Rhinosinusitis – more commonly known as sinusitis – is an inflammation of the mucous membranes lining the paranasal sinuses, four pairs of cavities that connect the nose to the throat. A cold or allergy usually creates the inflammation and congestion that prevents drainage of the warm, moist, mucus-filled sinus cavity. This creates a perfect breeding ground for viral, bacterial or fungal infections.
Rhinosinusitis is either acute or chronic:
Acute rhinosinusitis. Lasts for just a few weeks and usually needs either no treatment or a course of antibiotics.
Chronic rhinosinusitis. Lasts longer and can be more difficult to treat. However, treatment is essential, as long-term bouts of rhinosinusitis can develop into dangerous medical conditions. Chronic rhinosinusitis is a major health problem in the United States, afflicting more than 33 million Americans annually, according to the U.S. Centers for Disease Control and Prevention.
In addition, rhinosinusitis is either infectious or noninfectious:
Infectious rhinosinusitis usually stems from a viral infection. Less frequently, it is the result of bacterial growth.
Noninfectious rhinosinusitis is usually the result of allergies or another nonviral irritant.
About rhinosinusitis
Rhinosinusitis occurs when the linings of the sinuses and cavities of the nose become inflamed. The body has four pairs of hollow sinuses located within the dense portions of the skull and bones of the head surrounding the nose. These paranasal sinuses connect the nose to the throat and allow for the exchange of mucus and air. They include:
Frontal sinuses (in the forehead)
Maxillary sinuses (behind the cheek bones)
Ethmoid sinuses (between the eyes)
Sphenoid sinuses (behind the eyes)
The sinuses help insulate the skull, reduce its weight and allow the voice to resonate within it. The membranes in the sinuses produce mucus, which moistens and cleanses the nasal passages. They also warm air that is breathed in through the nose before it moves on to the lungs.
Rhinosinusitis can develop when colds, allergies or other conditions damage the cells of the sinus lining, causing it to swell and thicken. This impairs the sinuses by blocking the small openings (ostia) between the sinuses and the nose and preventing the free exchange of air and mucus.
When this happens, symptoms often result. Trapped air in the sinus creates pressure on the sinus wall, causing pain. Mucus and pus trapped in the sinuses become breeding grounds for viral, bacterial or fungal infections.
Long–term rhinosinusitis can cause serious health problems if left untreated. Conditions known to develop over time include:
Infection of the eye socket (orbital cellulitis), leading to vision loss
Infection of the brain linings (meningitis), which can cause brain damage
Infection of the bones of the face (osteomyelitis)
Chronic facial pain
Loss of sense of smell or taste
Chronic headaches
Chronic nasal and sinus congestion
Chronic bad breath
Blood vessel complications that can cause aneurysms and blood clots
Chronic rhinosinusitis also increases the risk for asthma attacks in people with asthma.
Types and differences of rhinosinusitis
Every bout of rhinosinusitis can be classified according to the duration of the inflammation and whether or not it is caused by an infection. The length of inflammation is divided into two categories:
Acute rhinosinusitis. Involves fewer than three or four weeks of symptoms. A viral infection usually causes acute rhinosinusitis, which often begins suddenly after a bout with a common cold. However, allergies can also be the source of acute rhinosinusitis. Several episodes of acute rhinosinusitis in the span of a year are referred to as recurrent rhinosinusitis.
Acute rhinosinusitis involves post-nasal drainage and discomfort in the cheeks, forehead and eyes. Nasal congestion, cough, headache, toothache and fever are also typical symptoms. Many cases disappear by themselves, but those involving bacterial infection must be treated with antibiotics.
Chronic rhinosinusitis. Defined as two or more episodes per year of rhinosinusitis that requires antibiotic treatment for at least two years. Bouts of chronic rhinosinusitis typically last longer than three months and can be caused by bacterial infections (treated with antibiotics) or a chronic inflammatory disorder similar to bronchial asthma (treated with corticosteroids). This is the most common form of rhinosinusitis.
