Have you experienced sinusitis or a sinus infection?
Imagine that feeling where your nose feels clogged and your face feels painful everywhere.
If it has been a recurrent problem for you, don’t fret!
Sinusitis is one of the most common problems that would usually lead to a visit to a doctor.
The Center for Disease Control (CDC) estimated that in 2018, the number of adults with chronic sinusitis is at 28.9 million and around 4.1 million physician visits per year are because of it! (1)
That’s a lot of people getting sinusitis in a year and it’s not only causing people money but also decreases productivity in people who work or children who are in school.
The newer term for sinusitis is rhinosinusitis because it was found out that sinus disease without rhinitis is rare and both usually occur together.
For this article, we’ll put it that sinusitis is the same as rhinosinusitis to avoid confusion.
Believe it or not, there are classifications of sinusitis, depending on how long it has occurred and how recurrent it can become.
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Classification of Sinusitis
There are four main classifications of sinusitis: (2)
- Acute rhinosinusitis- occurs suddenly in onset and usually lasts 4 weeks with complete improvement from symptoms
- Subacute rhinosinusitis- is typically the same as acute rhinosinusitis but occurs less than 12 weeks.
- Recurrent acute rhinosinusitis- is usually acute rhinosinusitis occurring for four or more episodes lasting about a week in one year.
- Chronic rhinosinusitis- has the same signs and symptoms but persists for more than 12 weeks or longer.
What are sinuses?
We know that we can get an infection in our sinus area but what are sinuses and what are their functions in our face?
Do we even need our sinuses?
The short answer is YES.
Our face actually has 5 pairs of sinuses, in our facial area, we have the following: the maxillary, frontal, anterior ethmoid, posterior ethmoid and the sphenoid sinus.
The maxillary sinuses are the biggest and are located on each side of the nose, near our cheekbones. They are shaped like a pyramid.
The frontal sinuses are on top of the eyes, near the forehead.
The anterior ethmoid and the posterior ethmoid sinuses are located in the spongy ethmoid bone, on the upper part of the nose, in between the eyes.
The sphenoid sinuses are in the bones behind your nose.
Adults have five pairs of developed sinus cavities while children only have the ethmoid and maxillary sinus present at birth. The frontal sinus appears from 5 to 6 years of age and develops up until puberty.
The sphenoid sinus starts to develop at 5 years of age and is fully developed at 20 or 30 years of age, which is pretty amazing when you think about it because we really don’t stop growing! Our body continues to form to make way for our needs.
As we grow, so does our bone and as it becomes heavier, our body needs to make ways to keep it lighter.
The sinuses are important parts of our body. They function to make mucus that helps filter out dust, bacteria, and pollutants when we inhale them. They drain in different areas that may cause congestion when infection arises.
Aside from filtering out dust, the sinuses lighten the skull and help improve our voice.
Sinusitis happens when the sinuses and the nasal passages have difficulty clearing out the antigens which eventually leads to inflammation or swelling.
This happens because of 3 main factors: obstruction in the sinus, a problem in the cilia (or small hairs on the lining of the nasal passages), and thickening of secretions in the sinuses.
The most common cause of obstruction is an upper respiratory tract infection (URTI) either from a bacterium or a virus or because of a nasal allergy from an environmental cause.
Everyone can get sinusitis no matter the age, but certain anatomical differences or risk factors may make you prone to getting sinusitis more often than other people.
What are these risk factors?
The risk factors of sinusitis can be any of the following:
- A defect in the anatomy of the nose (septal deviation), polyps, or trauma
- Cystic fibrosis or ciliary dyskinesia affects mucus transport in the nasal area.
- Immunodeficiency either from chemotherapy or HIV
- Patients with nasogastric or nasotracheal tubes
- Use of oxygen which dries the mucosal lining
Rhinosinusitis is usually caused by viruses or bacteria. The most common bacteria causing acute rhinosinusitis is Haemophilus influenza in 21% of the population while Staphylococcus aureus causes 20% of chronic rhinosinusitis.
Have you been suffering from sinusitis but unsure if you really have it?
Aside from the usual pain or runny nose, there are other symptoms associated with it that may be warning signs that you have sinusitis.
Here are 11 of the most common symptoms of sinusitis:
Purulent nasal drainage
Patients with sinusitis often complain of a nasal discharge that is purulent in nature. Sinusitis often comes with a nasal discharge that is colored green or yellow and thick in consistency. This is very typical of a sinus infection and it is different from the flu where the discharge is more watery and clear in color. The discharge from sinusitis may even be foul-smelling since it’s made up of bacterial debris and cells.
Facial pain or pressure
The inflammation or swelling around the sinus is what causes the facial pain or pressure that you may experience when you have sinusitis. It is often felt on the forehead (where the frontal sinus is located) or on the side of your nose (where the ethmoid and maxillary sinus is positioned) and may radiate on your jaw, between the eyes, and even on your teeth.
Taking an over-the-counter pain reliever like ibuprofen or acetaminophen may help relieve the pain. The pain may even be accompanied by redness on the area where there is an infection present and it may be warm to touch.
