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Sinus Problems

Sinusitis is a chronic ailment for which millions of doctor visits are made annually. Living with one sinus infection after another can make your daily life a miserable ordeal. But what many people don't realize is that sinusitis can be prevented and cured relatively easily.

What are Sinuses?

A sinus is simply a hollow space, of which there are many in the human body. The four pairs inside the skull are called the paranasal sinuses, and their names and locations are as follows:

  • Frontal—Over the eyes in the brow area

  • Maxillary—Inside each cheekbone

  • Ethmoids—Behind the bridge of the nose

  • Sphenoids—Upper region of the nose and behind the eyes

The paranasal sinuses lighten the skull and give resonance to the voice. The sinuses open into the nose and are lined with the same kind of tissue that lines the inside of the nose. The same things that can cause swelling in the nose—such as allergies or infection—can also affect the sinuses.

The tissue lining the sinuses normally secretes a fluid called mucus. This fluid helps to keep the tissue moist and to flush away particles inhaled when you breathe. When the tissue inside the sinuses becomes inflamed, this mucus discharge is increased. Over time, air trapped inside the swollen sinuses can create painful pressure inside the head. Similarly, when air cannot enter the sinuses because of the swollen tissue at the opening, a vacuum can be created, which also causes pain. This is what is known as a "sinus headache."

What Are the Symptoms of Sinusitis?

A sinus infection may produce different kinds of symptoms, depending on which of the sinuses are affected. One of the most common symptoms of sinusitis is headache, especially when you first wake up in the morning. Other symptoms, and the sinuses that may be affected, may include:

  • Pain in the middle of the forehead (frontal sinuses)

  • Aching of the upper jaw and teeth (maxillary sinuses)

  • Swelling and pain around the eyes (ethmoid sinuses)

  • Earache, neck pain, or a deep, aching pain at the top of the head (sphenoid sinuses)

With a severe sinus infection, you may have a fever or feel weak, tired and aching. You may have a cough that worsens at night or a runny or stuffed-up nose. Drainage of mucus from the sinuses down the back of the throat can cause a sore throat.

What Causes Sinusitis?

Most cases of sinusitis are caused by infection with a virus and clear up on their own, without treatment. If the sinuses remain blocked for a long time, though, a secondary infection may result. The secondary infection is caused by bacteria that are normally present within the respiratory tract.  These bacteria multiply and cause a sinus infection when they are unable to drain out of the blocked sinuses.

When normal mucus drainage does not occur during you can experience symptoms ranging from: drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat; nasal obstruction or congestion; tenderness and swelling around the eyes, cheeks, nose and forehead; and/or a reduced sense of smell and taste. 

This resulting sinusitis can be classified into two types:

Acute sinusitis. This temporary inflammation of the sinuses is known as acute sinusitis.   During acute sinusitis the mucous membranes of your nose, sinuses and throat become inflamed, possibly from a pre-existing cold or allergies. Swelling obstructs the sinus openings and prevents normal mucus drainage, causing mucus and pressure to build up. 

Chronic sinusitis. When symptoms become more frequent or persistent however sinus infections may cause chronic sinus inflammation and symptoms. If you have more than three sinus infections in a year or experience symptoms for longer than 12 weeks you could have chronic sinusitis. More than 50 percent of persons with moderate to severe asthma also have chronic sinusitis.

How Is Sinusitis Treated?

The first step in treating sinusitis is to unblock the nasal passages. This allows proper drainage of the sinuses, which goes a long way toward flushing out a bacterial infection. Decongestants are usually used for this purpose.

Be very careful with the use of topical over-the-counter decongestants. Overuse of these products can result in a "rebound effect" and can actually make your stuffy nose worse. After the effects of these products wear off, the tissue inside the nose and sinuses tends to become swollen. This can prompt you to use more of the medication, after which these tissues swell even more. A vicious cycle can begin if you keep using the product.

Beyond this, treatment depends on what the cause of sinusitis is thought to be and how severe a particular case is. If a bacterial infection is present, antibiotics are used to combat it. To reduce inflammation, your doctor may also prescribe a steroid nasal spray. This medication also helps to reduce congestion and does not produce a rebound effect. An additional medication may be either prescribed or obtained over the counter to combat the pain of sinusitis.

In certain cases some patients may also be candidates for sinus surgery which includes conventional sinus surgery, known as functional endoscopic sinus surgery (FESS), or a less-invasive option that uses a balloon catheter, called “balloon sinuplasty,” to open up blocked sinus passageways, restoring normal sinus drainage. These treatment options are recommended for patients with chronic sinusitis symptoms that will not go away with antibiotics or medication.

How Can I Prevent Sinusitis?

The best course for preventing sinusitis is to keep your nasal passages as free and clear as possible. This is particularly important if you have allergies.

If you have chronic sinusitis, your doctor may prescribe a steroid nasal spray. Taken every day, this medication will help to keep the sinuses from becoming inflamed.

To the extent possible, avoid exposure to the things that trigger your allergies. Keep cigarette smoke out of your home and avoid it in other places as much as possible.

Most important, keep your doctor informed of your symptoms. Together you can devise a plan of action to take before a minor case of sinusitis turns into a bigger health problem.


SOURCE: This information should not substitute for seeking responsible, professional medical care. First created 1995; fully updated 1998; most recently updated 2005.
© Asthma and Allergy Foundation of America (AAFA)
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© Asthma and Allergy Foundation of America
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