Chronic rhinosinusitis is often the result of untreated acute rhinosinusitis. Symptoms are similar to those of acute rhinosinusitis, except fever usually is not present. Nasal polyps (sinus tissue growths) also occur in a minority of cases and cause additional cavity blockage. Allergies – particularly allergic rhinitis or mold allergies – often play a major role in chronic rhinosinusitis by keeping the sinus membranes inflamed for extended periods of time.
Sometimes, structural problems in the nose are the root cause of chronic rhinosinusitis. Surgery may be needed to correct the problem in such situations.
Rhinosinusitis can result from anything that prevents air from getting into the sinuses and mucus from getting out. Classes of rhinosinusitis include:
Infectious rhinosinusitis usually stems from a viral infection. Less frequently, it is the result of bacterial growth. Types of infectious rhinosinusitis include:
Viral rhinosinusitis. Usually occurs with an upper respiratory tract infection. Viruses attack the lining of the sinuses, which causes swelling of the nasal tissues.
Bacterial rhinosinusitis. Follows a viral infection when bacteria grow outside the sinuses. Swelling or narrowing of the eustachian tube due to inflammation prevents drainage from the middle ear, which also causes bacterial rhinosinusitis.
Fungal rhinosinusitis. Usually occurs in people with repressed immune systems, allergies to environmental fungi or those who have suffered injuries to the sinuses.
Noninfectious rhinosinusitis is usually the result of allergies or another nonviral irritant. Types of noninfectious rhinosinusitis include:
Allergic rhinosinusitis. Pollens, animal dander or other allergens trigger an allergic reaction, causing the lining of the nose and sinuses to become inflamed.
Aspirin sensitivity rhinosinusitis. Occurs in some individuals who have severe asthmatic responses to aspirin and aspirin-like medicines, such as ibuprofen.
Cold air rhinosinusitis. Produces symptoms when an individual is exposed to cold air
Potential causes of rhinosinusitis
There are many causes of rhinosinusitis. Anything that interferes with airflow into the sinuses and mucus drainage out of the sinuses can cause the inflammation associated with rhinosinusitis. Some of the disorders that can cause rhinosinusitis include:
Allergies.
Aspirin sensitivity.
Colds, viruses and other respiratory infections.
Tumors or growths in the sinuses, such as nasal polyps (small, round growths).
Overuse of decongestant nasal sprays, which can lead to “rebound congestion” that inflames the sinuses.
Structural abnormalities. These can be natural, such as a crookedness in the wall dividing the nostrils (deviated septum), or caused by trauma. An example of the latter would be an injury, such as a fractured facial bone, that can obstruct one or more sinus cavities, leading to rhinosinusitis.
Dental infections that spread to the sinuses.
Use of illegal drugs that are snorted, such as cocaine.
Other medical conditions, including:
Asthma. Those with asthma may have hyperactive nasal airways, which can lead to rhinosinusitis. Also, pus inside an infected nasal cavity that manages to drain into the throat can sometimes trigger an asthma attack.
Failure of the cilia to move mucus. The cilia are tiny hairs of mucus-producing cells that move mucus out of the sinuses and into the nose and throat. Tobacco smoke is known to damage the cilia. Several health disorders also can complicate this process, including:
Cystic fibrosis (a hereditary disorder affecting the lungs and digestive tract). This condition causes mucus to thicken, which prevents cilia from moving the mucus out of the nose. As the mucus builds, infections become more likely.
Kartagener’s syndrome (a congenital disorder that consists of three sinus afflictions):
Situs inversus
Chronic sinusitis
Bronchiectasis
Immotile cilia syndrome (a disorder that causes failure of the cilia to clear mucus).
Immune deficiency diseases such as AIDS and hypogammaglobulinemia. Suppressed immune system response leads to an increased risk of chronic rhinosinusitis.
