According to the Centers for Disease Control and Prevention (CDC), the National Health Interview Survey for 2017, revealed that 30.8 million adults in the United States are diagnosed with sinusitis every year. This accounts for 18-22 million physician visits in the United States each year and a direct treatment cost of $3.4-5 billion annually. Moreover, the direct cost of managing acute and chronic sinusitis exceeds $11 billion per year with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life. Consequently, more than 1 in 5 antibiotics prescribed for adults is for sinusitis, making it the fifth most diagnosis responsible for antibiotic therapy.
Sinusitis, also known as a sinus infection or rhinosinusitis, is an inflammation of the mucosa-lined, air-filled spaces in your skull that connect to the nose and throat. When the sinuses become inflamed, blocked or swollen, normal mucus drainage may not occur trapping air and other fluids, creating vacuums and/or pressure. This pressure can cause pain, which can sometimes be intense. Clogged sinuses may also lead to infections.
The sinuses are air-filled structures within the facial skeleton, adjacent to the nasal cavity around the eyes and nose, which have a mucous-secreting lining. There are four paired sinuses, eight in total: frontal (above the eyes), ethmoid (between the eyes), maxillary (below the eyes), and sphenoid (all the way in the back). The bony cavities surrounding them are lined with soft tissue called mucosa.
The sinuses produce a large amount of mucus daily, and this mucus drains through small openings (ostia) into the nasal cavity where it is swept back into the nasopharynx and down into the throat (esophagus) where it is swallowed. Mucus is a fluid that cleans bacteria and other particles out of the air you breathe. Tiny hair cells (called cilia) remove mucus from your sinuses so it can drain out through your nose.
The sinuses connect to the nose through small, narrow channels, and as long as these channels are open, the sinuses stay healthy allowing air from the nose to enter the sinuses and mucus made in the sinuses to drain into the nose.
Each of the sinuses has a unique drainage pattern, but the frontal, maxillary and part of the ethmoid (anterior ethmoids) sinuses all drain into a central region known as the middle meatus. Blockage or obstruction of this middle meatus area can lead to backup in these three sinuses and result in inflammation (sinusitis).
Sinusitis occurs when viruses or bacteria infect the sinuses and begin to multiply. According to the CDC, 9 out of 10 cases in adults and 5-7 out of 10 cases in children are due to viruses. Comparatively, 1 out of 10 cases in adults and 3-5 out of 10 cases in children are due to bacteria. Infections cause the sinus lining to swell, blocking the channels that drain the sinuses, causing mucus and pus to fill up in the nose and sinus cavities. When fluid is trapped or blocked in the sinuses, this buildup allows germs to grow.
Allergies, nasal blockages (from growths such as polyps), nasal conditions (such as a deviated septum), changes in temperature or air pressure, and certain diseases can also cause acute and chronic sinusitis.
There are several types of sinusitis, including:
Acute Sinusitis or Acute Rhino-Sinusitis (ARS) often starts as a cold, which then turns into a bacterial infection. Symptoms usually include discolored nasal drainage along with nasal obstruction, nasal congestion, facial pain and pressure, and/or facial fullness for up to 4 weeks. Other symptoms may include a cough, fever, fatigue, a headache, post-nasal drip, a reduced sense of smell and taste, dental pain and ear fullness.
Symptoms for Chronic Sinusitis or Chronic Rhino-Sinusitis (CRS) often include nasal obstruction (e.g., polyps), nasal congestion, facial pressure and fullness, thick discharge or discolored mucus, swelling (edema), and a reduced sense of smell and taste for over 12 weeks.
The risk factors that increase your chances of getting sinusitis include having a cold, having allergies, overusing decongestant nasal sprays, smoking, swimming or diving.
During your consultation, your ENT (ear, nose, and throat) doctor will review your medical history with you, and discuss your sinus-related symptoms, including duration and any association with seasons or other environmental exposures such as allergies or smoking. Your doctor will also ask you if you have tried any treatments in the past, and if so for how long and if they were effective at all.
Your physical exam will focus on any anatomical issues that may be contributing to your symptoms, such as a deviated septum, a swollen or allergic appearing nose and sinus lining, enlarged adenoids or turbinates, masses or polyps. An in-office nasal endoscope will be used to examine your sinuses and your mucus.
After your exam, your doctor will develop a personalized treatment plan for you, recommending medication and/or further testing (e.g., CT Scan, Allergy Testing).
If you have a CT scan done, it would confirm whether you have an acute or chronic condition. A CT scan for patients with an ARS diagnosis will usually show bubbles indicating an acute infection, and a CT scan for patients with a CRS diagnosis will usually show generalized swelling along sinus walls.
For acute cases, your doctor may also take an endoscopically-guided culture to help direct the choice of antibiotic.
Treatment options for sinusitis focus on reducing nose and sinus inflammation and on keeping the drainage pathways open and functioning properly.
Medical management of sinusitis includes prescription medications as well as over-the-counter medications to relieve sinusitis symptoms. Medications commonly recommended include decongestant nasal sprays, decongestants, nasal antihistamines, nasal corticosteroids, nasal irrigation, oral antibiotics, and oral antihistamines.
In patients with severe allergies that are not responsive to treatment with medication, allergy testing may be performed. Allergy testing can help determine things that patients need to avoid. Also, in some patients allergy shots can successfully provide long term relief of allergies that may be contributing to sinusitis.
Whatever medications are actually prescribed will be based on the severity of your symptoms. Your doctor will devise a treatment plan accordingly and will want to follow up with you in a few weeks to see how the medications are working to alleviate your symptoms. Medical treatment is effective for most patients.
For a patient who doesn’t respond to medication, and who suffers from chronic or recurrent acute sinusitis, there are other treatment options available. Depending on the cause of your sinusitis, your doctor may recommend one of several procedures (e.g., balloon sinuplasty, septoplasty, turbinate reduction, or polyp removal) to help relieve your sinusitis symptoms and help you breathe better through your nose.