Sinusitis (sinus infection) 101: Symptoms, causes, types, treatment & tips

Everyone’s heard it at least once — someone sniffles before apologetically declaring, excuse my sinuses, often with a weak smile asking for understanding. In fact, plenty of us have probably said the same words ourselves. Sinus infections may be one of the most annoyingly persistent things to experience in life.

What is sinusitis?

Sinuses have a variety of medical definitions that include cavities or hollow spaces in bone or tissue, dilation or widening in blood vessels, or a fistula or tract that turns into a cavity.

Out of the many types of sinuses, what’s commonly recognised and understood by the word sinuses , are actually the paranasal sinuses. These are air-filled pockets or hollow spaces in your face that are found near your nose and connect to your nasal cavity.

As its name suggests, sinusitis, or sinus infection happens when your sinuses are inflamed, often due to an infection, explaining its synonymous association with sinus infection.

Sinusitis symptoms

Most of us would be familiar with the common classic symptoms of sinus infection. Here are some of the major and minor symptoms of sinus infections.

Major symptoms

• Facial pain, or pressure
• Facial congestion, or fullness
• Blocked nose
• Runny nose
• Hyposmia, or decreased sense of smell

Minor symptoms

• Headache
• Halitosis, or bad breath
• Fatigue
• Malaise, or general discomfort, unease, or pain
• Dental pain
• Cough
• Otalgia, or ear pain

Minor symptoms are diagnostically significant only if you have one or more major symptoms. In other words, major symptoms are more indicative of a sinus infection, and minor symptoms help to further confirm the diagnosis, or narrow down the cause of your sinus infection.

ALSO READ: How to get rid of sinus problems

Types of sinusitis

Generally, sinus infections can be  categorised by frequency and duration, or how often and for how long you experience them.

The four types of sinus infections are:

1. Acute sinusitis

Acute sinusitis  refers to when your sinus infection is characterised by a sudden onset, a duration of less than four weeks and with complete resolution.

2. Subacute sinusitis

Subacute sinusitis is a continuum of acute sinusitis and refers to when your sinus infection is characterised by  a sudden onset, a duration of less than 12 weeks and with complete resolution.

3. Recurrent acute sinusitis

Recurrent acute sinusitis refers to when you experience four or more episodes of acute sinusitis, each lasting for at least seven days, which all occur within a one-year period.

4. Chronic sinusitis

Chronic sinusitis refers to when your sinus infection symptoms persist for 12 weeks or even longer.

Sinus infections can also be further categorised according to which exact paranasal sinus has been infected.  There are 4 pairs of paranasal sinuses located in your face, of which any of them could be infected.

The following sinus infections are thus possible:

Ethmoid sinusitis

Ethmoid sinusitis refers to when your ethmoid sinuses, located on either side of your nose bridge immediately adjacent to your eyes, are inflammed.

Maxillary sinusitis

Maxillary sinusitis refers to when your maxillary sinuses, located on either side of your nose, below your eyes, are inflamed.

Frontal sinusitis

Frontal sinusitis refers to when your frontal sinuses, located immediately above your nose and eyebrows, are inflamed.

Sphenoidal sinusitis

Sphenoidal sinusitis refers to when your sphenoidal sinuses, located on the front of your nose bridge, next to the ethmoid sinuses, are inflamed.

All four kinds of sinusitis share symptoms in common. A doctor will best be able to diagnose and differentiate what exact type and kind of sinusitis you may have.

Sinusitis causes

There are a variety of causes for sinusitis

Common causes include:

• Infection — viral, bacterial or fungal
• Allergic and non-allergic rhinitis
• Anatomical variations such as: abnormality of the osteomeatal complex, or channel that connects your frontal, ethmoid, and maxillary sinuses; s eptal deviation, or displacement of your septum to one side; c oncha bullosa, or an air pocket within your nasal bones; and, h ypertrophic middle turbinates, or excessive growth or enlargement of bony structures inside your nose
• Cigarette smoking
• Diabetes mellitus
• Swimming, diving, high altitude climbing
• Dental infections and procedures

Rhinitis vs sinusitis

Rhinitis is a medical condition commonly mistaken with sinusitis. While they are both associated with inflammation and discomfort in the nasal passages, there are distinct differences.

In contrast with sinusitis, rhinitis is strictly defined as the inflammation of the mucous membrane lining in your nasal passages. It is usually the result of an upper respiratory tract infection.

Common symptoms include nasal congestion, sneezing, runny nose, or post nasal drip, some of which overlap with sinusitis, causing confusion. It is important to differentiate between  rhinitis and sinusitis so that the appropriate treatment is used.

Is sinusitis contagious?

If your sinusitis is caused by environmental factors or non-infectious agents or conditions, it is not contagious. If your sinusitis is caused by a viral, bacterial, or fungal infection, it is definitely contagious, no matter how small the risk.

Since most cases of sinusitis are caused by viral upper respiratory tract infections, it is likely to be contagious. If you have been experiencing any symptoms of sinusitis, it is best to be safe than sorry and observe good hygiene to avoid spreading any potential microbes that might be causing your sinusitis to others around you.

Sinusitis risk factors

There are also certain risk factors for sinusitis that we may wish to look out for.

