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Sinusitis

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

Sinusitis is an infection or inflammation of the membranes that line the nasal passages and sinuses, the air-filled spaces at the front of the skull.

Sinusitis is an infection or inflammation of the membranes that line the nasal passages and sinuses, the air-filled spaces at the front of the skull.

Most colds – infection with one of the common cold viruses ­– cause a stuffy or bunged up nose, which clears up within a few days. But if the sinuses become inflamed, other symptoms such as headache and painful swelling of the face may develop.

Sinusitis may only last a few days (acute sinusitis), or it may be an ongoing problem that, without treatment, never completely goes away (chronic sinusitis). Acute sinusitis is common, chronic sinusitis is less common. Babies under one do not get sinusitis because their sinuses are not fully developed, but it can otherwise affect people of any age.

Sinusitis

Sinusitis

The sinuses are hollow air-filled spaces in the skull bones. Theyre connected to the nose and lined with the same membrane, called mucous membrane, which produces a slimy secretion (mucus) to keep the passageways moist and trap dirt particles.

There are four main sets of sinuses. The frontal sinuses are on either side of the forehead above the eyes. The maxillary sinuses are in each cheekbone. The smaller ethmoid sinuses are behind the bridge of the nose and between the eyes, and the sphenoids are between the upper part of the nose and behind the eyes.

The main symptom of sinusitis is a throbbing pain and pressure in the face, which is made worse by bending forwards. Frontal sinusitis causes pain over the forehead above the eyebrows, which may be tender to touch. Maxillary sinusitis causes aching in the upper jaw, teeth and cheeks which may be mistaken for toothache.

Inflammation of the ethmoid sinuses causes pain around and between the eyes and the sides of the nose. Inflammation of the sphenoid sinus can cause earache, neck pain or an ache behind the eyes, at the top of the head or in the temples.

Other typical symptoms include:

  • return of a stuffy nose after a cold has cleared up
  • thick yellow or green discharge from the nostrils
  • cold symptoms that do not respond to treatment
  • foul smell in the nose

Sinusitis can also cause a high temperature, weakness, tiredness, loss of taste and sense of smell, and a cough that produces mucus, which is worse at night.

Very rarely, the infection can spread to the facial bones or the membranes lining the brain (meningitis). Occasionally a pocket of pus (abscess) can form in an eye socket, the brain or a facial bone.

Most cold viruses only result in a blocked nose. However, if the mucous membrane lining the nasal passages and sinuses swells up, this can block off mucus drainage holes. Mucus builds up behind the blockage causing the pressure and pain of sinusitis. Bacteria or fungi are more likely to grow in sinuses that cant drain properly, and bacterial infection often causes more inflammation and pain.

Chronic sinusitis is caused by anything that irritates the lining of the nose over long periods and causes the mucous membrane to swell. Examples include:

  • grass and tree pollen
  • cold air
  • alcohol
  • perfumes
  • damp weather
  • allergy to house dust mite, mould, and fungi

People who have allergy-based asthma often have sinusitis as well. Any problem with the nose which blocks the drainage holes can produce sinusitis, such as polyps (little nodules of mucous membrane) or injury causing the bridge to lean to one side (deviated nasal septum). Dental infections can spread to the sinuses. Rarer causes of sinusitis include conditions that impair the immune system such as AIDS and cystic fibrosis. Swimming, air pollution and smoking can aggravate sinusitis.

The doctor will ask about symptoms, touch parts of the face to find any pain or swelling, and may use a technique called transillumination, where a bright light held against the cheek or forehead in a dark room. The light should pass through normal sinuses; if it does not, this suggests a blockage.

If the symptoms and physical findings are typical of sinusitis, no further testing is usually needed. If there is any doubt, the doctor may recommend X-rays, magnetic resonance imaging (MRI) or computerised tomography (CT).

Nasal endoscopy may be used to investigate chronic sinusitis. A flexible telescope with a light on the end is inserted into the nostril to examine the inside of the sinuses. This test usually done under local anaesthetic.

Acute sinusitis

Often sinusitis can be treated with home treatments. Rest, inhalation of steam from a bowl of hot water, and over the counter medicines should help. A pharmacist will be able to advise you on a suitable choice. Ibuprofen or paracetamol help to relieve pain and lower temperature. Decongestants, such as pseudoephedrine (tablets or linctus, e.g Sudafed tablets), and menthol, which can be inhaled, reduce the swelling in the nose and allow the sinuses to drain. Decongestants should not be used for more than a week, as prolonged use can actually aggravate nasal blockage.

A doctor should be consulted if symptoms do not improve after a week of trying home remedies. The doctor will probably prescribe a course of antibiotics for 3-10 days.

Chronic sinusitis

Steroid nasal sprays (e.g. beclometasone Beconase), available from pharmacists and on prescription, are helpful in two ways. If long–term infection is present they help to reduce swelling of the nasal lining and open up the drainage holes, and if allergy is involved they also reduce inflammation. Antihistamines such as loratidine (Clarityn) might also help. In severe cases, the doctor may recommend short courses of steroid tablets. These are only available on prescription.

Endoscopic nasal surgery may be needed as a last resort. Tubes and instruments passed down the nasal endoscope are used to wash out the sinus and widen the drainage hole. This can be done under general or local anaesthetic. It is a routine and generally safe procedure, but all surgery does carry some element of risk. Complications include minor damage to the lining of the nose or sinuses, or damage to the skull bone.

