LawrenceS. Pohl, M.D., M.P.H., Medical Director MissionValleyMedical Clinic 5333 Mission Center Road, Suite 100| San Diego, CA 92108 | 619.295.3355 www.missionvalleymedical.com
Fact sheet: Acute sinusitis It usually starts in autumn: more and more colleagues call in sick and stay at home in bed with a feverish cold. Sometimes a common cold can develop into sinusitis, which can last a few days or even weeks. Sinusitis makes people feel weak and sick, and besides the symptoms of a cold, they often have severe pain around the face. In this fact sheet we will inform you about the causes and symptoms of acute sinusitis, as well as the treatment options. What is sinusitis and what causes it?Sinusitis, or rhinosinusitis (from rhino = nose), is an inflammation of the sinuses or, more specifically, the mucous membranes lining the sinuses. The sinuses are part of the respiratory system and are found on either side of the nasal bone. They consist of several empty spaces in the head, extending up to the forehead and down to the jaw. Depending on where they are, they are called the frontal, maxillary, sphenoid or ethmoid sinus. Sinusitis mostly affects the maxillary sinuses. The sinuses are lined with mucous membranes that have small hairs on them (ciliated epithelium). The air we breathe flows through the sinuses, where it warms up and becomes moist. The sinuses produce a fluid (mucus secretion) that leaves the nose through the nostrils.
Sinusitis often develops following a cold, but it can also be caused by hay fever and other allergies. Common colds are usually caused by respiratory viruses rather than bacteria. Bacterial infections then often develop in addition to viral infections. The viruses or bacteria cause an inflammation, which makes the membranes swell up. This can prevent the fluid from draining out of the sinuses. If that happens, the fluid becomes thicker and the sinuses fill up with the sticky, often yellow-green mucus. Sinusitis may be acute or chronic. Acute sinusitis can occur several times a year, but usually goes away again after a few weeks at the most. In chronic sinusitis the symptoms are more persistent and do not go away for a long time. Sometimes they are worse and sometimes they are better. This fact sheet is not about the treatment of chronic sinusitis. What are the symptoms and consequences of sinusitis?Sinusitis is an infection that is often associated with the following typical symptoms:
If someone has sinusitis, their nose becomes stuffed up due to the swelling and build-up of secretions. This makes it more difficult for them to breathe through their nose, which feels stuffy. The yellow-green color of the discharge is a sign of disease-causing germs. Sinusitis often causes pain in the forehead, the jaw and around the eyes and – less commonly – tooth pain. The pain usually gets worse if you lean forward, for example when getting up out of bed. Sense of smell is often impaired or may even disappear completely. Many people also feel pressure in their face. Sinusitis usually has no other symptoms apart from the ones described above. But if acute sinusitis is not completely cured it can become chronic. In very rare cases sinusitis can become severe and have serious consequences, because the inflammation spreads to nearby areas of the body like the eyes or brain, for example. Signs of a serious form of sinusitis include high fever, swelling around the eyes, inflammatory redness of the skin, severe facial pain, sensitivity to light and a stiff neck. If you have symptoms like this it is important to see a doctor. You might need to take antibiotics. How is sinusitis diagnosed?The first thing a doctor will do is ask about symptoms such as pain, fever and your general wellbeing, as well as coughing, coughed-up phlegm and loss of smell. To diagnose sinusitis it is not absolutely necessary to do specific tests. But the doctor might do various examinations. With the help of a tube-like device with a small lamp on it (endoscope), he or she can take a closer look at the inside of your nose and see whether, for instance, the membranes are swollen or what color the secretions are. They might also take a sample (swab) of the secretion by putting a tube through the nose into the sinus. The sample taken is then tested for germs in a lab. Sometimes ultrasound or x-rays are used, too. Generally speaking, finding out whether sinusitis is caused by bacteria or viruses can take up a lot of time and resources. Moreover, this diagnosis does not usually influence the course of the disease. People with sinusitis usually recover within one or two weeks. Do antibiotics help?Antibiotics only work against bacteria. Sinusitis is usually caused by viruses, so antibiotics often do not work. But even when a more accurate diagnosis is made and people who have a bacterial infection are given antibiotics, they are still not very effective. That is because sinusitis usually clears up just as quickly on its own without antibiotics: in 8 out of 10 people with maxillary sinusitis, symptoms improve on their own within two weeks. In people who take antibiotics, this number is only raised to 9 out of 10 – this means that only about an extra 10% of people affected get better. One option is to wait for 7 to 10 days and see whether the symptoms get better on their own. However, research has not shown that treatment with antibiotics after 7 to 10 days has any benefits. Sinusitis can be very persistent despite treatment, and may only clear up after several weeks. If there is no improvement, it may be advisable to see a doctor again. Antibiotics can have adverse effects, including stomach and bowel problems and fungal infections, but these are usually not severe. They possibly affect up to 2 out of 10 people who take antibiotics. The overuse of antibiotics in the treatment of less serious illnesses can have negative outcomes for the population as a whole. In recent years there has been an increase in bacteria that are resistant to antibiotics. This means that some illnesses can no longer be treated as effectively as they used to. You can read more about the dangers and prevention of antibiotic resistance here. In the rare cases when sinusitis becomes severe, it is essential that antibiotics are used quickly to prevent serious complications such as meningitis from developing. You can read about the research on antibiotic treatment for sinusitis here. What other treatment options are there?Nasal corticosteroid sprays aim to reduce the inflammation and thereby reduce the swelling of the mucous membranes in the sinuses. Research has shown that these sprays relieve sinusitis symptoms, although it often takes a few days before they start working. Corticosteroid sprays reduce the production of secretions, clear the nose and relieve pain. Similar to antibiotics, they do not help more than 1 out of 10 people. The disadvantages of these nasal sprays: they can sometimes cause nosebleeds and headaches. There are several medications that can relieve symptoms, but do not speed up recovery. These include ASS (acetylsalicylic acid, in Aspirin for example), paracetamol (also called acetaminophen) and nasal sprays/drops to reduce swelling (decongestants). Unlike corticosteroid sprays, decongestants start to work straight away. Overall, their use in the treatment of sinusitis has not been very well studied. They aim to reduce the swelling of the mucous membranes and to rapidly make it easier to breathe through the nose. Such a short-term effect can help to sleep better at night, for example. These nasal drops and sprays do not have an anti-inflammatory effect, however. After a while decongestants can have the opposite effect: the membranes in the nose tend to swell again. Decongestant nasal sprays are available in pharmacies as over-the-counter medication. But there are many different drugs with different active ingredients that can also cause very unpleasant adverse effects. It helps to find out about these beforehand and watch out for possible symptoms while using them – headache or dizziness, for example. As well as medication, some people use saline (salt) solutions to relieve the swelling of the membranes and loosen secretions. Saline solutions come in the form of ready-made nasal sprays. You can also rinse your nose with salt water or dissolve some salt in hot water and inhale the steam. But there are no good studies that show whether saline solutions help in the treatment of acute sinusitis or not. There has only been research on the long-term use of saline solution for chronic sinusitis, indicating that saline solutions clear the nose. There are also no good studies on the use of infrared radiation. Although there is not much people can do to speed up their recovery from sinusitis, there are several things that can be done to prevent it from developing in the first place. You can read more about how to protect yourself and your family from colds and other respiratory infections, which can trigger sinusitis, here. References
Zalmanovici A, Yaphe J. Intranasal Steroids for acute sinusitis. Cochrane Database of
Courtesy of:
National Library of Medicine http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005171/
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