What is Sinusitis?

Sinuses are hollow air filled cavities within the facial bones.  They are also called paranasal sinuses because they are located around the nose.  They are paired structures, one situated on each side of the nose. Maxillary sinuses are located inside the cheek bones.  Frontal sinuses are behind the forehead.  Ethmoid sinuses are between the eyes.  Sphenoid sinuses are behind the eyes.

The sinus cavities are lined inside by a thin membrane which secretes mucus.  This mucus drains into the nose through small openings called ostia.  The sinus cavities also contain thin hair-like cells called cilia. These cells move in a coordinated wave-like fashion, propelling the mucus into the nasal cavity.  The function of the mucus is to moisturize the inside of the nose and to form a layer which protects the nose from dust, microbes, and pollutants.  Apart from this, the other function of the paranasal sinuses is to give resonance to our voice.

“Sinusitis” denotes inflammation inside the sinus cavities.  Inflammation results in swelling and thickening of the mucus membranes inside the sinuses.  There is also excessive secretion of mucus, which can be sometimes thick and tenacious.  The swelling of the tissues around the ostia can close the openings into the nostrils, making the sinus a closed cavity.  This can result in the obstruction of mucus drainage, which is collected in large quantities inside the sinus, leading to a build-up of pressure.  It also predisposes the sinuses to excessive growth of micro-organisms which may lead to sinus infections.

Rhinitis, which is inflammation of the tissues inside the nose, is usually a forerunner of sinusitis and they often coexist in the form of rhinosinusitis. Chronic inflammation also plays a role in the causation of the formation of polyps inside the nose and sinuses.  Rhinitis may be allergic, non-allergic, or a combination of both.  As the swollen turbinates and thickened mucus membranes inside the nose impedes the free flow of mucus from the sinuses, individuals who have long-standing rhinitis may also suffer from more frequent sinus infections.

Sinusitis can be acute, lasting 2 to 3 months, or chronic, lasting 3 months or longer.  Recurrent sinusitis is defined as more than three acute episodes in a year.  Most cases of acute sinusitis follow upper respiratory infections (e.g., common cold, flu) which are most commonly caused by viruses. Frequently, the sinuses can become secondarily infected with bacteria and antibiotics may then be necessary.  Although many cases of chronic sinusitis are caused by viruses, other microbes (e.g., bacteria, fungi) are a much more common cause of chronic sinusitis than in acute cases.

Allergic fungal sinusitis is a condition caused by an immunologic reaction to a fungus.  Certain chronic inflammatory disorders, immunodeficiencies, and hormonal imbalances predispose an individual to chronic sinusitis.  Some structural abnormalities such as narrow passages and deviated nasal septums (i.e., the wall between the nostrils is crooked) can also contribute to the repeated sinus infections.  Aspirin and other medication sensitivities play a role in the causation of chronic sinusitis in some individuals.

Symptoms of sinusitis may include nasal congestion, thick nasal secretions, discolored nasal discharge, postnasal drip, cough, facial pressure/pain/headache, and a decreased sense of taste and/or smell.  Patients also may complain of fatigue, achiness, and difficulty in concentration.  In some instances, this condition can linger causing an individual to feel ill for many years.

The diagnosis is established by a comprehensive history of the onset and progress of the symptoms, physical examination of the nasal cavity, and imaging studies (e.g., CT scan of the paranasal sinuses, X-rays).

The management of this condition includes aggressive treatment of the causative factors such as aeroallergen sensitivity.  Medications (e.g., decongestants, mucus thinners, antihistamines, corticosteroid nasal sprays) may provide relief from the symptoms.  Irrigation of the nasal cavity with isotonic normal saline using distilled water can sometimes help clear the nasal passages of irritants and promote drainage of the mucus.

Though decongestant nasal sprays (e.g., Afrin, Neosynephrine) provide quick relief from nasal obstruction, they cause rebound congestion if used continually for more than 3 days.  Use of these topical nasal decongestant sprays can lead to overuse and habituation.

Antibiotics are usually not needed in most cases of acute sinusitis as virus infections are responsible for the vast majority of these cases.  However, antibiotics are sometimes helpful especially if the sinusitis is associated with a fever of more than 101.5 °F and/or if the illness lasts longer than 7 to 10 days.  In chronic sinusitis, antibiotics are often used for up to 4 weeks to control bacterial infections.

In more severe cases unresponsive to medications and conservative measures, surgical procedures to open the clogged drainage pathways and removing excessive infected mucus from the sinus cavities can offer long-term benefit.  Surgery is usually not necessary but may be necessary for recalcitrant cases.

The board certified allergists at Black & Kletz Allergy have been treating sinus-related conditions in their adult and pediatric patients for more than 5 decades.   With convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, we are Metro accessible at our Washington, DC and McLean, VA offices.  Please call us to make an appointment if you suffer from sinus problems or allergies so that we can help alleviate your unpleasant symptoms.