As the sinuses become blocked, mucus inside the sinus cavity cannot drain to the back of the throat. This provides a breeding ground for viruses and bacteria to grow, resulting in infection. Pus then starts to form, and has nowhere to drain, further exacerbating the situation.
Signs and symptoms of rhinosinusitis
Acute rhinosinusitis and chronic rhinosinusitis share many symptoms. The chief differences between the two are found in:
Length of time symptoms occur. Acute rhinosinusitis tends to unfold in a period of a month or less, while chronic rhinosinusitis can stretch on for months and tends to recur.
Severity of symptoms. Symptoms tend to be more pronounced in acute rhinosinusitis and more subtle in chronic rhinosinusitis.
Fever. Acute rhinosinusitis often is accompanied by low-grade fever, but this is rarely the case in chronic rhinosinusitis.
One typical symptom shared by both forms of rhinosinusitis is a sinus headache, a nonvascular headache caused by pressure changes in sinus cavities. Trapped air, pus and other secretions create pressure on the sinus wall. Pain, pressure or fullness usually is present in the cheeks, brow or forehead.
Certain symptoms may indicate which of the sinuses are affected. These include:
Facial pain. Pain when the forehead is touched indicates inflammation of the frontal sinuses.
Achiness of the upper jaw and teeth, and tenderness in the cheeks when touched. This indicates infection in the maxillary sinuses.
Pain between the eyes, swelling of the eyelids and tissues around the eyes. This indicates inflammation of the ethmoid sinuses, which may also cause tenderness when the nose is touched and loss of smell.
Earaches, neck pain and a deep ache at the top of the head indicate infection of the sphenoid sinuses.
Patients should seek prompt medical attention if they suffer from any of the following symptoms:
Fever greater than 100.5 degrees Fahrenheit (38 degrees Celsius)
Pain, swelling or redness on the face or around the eyes
Severe headache
Confusion
Stiff neck
Diagnosis methods for rhinosinusitis
A physician can accurately diagnose whether a patient has rhinosinusitis and determine what is causing the inflammation. An accurate diagnosis is crucial, because the different types of rhinosinusitis require different treatment methods.
A physical examination, patient medical history and list of symptoms are important parts of this diagnosis. The physician will look for tenderness over the sinus cavities, swelling of the mucous glands, nasal secretions, postnasal drip and swelling around the eyes. A sample of nasal discharge may be collected and tested for the presence of bacteria.
A sinus x-ray or computed axial tomography (CAT) scan may help better define the extent of rhinosinusitis in a patient and the degree of blockage present. A nasal endoscopy, or rhinoscopy, uses a camera and telescope to help the physician examine the area where the sinuses and middle ear drain into the nose.
If allergies are a suspected cause of rhinosinusitis, a number of tests may be used to identify the specific allergies triggering symptoms.
Treatment options for rhinosinusitis
Treatment of rhinosinusitis depends on whether the problem is acute or chronic.
Acute rhinosinusitis often resolves on its own without the need for treatment. However, antibiotics may be recommended for patients with moderate or severe symptoms. These drugs help shorten the duration of the condition and also reduce its severity. A course of antibiotics over 10 days to two weeks is usually successful in curing an infection caused by bacterial rhinosinusitis. Decongestants may be prescribed to open the sinuses and reduce the volume of mucus that is present. Hypertonic saline sinus washes are also very effective and commonly used.
Chronic rhinosinusitis can be more difficult to treat. Many medications may be necessary to successfully treat this condition. These medications may include antibiotics for three weeks or longer (when bacterial infection is involved), decongestants, mucus–thinning medications, and antihistamines or anti-inflammatory corticosteroid nasal sprays (both of which are used to reduce swelling and mucus production). For patients using nasal sprays, physicians may recommend a saltwater or saline wash be used before the spray to help remove mucus and bacteria from the nose and sinuses. Normal saline is the most commonly used type of saline. However, hypertonic saline also serves as a good sinus wash.
