Sinus Infections
Sinus infections are quite common. They can vary in severity from being a nuisance on one end of the spectrum to severe and debilitating on the other end. The sinuses referred to in “sinus infections” are actually called “paranasal” sinuses because they are “near the nose.” Paranasal sinuses are cavities in the cranial and facial bones (i.e, skull) near the nose which help in filtering and moisturizing inhaled air that is inhaled through the nose. They also lighten the weight of the skull and are involved with voice resonance. There are 4 pairs of sinuses named for the corresponding bone that they are situated upon:
- Maxillary sinuses: Located on the cheekbones to the right and left of the nostrils.
- Frontal sinuses: Located above the eyes in the forehead region.
- Ethmoid sinuses: Located on each side of the upper nose between the eyes.
- Sphenoid sinuses: Located behind the eyes in the deeper recesses of the skull.
In the medical field, sinus infections are referred to as “sinusitis.” Technically, the word sinusitis means inflammation of the sinuses. Sinusitis can be classified into 4 main types: acute sinusitis, subacute sinusitis, chronic sinusitis, and recurrent sinusitis.
- Acute sinusitis: Lasts less than 4 weeks. Usually comes on suddenly. Most often caused by viruses such as the common cold, although bacteria and less often, fungi are responsible for this type of sinusitis. Allergic rhinitis (i.e., hay fever) is a risk factor.
- Subacute sinusitis: Lasts 4-12 weeks. Commonly occurs with bacterial infections or partially treated infections. Allergic rhinitis is a risk factor.
- Chronic sinusitis: Lasts greater than 12 weeks. Commonly occurs with bacterial or rarely fungal sinus infections. Partially treated acute or subacute sinus infections may fester into a chronic sinus infection. Allergic rhinitis is a risk factor.
- Recurrent sinusitis: Sinus infection occurs 4 or more times a year.
Sinus infections are usually caused by viruses; however, bacteria, fungi, and parasites can also infect the sinuses. It should be noted that bacterial sinus infections are much more common than fungal infections and parasitic infections of the sinuses are quite rare. Sinus infections occur when fluid builds up in the air-filled sinus cavities. In addition to the fluid buildup, the affected sinuses become inflamed. This inflammation causes an increase in the internal pressure of these sinuses. As a result, some common symptoms of a sinus infection may include the following:
Nasal congestion
- Post-nasal drip (i.e., mucus dripping down the back of the throat)
- Sore throat
- Cough
- Facial pain or pressure
- Headache
- Bad breath
- Exacerbation of asthma
Although anyone can come down with a sinus infection, there are a number of risk factors that facilitate one’s likelihood of developing a sinus infection. Some risk factors for sinus infections may include:
- Allergic rhinitis (i.e., hay fever)
- Previous “cold” or viral upper respiratory infection (URI)
- Structural abnormalities of the nose or sinuses
- Smoking and/or exposure to smoke
- Nasal polyps
- Immunodeficiency (i.e., weakened immune system)
Diagnosis:
The diagnosis of an acute or subacute sinus infection is often made by the history and physical examination alone. Rhinoscopy is sometimes utilized as a tool to visualize the nasal passages and sinuses in individuals with any type of sinus infection. During rhinoscopy, a thin flexible tube with a fiber-optic light at the end is inserted in the nose. In patients with either chronic or recurrent sinus infections, a CT scan of the sinuses may be needed in order to establish the diagnosis. Rarely, a culture from the sinus is taken in order to either diagnose fungal sinusitis or to determine which antibiotic is necessary to treat a recalcitrant bacterial sinus infection.
Treatment:
Most sinus infections resolve without any treatment. This may be because most sinus infections are viral in nature. Nasal corticosteroids are often prescribed to help treat the inflammation associated with sinus infections. Decongestants may also be recommended in certain people depending on their underlying medical history. Bacterial sinus infections are normally treated with oral antibiotics. Amoxicillin or Augmentin (i.e., amoxicillin + clavulanic acid) is the antibiotic of choice for most areas in the U.S. unless an individual is allergic to penicillin. Whereas antibiotics are typically prescribed for 10-14 days for an acute sinus infection, the course of an antibiotic for a chronic sinus infection is typically 3-4 weeks in duration. Rest and fluids are also generally recommended. Breathing in steam from a hot shower or bowl of hot water brings symptomatic relief in many sufferers. Using saline irrigation in the form of a nasal spray or a Neti pot is helpful in some people. Pain relievers may need to be taken for individuals who have accompanying fever, headache, and/or sinus pain.
It should be emphasized that allergies (i.e., allergic rhinitis) play an important role in the development of sinus infections in many individuals. It is thus important to see a board certified allergist if you or someone you know suffers from sinus infections, as an underlying allergy may make that individual more susceptible to getting sinus infections.
The board certified allergy specialist physicians at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating all types of sinus infections. We treat both pediatric and adult patients. Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with the utmost state-of-the-art allergy care in a friendly and pleasant environment.