Nasal obstruction is common in sinusitis because of the blockage of the secretions, which causes limitation of air that flows on the nasal passages. (3) This causes discomfort and adds to the pressure which in turn causes headache or facial pain. Nasal obstruction may also cause a change in your voice which is only temporary.
A headache is one of the systemic symptoms that you may feel when you have sinusitis. The blockage on the nasal area and the pressure because of the swelling causes the headache and this may also be relieved by over-the-counter pain relievers.
A headache accompanied by a difficulty to ambulate, or problems in the sensorium warrant an emergency room visit since this may be a sign of a neurologic problem more serious than a sinus infection.
You won’t always get a fever when you have sinusitis but it may be a symptom that would indicate that you have a viral or bacterial infection. With the ongoing pandemic, aside from sinusitis, you must always make sure that you do not have Covid- 19 when you have fever plus any respiratory symptoms (runny nose, dry cough, sore throat, etc.)
Mucus and fluid that may back up the throat from sinusitis can cause itchiness and lead to either a dry or productive cough. The nose and the throat are interconnected and any discharge that may be up in your sinuses can drain in the throat area causing coughing and throat discomfort.
Hyposmia or anosmia
Hyposmia is the reduction in the ability to smell while anosmia is the inability to smell either temporarily or permanently. For patients with sinusitis, hyposmia, or anosmia is experienced because of the inflammation in the inner lining of the nose where the sensors for smell are located. Oftentimes, patients with sinusitis may experience a decrease or total inability to smell but temporarily. Once the inflammation is gone, the sense of smell goes back to normal.
Ear fullness or pressure
An important function of the sinuses is to decrease the pressure and weight of the face. Once the sinuses are filled with mucus, it can cause ear fullness. This is also temporary and swallowing, yawning, using nasal decongestants or sprays can help improve this symptom.
A sinus infection can also cause fluid to be trapped behind the eardrum. Because of this, bacteria or viruses can grow and cause an ear infection (otitis media). If this persists with your sinusitis, see your doctor immediately!
The presence of bacteria in the mucus secretion in the sinuses give out noxious odors that may cause halitosis or bad breath. Postnasal drip from sinusitis can travel to the throat (4) and cause bad breath. Aside from nasal decongestants and antihistamines, a saline nasal spray may also help with the secretions. A gargle with an antibacterial property may improve bad breath.
With the above symptoms that can happen when getting sinusitis plus an ongoing bacterial or viral infection, getting fatigued or feeling weak and tired is often experienced by patients suffering from sinusitis.
Sinusitis is often self-limiting and improves on its own but like any disease, complications can occur. 1 in every 1000 cases (5) may have complications such as preseptal cellulitis or periorbital cellulitis, which is an infection in the tissues around the eye.
Orbital cellulitis, orbital abscess or even intracranial complications like meningitis can occur from a severe sinus infection but is very rare.
Early identification of a sinus infection and giving the correct medication and management can avoid disastrous complications like the ones mentioned above.
How do we treat sinusitis?
Sinusitis may be bothersome but it can be easily relieved by taking ibuprofen, NSAIDs or acetaminophen, nasal corticosteroids spray, saline spray, and decongestants.
If your sinusitis is caused by a virus, it is usually self-limiting and will improve in a few days. If a bacteria causes your sinusitis, you may need oral antibiotics to speed up the healing process and to ensure that no complications will arise from it.
If you have recurrent sinusitis, one suspect is hay fever or an allergy to something in your environment. Getting an allergy skin test may help you look for the causes of your allergies so that you may avoid them. Molds, animal dander, and even bed bugs can cause allergic reactions that may further complicate into a sinus infection!
You don’t need to suffer because you have sinusitis, be it acute or chronic, you only need to get the correct diagnosis from your health care provider so that they can give you the correct treatment plan!
In these trying times, symptoms that involve the respiratory system (cough, runny nose, sore throat, fever, etc) should warrant further tests to rule out other infections especially Covid 19.
Let’s recap what we covered:
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It is important that you see your doctor when you have the signs and symptoms listed above!
Do you have sinusitis often? Has it significantly affected your daily activities? What do you do to help cope with the infection? We would love to hear from you in the comment section!
If you have any more questions, you can also message us or book a consultation with us here.
If you are interested in other topics like allergies or allergy immunotherapy, we have discussed it in detail on our website.
- FastStats – Sinus Conditions. (2020, February 21). Retrieved from https://www.cdc.gov/nchs/fastats/sinuses.htm
- Battisti AS, Modi P, Pangia J. Sinusitis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470383/
- Naclerio, R. M., Bachert, C., & Baraniuk, J. N. (2010). Pathophysiology of nasal congestion. International journal of general medicine, 3, 47–57. https://doi.org/10.2147/ijgm.s8088
- Gokdogan, O., Catli, T., & Ileri, F. (2015). Halitosis in otorhinolaryngology practice. Iranian journal of otorhinolaryngology, 27(79), 145–153.
- Aring, A. M., & Chan, M. M. (2016). Current Concepts in Adult Acute Rhinosinusitis. American family physician, 94(2), 97–105.