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Acute sinusitis

Overview

Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.

With acute sinusitis, it might be difficult to breathe through your nose. The area around your eyes and face might feel swollen, and you might have throbbing facial pain or a headache.

Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve within a week to 10 days.

In most cases, home remedies are all that's needed to treat acute sinusitis. However, persistent sinusitis can lead to serious infections and other complications. Sinusitis that lasts more than 12 weeks despite medical treatment is called chronic sinusitis.

Symptoms

Acute sinusitis symptoms often include:

  • Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat (postnasal drainage)
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead that worsens when bending over

Other signs and symptoms can include:

  • Ear pressure
  • Headache
  • Aching in your upper jaw and teeth
  • Reduced sense of smell and taste
  • Cough, which might be worse at night
  • Bad breath (halitosis)
  • Fatigue
  • Fever

When to see a doctor

Most people with acute sinusitis don't need to see a doctor.

Contact your doctor if you have any of the following:

  • Symptoms that either don't improve within a few days or worsen
  • A persistent fever
  • A history of recurrent or chronic sinusitis

See a doctor immediately if you have signs or symptoms that may indicate a serious infection:

  • Pain, swelling or redness around your eyes
  • Swollen forehead
  • Severe, unrelenting headache
  • High fever
  • Confusion
  • Double vision or other vision changes
  • Stiff neck

Causes

Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, a bacterial infection develops.

Acute sinusitis is most often caused by the common cold. Signs and symptoms may include nasal obstruction and congestion, which may block your sinuses and prevent drainage of mucus.

Risk factors

You may be at increased risk of getting sinusitis if you have:

  • Hay fever or another allergic condition that affects your sinuses
  • A nasal passage abnormality, such as a deviated nasal septum, nasal polyps or tumors
  • A medical condition such as cystic fibrosis or an immune system disorder such as HIV/AIDS

Complications

Acute sinusitis complications are uncommon. If they occur, they might include:

  • Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis lasts longer than 12 weeks.
  • Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
  • Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
  • Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
  • Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Diagnosis

Your doctor will feel for tenderness in your nose and face and look inside your nose.

Other methods that might be used to diagnose acute sinusitis and rule out other conditions include:

  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
  • Imaging studies. A CT scan or MRI can show details of your sinuses and nasal area. While not recommended for uncomplicated acute sinusitis, imaging studies might help identify abnormalities or suspected complications.
  • Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing acute sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as a bacterial infection.
  • Allergy testing. If your doctor suspects that allergies have triggered your acute sinusitis, he or she will recommend an allergy skin test. A skin test is safe and quick, and can help pinpoint the allergen that's responsible for your nasal flare-ups.

Treatment

Most cases of acute sinusitis, those caused by a viral infection, resolve on their own. Self-care techniques are usually all you need to ease symptoms.

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms, including:

  • Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).
  • Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Use nasal decongestants for only a few days. Otherwise they may cause the return of more severe congestion (rebound congestion).
  • OTC pain relievers, such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

    Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

  • Antibiotics

    Antibiotics usually aren't needed to treat acute sinusitis. Even if your acute sinusitis is bacterial, it may clear up without treatment.

    Your doctor might wait and watch to see if your bacterial acute sinusitis worsens. However, severe, progressive or persistent symptoms might require antibiotics. If your doctor prescribes an antibiotic, be sure to take the whole course, even after your symptoms get better. If you stop taking them early, your symptoms may recur.

    Immunotherapy

    If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms.

    Alternative medicine

    No alternative therapies have been proved to ease the symptoms of acute sinusitis, but products containing certain combinations of herbs may help. These combination therapies, sold under brand names such as Sinupret and SinuGuard, contain cowslip, gentian root, elderflower, verbena and sorrel.

    Possible side effects include stomach upset, diarrhea and allergic skin reactions.

    Preparing for an appointment

    When you see your doctor, expect a thorough examination of your sinuses. Here's information to help you get ready for your appointment.

    What you can do

    Make a list of:

    • Your symptoms, including any that seem unrelated to the reason for your appointment
    • Key personal information, including whether you have allergies or asthma and family medical history
    • All medications, vitamins or other supplements you take, including the doses
    • Questions to ask your doctor

    Take a family member or friend along, if possible, to help you remember the information you're given.

    For acute sinusitis, questions to ask your doctor include:

    • What's likely causing my symptoms?
    • What are other possible causes for my symptoms?
    • What tests do I need?
    • Is my condition likely temporary or chronic?
    • What's the best course of action?
    • What are the alternatives to the primary approach you're suggesting?
    • I have these other health conditions. How can I best manage them together?
    • Are there restrictions I need to follow?
    • Should I see a specialist?
    • Are there brochures or other printed material I can have? What websites do you recommend?

    Don't hesitate to ask other questions.

    What to expect from your doctor

    Your doctor is likely to ask you questions, such as:

    • When did your symptoms begin?
    • Have your symptoms been continuous or occasional?
    • How severe are your symptoms?
    • What, if anything, seems to improve your symptoms?
    • What, if anything, appears to worsen your symptoms?
    • Do you smoke or are you around smoke or other pollutants?

    Lifestyle and home remedies

    These self-help steps can help relieve sinusitis symptoms:

    • Rest. This will help your body fight infection and speed recovery.
    • Drink fluids, such as water or juice. This will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, as they can be dehydrating. Drinking alcohol can also worsen the swelling of the lining of the sinuses and nose.
    • Moisten your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
    • Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
    • Rinse your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses.

      If you make your own rinse, use water that's contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water and leave open to air-dry.

    • Sleep with your head elevated. This will help your sinuses drain, reducing congestion.
    Neti pot

    A neti pot is a container designed to rinse the nasal cavity.

    Prevention

    Take these steps to help reduce your risk of getting acute sinusitis:

    • Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals.
    • Manage your allergies. Work with your doctor to keep symptoms under control.
    • Avoid cigarette smoke and polluted air. Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.
    • Use a humidifier. If the air in your home is dry, such as it is if you have forced-air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

    Last updated: July 29th, 2017

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