Other types of surgery sometimes required to treat chronic sinusitis include correcting a bent nasal cartilage (septoplasty) or removing nasal polyps.

it is possible to reduce the chances of developing sinusitis. Here are some things that might be helpful, especially for people who are prone to sinusitis

  • keeping the air humid at home
  • using an air-filtering vacuum cleaner
  • removing pets
  • having a course of anti-allergy injections
  • stopping smoking
  • drinking less alcohol
  • using a decongestant spray or tablets before diving or swimming

1. Can I fly if I have chronic sinusitis?

Flying can cause sinus pain so you may not wish to fly if you're going through a bad patch with chronic sinusitis. However, using decongestants and nasal sprays may relieve your symptoms enough for you to be able to fly more comfortably.

When you go up in a plane the air pressure is lower than on the ground. You may have noticed that a bottle of water expands as the plane gets higher and will give a hiss of air escaping when you open it. This is because the air that was sealed inside when you were on the ground expands when the air pressure outside is reduced. The same thing happens to the air inside your sinuses. Usually the expanded air flows out through your sinuses so the air pressure inside them is the same as that of the surrounding air. This is called equalising. However, if your sinuses are inflamed, the air may be trapped inside and expand against the walls of your sinuses causing pain that can be very severe. You may get a headache or facial pain. In extreme circumstances the expanding air can cause bleeding inside your sinuses or may damage some nearby nerves.

If you have chronic sinusitis, you may also have problems when the plane lands. If air doesn't flow into your sinuses on landing, the air trapped inside takes up less space. This may cause painful 'sucking' on your sinus walls.

Using nasal decongestant drops or a spray such as oxymetazoline may help your sinuses to equalise. Oral decongestants may help too, however, you shouldn't use these if you have high blood pressure or heart disease. If you have allergies that make sinusitis worse, make sure they are under control. See your GP or pharmacist for advice. If you do fly but get ongoing pain afterwards for more than one or two days, or if your symptoms get worse, you should see a GP.

It may be hard for you or your GP to know for sure whether your sinusitis is going to be a problem when flying. If you know that you have difficulty equalising the pressure in your sinuses, you may decide that it's better not to fly.

2. Is sinusitis contagious?

No, sinusitis isn't contagious.

Sinusitis isn't contagious, but the cause of it can be. The most common cause of sinusitis is a cold or flu. When you have a cold or the flu virus, your sinuses can get inflamed and this can stop mucus draining properly away from them. This can then lead to a secondary bacterial infection, which can cause further inflammation and swelling.

If you or a member of your family has a cold, try to avoid spreading the virus by:

  • covering your mouth when you cough or sneeze
  • washing your hands frequently and drying them properly
  • putting used tissues in the bin straight away

You may also want to discourage your children from sharing toys if one of them has a cold or the flu and wash any toys in soapy water after use.

3. I've had sinusitis for a few days and have noticed the area around my eye is getting red and puffy. What should I do?

If you have an infection in your sinuses, particularly ethmoid sinusitis, it can spread to your eye socket and the surrounding area. This can be a serious complication of acute sinusitis and you should seek medical treatment as soon as possible.

Mostly sinusitis gets better without any problems, often without any specific treatment. However, more serious problems can develop if the infection spreads to the parts of your face and skull that are nearby, including the eye sockets and brain. The infection can also spread into surrounding bone and blood.

If you have sinusitis and develop swelling or redness around your eye, your eye appears to be bulging, or your vision gets worse (such as seeing double), this could be a sign that the area around your eyeball has become infected. This is called orbital cellulitis. If you don't get treatment quickly, it could lead to serious problems, including blindness and meningitis. Treatment may include an antibiotic injection or surgery to drain the swelling if it's likely to permanently affect your vision.

The sinuses are very close to the protective coatings of your brain and infection can spread there. This is called meningitis. Seek urgent medical attention if you develop any of the following symptoms in addition to your sinusitis:

  • a severe headache with a stiff neck
  • confusion and drowsiness
  • sensitivity to light
  • co-ordination problems
  • vomiting and diarrhoea

Further information

 

Sources

  • Sinusitis. ENT UK. www.entuk.org, accessed 11 December 2009
  • Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews 2009, Issue 4. doi: 10.1002/14651858.CD005149.pub3
  • Sinus infection (Sinusitis). National Institute of Allergy and Infectious Diseases. www.niaid.nih.gov, accessed 11 December 2009
  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010
  • Harvey R, Hannan SA, Badia L, et al. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Systematic Reviews 2007, Issue 3. doi: 10.1002/14651858.CD006394.pub2
  • Ahovuo-Saloranta A, Borisenko OV, Kovanen N, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Systematic Reviews 2008, Issue 2. doi: 10.1002/14651858.CD000243.pub2
  • Aerospace Medical Association. Medical guidelines for airline travel, 2nd edition. Aviation, Space and Environmental Medicine 2003; 74(5):Section II (supplement)
  • Sinusitis. American Academy of Otolaryngology - Head and Neck Surgery. www.entnet.org, accessed 11 December 2009
  • Common cold. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 11 December 2009
  • Preseptal and orbital cellulitis. The Merck Manuals Online Library. www.merck.com/mmhe, accessed 11 December 2009
  • Orbital cellulitis. British Society of Antimicrobial Chemotherapy. www.bsac.org.uk, accessed 11 December 2009
  • Meningitis symptoms. Meningitis UK. www.meningitisuk.org, accessed 11 December 2009

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