Acute Sinusitis Update

Acute sinusitis is another way of saying an acute sinus infection. Acute, in this context, refers to a sinus infection that is less than 4 weeks old. Chronic, on the other hand, refers to a sinus infection that has persisted for more than 12 weeks. There is also a category called subacute. Subacute refers to the vast majority of sinus infections are acute in nature. Most are viral in origin and thus do not need to be treated with antibiotics. The severity of a sinus infection may vary from mild to severe. Often an individual may experience mild cold-like symptoms. In some individuals however, severe symptoms may occur which may cause that person to feel very ill, prompting them to go to an urgent care center or an emergency room for treatment.

There are 4 types of sinuses located in one’s facial bones (i.e., skull). These sinuses serve to lighten the weight of one’s skull, help with voice resonance, and to filter and moisten inhaled air when breathing through one’s nose. The names of the sinuses are as follows:

  1. Frontal sinuses: These sinuses are located in the center of the forehead region.
  2. Ethmoid sinuses: These sinuses are located just above the upper nose between the eyes. They are actually comprised of between 6-12 small air cells as opposed to large sacs like the other sinuses.
  3. Sphenoid sinuses: These sinuses are located behind the eyes but in the deeper recesses of the skull.
  4. Maxillary sinus: These sinuses are located behind the cheekbones. They are the largest sinuses.

The sinuses are vulnerable to becoming infected due to their physical nature, particularly the maxillary sinuses. When someone develops a “cold” or has nasal congestion for other reasons such as allergies (i.e., hay fever or allergic rhinitis), the small holes that drain the sinuses become clogged and/or narrowed. This obstruction of the draining system may cause a “backup” in the draining process. As a result, the fluid that has built up in the sinuses stays in the sinus since it is unable to drain properly. The fluid in the sinuses is more likely to get infected given the stagnant nature of the fluid. Fluid that just “sits” in the sinuses is very susceptible a secondary infection, particularly with a bacteria.

The pathogenesis of an acute sinus infection is more understandable if one compares the sinuses to a pond and river. We all know that algae grow in ponds because the water is stagnant. We also know that algae do not usually grow in a river due to the constant motion of a river. Regarding sinus infections, this analogy can be evident as follows: When there is no obstruction to the drainage of a sinus, the sinus acts like a river which makes it is less likely for bacteria to grow. On the other hand, when there is an obstruction to the drainage of a sinus (i.e., nasal congestion, tumors, nasal polyps), the sinus acts like a pond which makes it more likely for bacteria to grow and thus cause a sinus infection.

The symptoms one may experience when having an acute sinus infection may include any one or more of the following: The symptoms of acute sinusitis typically involve one or more of the following: nasal congestion, post-nasal drip, sinus pressure, sinus headaches, discolored nasal discharge, sore throat, clogged ears (i.e., Eustachian dysfunction), fatigue, bad breath, pain in the teeth and/or ears, cough, fever.

The diagnosis of acute sinusitis usually is made by taking a comprehensive history with an additional physical examination. Most of the time other diagnostic tests are not needed, however other methods are occasionally used in order to diagnose acute sinus infections. Such approaches may include X-rays (i.e., CT scan, MRI), direct visualization (i.e., rhinolaryngoscopy), bacterial and fungal cultures, and allergy testing.

The management of acute sinus infections ironically usually requires no treatment at all because most acute sinus infections are viral in nature. Most of the time these viral sinus infections resolve on their own. Hydration by drinking plenty of water is usually recommended. Antibiotics however may be necessary in some individuals who have a bacterial infection whether primary or secondary. Saline irrigation, decongestants, nasal corticosteroids (e.g., Flonase, Nasacort AQ, Rhinocort Aqua), and/or over-the-counter analgesics (e.g., Tylenol, Advil, Aleve) are often also used in order to help alleviate the symptoms of an acute sinus infection. In addition to treating acute sinus infections, it is also important to try to prevent them. Individuals with allergic rhinitis (i.e., hay fever) are generally more prone to sinus infections since they often have nasal congestion, which predisposes them to sinus infections. It is prudent to evaluate someone for allergies if they are prone to sinus infections. Allergy skin testing can be done either by skin testing or blood testing. There are many types of allergy medications (i.e., antihistamines, decongestants, leukotrienes, nasal medications, eye drops) that are utilized in both the prevention and treatment of acute sinusitis. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) may also be recommended in selected individuals as they are very effective in reducing or preventing allergy symptoms (i.e., nasal congestion, sinus congestion) in 80-85% of individuals on allergy shots.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating acute, subacute and chronic sinusitis as well as other allergic and immunological conditions. Our allergy specialists treat both adult and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office directly or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer any sinus-related symptoms, we are here to help alleviate or hopefully end these undesirable symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a welcoming and professional setting.