Definition & Overview

Sinus problems refer to inflammation, swelling, and other symptoms that affect the sinuses. The sinuses are normally filled with air, but they are prone to becoming blocked by bacteria, viruses, fungi, or even fluid, which can lead to an infection. Problems with the sinuses have a wide range of possible causes, making them very difficult to accurately diagnose. However, there are now specific tests used to diagnose sinusitis, and treatment will depend heavily on the determined cause of the problem.

Cause of Condition

Sinus problems can be triggered by a long list of possible factors, but the most common are:

  • Common cold
  • Allergic rhinitis, or when the nose’s lining becomes swollen due to an allergic reaction
  • Nasal polyps, or small growths that form on the nasal lining
  • Deviated septum, or when there is a shift in the nasal cavity

Due to the wide variety of possible causes, sinus problems also come in different types, such as:

  • Chronic sinusitis – A long-term condition that causes an inflamed sinus and related symptoms lasting for longer than eight weeks

  • Recurrent sinusitis – Sinus problems that flare up several times in a year

  • Acute sinusitis – Sinus problems that occur suddenly, initially developing as cold-like symptoms; these are usually diagnosed as acute sinusitis when the symptoms have not disappeared after 14 days, but they are usually gone by the 4th week

  • Subacute sinusitis – If symptoms are not gone by the 4th week and extend until eight weeks, the condition is diagnosed as subacute sinusitis; by the 10th week, however, it will be considered as chronic sinusitis

Certain factors that affect a person’s risk of getting sinus problems include the following:

  • Common cold
  • Structural problems with the nose
  • Immune deficiencies that make a person more susceptible to infection
  • Taking medications that suppress the function of the immune system
  • Allergies
  • Environmental factors such as smoke exposure
  • Smoking

Key Symptoms

The primary symptoms of sinus problems include:

  • Facial pain
  • Facial pressure
  • Nasal stuffiness
  • Thick nasal discharge, green or yellow in color
  • Loss of smell
  • Congestion
  • Coughing
  • Fatigue
  • Dental/jaw pain

Those who have viral or bacterial infections may also have: * Fever * Bad breath

Chronic sinusitis may also have additional symptoms, such as pus in the nasal cavity, headaches, and discolored postnasal drainage.

Since some of these symptoms are similar to flu symptoms, not all patients seek treatment for sinus problems. In fact, many patients fail to get relief from their symptoms due to this. They only do so when the symptoms persist beyond the usual length of time the flu lasts. Sinusitis is diagnosed through a physical examination of the sinus region as the doctor checks for tenderness in the area. The teeth and mouth will also be examined for signs of an inflamed paranasal sinus.

If needed, doctors may prescribe special diagnostic tests such as a nasal endoscopy, allergy testing, some blood work, a mucus culture, X-rays, or a CT scan.

Who to See & Types of Treatments Available

Your family doctor or general physician is fully capable of treating sinus problems, but if the problem is chronic, recurrent, or causing severe symptoms that get in the way of your normal life, you may be referred an ENT or Ear Nose Throat specialist, also known as an otolaryngologist. These specialists are more capable of examining the nasal passages and the upper throat to get to the root cause of the sinus problems.

The goals of sinusitis treatment are to relieve symptoms and treat the underlying causes. Thus, there are many steps involved in the treatment process:

  • Addressing triggers or contributing factors, such as allergies to certain substances, environmental problems, or unhealthy lifestyle habits such as smoking
  • Relieving individual symptoms
  • Addressing the main cause, such as bacterial or viral infection

Congestion can be relieved with:

  • Decongestants
  • Nasal sprays
  • Nose drops
  • Steroid sprays

Inflammation can be reduced with oral steroids, while infections can be treated with antibiotics or antiviral medications. Fungal sinus infections, however, will require antifungal medication and will not respond to antibiotics.

If the condition is linked to allergies, antihistamines may be given. On the other hand, if immune deficiencies are detected, immunoglobin or antibodies may be used to treat them. Also, while battling with infection, it is best to increase fluid intake.

In some severe, but rare cases, sinus surgery may be necessary. This is only prescribed when the symptoms do not respond to conventional treatment options, when the swelling completely blocks mucus movement and no improvement is noted even with medications, or when structural problems are determined as the root cause. A surgery opens up the nasal passageway and the blocked sinuses to correct structural abnormalities such as deviated septum or to remove nasal polyps. The surgery is performed under local anaesthesia but may also be performed under general anaesthesia depending on circumstances or patient’s preference. However, since it is performed using an endoscope, patients can recover pretty quickly and can be back on their feet, doing normal activities within a week. Full recovery, however, usually takes around four to six weeks.

Aside from sinus surgery, other surgical options may also be considered. One of these is a turbinectomy, which works by shrinking the nose’s swollen tissues. This is a very quick procedure done at the doctor’s office; it usually takes just a few minutes and requires only local anaesthesia.

Another possible treatment is called balloon sinusplasty, another in-office procedure done under local anaesthesia. This treatment opens up inflamed sinuses using the same concept used by heart surgeons who open up blocked blood vessels through a balloon angioplasty.

Most surgeries for sinus problems are geared towards opening up the blocked sinuses or reducing inflammation. Once this is achieved, the mucus in the sinuses will flow more freely, thus bringing relief from symptoms.

Once sinus problems are diagnosed, it is best to get treatment as soon as possible. Otherwise, the patient will suffer from prolonged pain or discomfort. Also, if sinus problems are left untreated, there is a risk that the infection may lead to a more serious condition, such as meningitis, brain abscess, or bone infection.

References:

  • O'Handley, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 19.

  • Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for management of acute bacterial sinusitis in children 1 to 18 years of age. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006.

  • Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012; 54:e72-e112.

  • Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137:S1-S31.

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