In some cases, allergy shots (immunotherapy) may be helpful in reducing sensitivity to certain allergens for people with allergic rhinosinusitis.
For some patients, surgery may be necessary to treat chronic rhinosinusitis. This is more common in adults with a physical abnormality that is responsible for symptoms, such as nasal polyps (small, grape-like growths), crookedness in the wall dividing the nostrils (deviated septum) or another physical problem. It may also be used as a last resort when medications have failed. In functional endoscopic sinus surgery, the natural openings of the sinuses are enlarged to facilitate drainage. Serious complications are rare in this procedure.
In children, the removal of nose and throat lymphoid tissue known as the adenoids often eliminates the blockage causing problems.
Patients who suffer from some forms of fungal rhinosinusitis also require surgery to remove the fungus and prevent damage to the sinus, eyeball or brain.
Over-the-counter pain relievers may also be recommended. The drugs help relieve sinus headaches caused by either form of rhinosinusitis and lessen fever. Always consult with a physician before taking any medication.
Some physicians may recommend non-drug treatments to help soothe symptoms associated with chronic rhinosinusitis. These techniques, which keep nasal passages moist, include:
Inhaling hot, moist air – such as from steaming water in a bowl – for 10 minutes two to four times a day. Patients should wear a towel over their heads to prevent steam from escaping.
Applying hot packs to the face. This helps ease facial pain.
Rinsing nasal cavities with buffered salt water. This can help remove mucus and bacteria from the nose and sinuses.
Prevention methods for rhinosinusitis
Patients should take necessary precautions to reduce the symptoms of allergies and colds that increase the risk for rhinosinusitis.
During flu and cold season, several precautions can be taken to lessen the likelihood of contracting upper respiratory infections such as colds. Those with seasonal allergies should also take steps to treat or prevent their symptoms. The fewer cold and allergy symptoms that manifest, the less likely it is that congestion will develop and lead to acute allergic rhinosinusitis.
To prevent colds and allergies:
Eat a nutritious diet, including plenty of fruits and vegetables. These are rich in antioxidants and other chemicals that can boost immune system function.
Exercise regularly. This keeps the body primed to fight infection and reduces stress, which can leave an individual more vulnerable to sickness.
Wash hands often, particularly after shaking hands with others.
Get a yearly flu shot.
Drink plenty of fluids. Eight glasses a day are recommended to keep the body hydrated, which promotes thick nasal secretions and increased drainage.
Avoid drinks with caffeine and alcohol. These dehydrate the body, which thickens nasal mucus and makes it less likely to drain. Mucus that fails to drain is a breeding ground for viruses and bacterial infections.
Avoid exposure to allergens both inside the home and outside. Patients should make their home environment as allergen-free as possible, and should avoid contact with outdoor allergens to the greatest extent possible.
Avoid tobacco smoke or polluted air. Both can trigger inflammation of the lining of the sinuses and nose.
Install a humidifier in the home, or at least the bedroom. This keeps the air of the home moist. However, if used, the humidifier must be frequently cleaned and its use may lead to an increase in dust mites.
Avoid blowing the nose with great force. This can push bacteria into the sinuses. Instead, patients should gently blow one nostril at a time, while blocking the other.
Patients should avoid air travel during periods when they have rhinosinusitis. If travel must be undertaken, decongestants can reduce the pressure inside the sinuses. Do not take any medication without first consulting a physician.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about rhinosinusitis:
Do my symptoms suggest that I have rhinosinusitis?
What type of rhinosinusitis do I have?
What may have caused me to develop this condition?
What treatments are available to me?
Will I require surgery?
When can I expect my symptoms to subside?
Am I at risk for developing rhinosinusitis-related complications?
Will rhinosinusitis have an effect on my sense of smell?
Should I expect to develop rhinosinusitis again in the future? If so, how often?
What steps can I take to prevent rhinosinusitis in the future?