Here are some of them:

• Septal deviations
• Nasal polyps
• Conchae bullosa
• Sinus, or facial trauma or fractures
• Immune system disorders such as cystic fibrosis or HIV that inhibit the body’s ability to transport mucus in the respiratory tract.
• Immunodeficiency, or weakened immune system from chemotherapy, HIV, diabetes mellitus, etc.
• Body positioning that inhibits your body’s ability to clear substances from the mucus in your respiratory tract
• Prolonged oxygen use due to drying of mucosal lining
• Usage of nasogastric or nasotracheal tubes
• Existing allergies

Some of these risk factors may be less obvious than others. Consult a doctor to properly evaluate your risk of sinusitis if you are concerned.

Sinusitis in children

Pediatric sinusitis, or sinusitis in children can look different from sinusitis in children.

Your child might have sinusitis if they experience:

• A cold lasting more than 10 to 14 days
• Low- or even high-grade fever
• Thick yellow-green nasal mucus for at least three days in a row
• Post-nasal drip
• Sore throat
• Cough
• Halitosis, or bad breath
• Nausea and/or vomiting
• Headache—usually in children age 6 or older
• Irritability or fatigue
• Swelling around the eyes

You should bring your child to seek treatment for relief as soon as possible if they continue to experience these symptoms.

Diagnosing sinusitis

During your doctor’s consultation, your doctor will usually make a diagnosis based on a physical exam.

Although not typically needed, they may further recommend some diagnostic tests in some cases to find out the exact cause of your sinusitis.

These include:

Nasal endoscopy

An endoscope, or  thin, flexible tube is inserted through your nose  to allow your doctor to visually inspect the inside of your sinuses.

CT scan

A CT scan shows details of your sinuses and nasal area. It is not typically recommended for the average case of sinusitis, but it helps to identify abnormalities around the nasal cavity and other suspected complications.

Nasal and sinus culture

Generally, diagnosing sinusitis doesn’t really require laboratory tests. When treatment fails, or your condition worsens, however, your doctor might recommend taking tissue samples from your nasal passage and sinuses to help pinpoint the exact cause, which could be a viral or bacterial infection.

Allergy testing

If your sinusitis is suspected to have been triggered by an allergy, your doctor will recommend an allergy skin test. It’s safe, quick and effective for picking up which allergen is causing your sinusitis.

Sinus infection complications

Most sinus infection complications are a result of how close our sinuses are to other structures and tissues in our head.

Some of these complications can include:

• Orbital cellulitis, or infection of the soft tissue around the eye socket
• Orbital abscesses, or collection of pus around your eye
• Potential blindness from compression of the optic nerve
• Pott’s puffy tumour, or infection of the frontal bone
• Meningitis
• Intracranial abscess, or pus collecting in your skull
• Cavernous Sinus Thrombosis, or the formation of a blood clot that obstructs a vein underneath your brain and behind your eye sockets

These complications can be life-threatening and if you suspect any of them, you should immediately seek medical attention.

Sinusitis treatment

While most sinus infections are able to resolve on their own, there are several treatments your doctor may recommend to treat your sinus infection or to provide relief.

They include:

Antibiotics

Antibiotics are recommended for bacterial sinus infections which are relatively rare. As your sinuses are located deep within bone, a longer course of antibiotics may be prescribed for those of us with chronic or severe cases of sinus infection.

Ask your doctor for further clarity if you’re unsure about what kind of sinus infection you have. You should also note that antibiotics help to kill the bacteria causing your sinus infection, but they do not help relieve your symptoms until that happens. You may want to consider using other over-the-counter medication for symptom relief in the interim.

Nasal decongestant sprays

Topical nasal decongestants shrink swollen nasal passages, allowing your nose to be cleared more easily, providing relief for your sinusitis symptoms. Be careful of overusing them to avoid dependency.

Antihistamines

Antihistamines prevent and reduce inflammation caused by an allergic reaction so they can help to relieve symptoms of sinusitis if its caused by an allergy.

Topical nasal corticosteroids

These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, helping to provide immediate symptom-relief.

Topical nasal corticosteroid sprays are also used to shrink and prevent the return of nasal polyps. At the right dosage, they can be used over a long period of time without risk of developing over dependency.

Nasal saline washes

Rinsing your nasal passages can help clear thickened mucus and help provide symptom relief.

As always, before starting on any medication, you should always consult a doctor or medical professional first if possible.

Sinusitis surgery

In cases where your condition does not improve even after drug treatment or when complications are suspected, your doctor may recommend Functional Endoscopic Sinus Surgery (FESS).

FESS is intended to restore ventilation in your sinuses by removing any soft tissues obstructing your sinuses. It could also be used to drain any pus or decompress the affected sinus.

Surgery is typically not needed at all for most cases of sinusitis and you should heed your doctor’s advice in figuring out if surgery is required for your specific condition.

Remedies

Given how sinusitis is usually nothing to worry about, here are some home remedies that you can try out for symptom relief:

• Get plenty of rest
• Stay hydrated
• Take painkillers like ibuprofen or paracetamol
• Avoid allergic triggers
• Stop smoking
• Clean your nose with a salt water solution

This article was first published in Homage.