and sticky, so it can't flow through the tiny openings, called ostia, that lead to the nose. Fluid builds up in the sinuses, causing pressure and pain — and just like that, you've got sinusitis.
What causes sinusitis?
Sinusitis is an infection caused by bacteria. If sinus drainage is blocked, the bacteria multiply and cause infection. Blockage of the narrow sinus draining channels is the main reason we get sinusitis, and restoration of drainage is the key to treatment.
What triggers sinusitis?
The common cold is the leading culprit. Cold viruses produce swelling of the nasal tissues, which can sometimes block the sinuses.
You may get some sinus pressure when you get a cold, but that doesn't mean you have sinusitis or that you need an antibiotic. Only about one cold in 100 leads to sinusitis, and you can make the odds work for you by doing what it takes to keep your sinuses draining. Many other things can block your sinuses and lead to infection. The list includes allergies, cigarette smoke and other irritating fumes, changes in barometric pressure during flying or scuba diving, nasal polyps, and a deviated nasal septum.
Painful pressure is the main symptom. Depending on which sinus is involved, the pain is in the forehead (frontal sinusitis), over the cheek or in the upper jaw and teeth (maxillary sinusitis), behind the eyes (ethmoid or sphenoid sinusitis), or at the top of the head (sphenoid sinusitis). Sinus pain usually increases when you bend forward.
Nasal congestion and a thick, dark-colored nasal discharge are also common. Finally, you may feel feverish, achy, and tired.
In most cases, your doctor can diagnose sinusitis simply by asking about your symptoms. If pressing over your sinuses causes pain, sinusitis is likely. CT scans can be very helpful if your sinusitis is unusually severe or if your doctor suspects complications. ENT (ear, nose, and throat) specialists can also diagnose sinusitis by looking up your nose with a scope.
Treatment: Promoting drainage
Many people with sinusitis will recover quickly and completely without taking antibiotics simply by promoting drainage. Here's what you should do:
- Drink lots of water. Good hydration helps keep the mucus thin and loose.
- Inhale steam. Linger in a hot shower. Boil a kettle, pour the water into a pan, and bend over the pan with a towel over your head to inhale the steam. Even hot tea or chicken soup will help. One way or another, inhale steam three to four times a day.
- Sleep with your head elevated.
- Use decongestants. Tablets containing pseudoephedrine or phenylephrine are very helpful but may sometimes raise your blood pressure, speed your pulse, or make you jittery and keep you up at night.
- Use a saline (salt water) nasal spray to loosen mucus and rinse your sinuses.
- A warm compress on your face may soothe sinus pain. Over-the-counter pain relievers such as aspirin or acetaminophen will help reduce pain and fever.
You may be surprised that antibiotics are not listed as the first step in treatment. Indeed, antibiotics have been a great step forward in treating sinusitis — but they won't work unless good drainage is achieved, and if good drainage is achieved, antibiotics are often not necessary.
Good as they are, antibiotics have potential disadvantages. They can trigger allergic reactions or cause side effects. Widespread use of antibiotics has encouraged the spread of antibiotic-resistant bacteria ("superbugs"). And many of these drugs are expensive.
Still, if your sinusitis does not improve with two to four days of drainage therapy — or if it's very severe to begin with — your doctor should prescribe an antibiotic.
Sinusitis that lasts more than three weeks or recurs more than three times a year is called chronic sinusitis. The most common cause of chronic sinusitis is inadequately treated acute sinusitis — and since the diagnosis and treatment of acute sinusitis have improved so much, chronic sinusitis is less common than it used to be.
Living with your sinuses
To protect your sinuses, stay well-hydrated. Avoid tobacco smoke and irritating fumes. Treat symptoms of sinusitis promptly with steam inhalation, decongestants, and nasal irrigation. If you don't recover as expected — or if you have serious sinusitis or warning symptoms — see your doctor for antibiotics and, possibly, nasal steroids.
January 2009 update