Sinus Infection Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the sinuses?

The paranasal sinuses are mucosal lined and air-filled spaces in the bones around your nose. There are typically four pairs of sinuses. The frontal sinuses are located in the forehead region, the maxillary sinuses are located the cheek region, the ethmoid sinuses are located between your eyes along the roof of your nasal cavity, and the sphenoid sinuses are located behind your nasal cavity.

What are the functions of the sinuses?

Under normal conditions, air enters the sinuses and mucous are drained from the sinuses into the nasal cavity through small openings called ostium. The lining of the sinuses has microscopic cilia (hair-like structure) that move the mucous towards the ostium, called mucociliary clearance. In order for the sinuses to drain appropriately, the ostium of the paranasal sinuses must be open and the mucosa must have functional and healthy cilia.

The air-filled spaces in the facial bones have a theoretical benefit of decreasing the weight of the head. In addition, the sinuses may act as a crumble zone, protecting the eyes and brain in unfortunate cases of head and facial trauma. The sinuses also help humidifies the air and increase the resonance speech.

Natural sinus drainage pathway. Source: Ludman et. al. ABC of Ear, Nose & Throat & enttech.com.au

What is sinusitis (sinus infection)?

Rhinosinusitis, or commonly known as sinusitis, is inflammation and infection of the paranasal sinuses. This typically occurs when the channels (ostiums) of the sinuses are blocked and the sinuses and nasal cavities are filled with mucous and pus. The underlying cause may be anatomical abnormalities (deviated septum, enlarge turbinate, narrow ostium), nasal polyps, allergy, a viral infection (cold/flu), a bacterial infection, or a fungal infection. It affects 1 in 8 adults yearly and can cause significant quality of life impairment with loss of productivity in work and school.

What is sinusitis with nasal polyps?

Nasal polyposis is typically the end result of chronic sinus infections and can present in a small subset of patients with sinus infections. Nasal polyps develop from the lining (mucosa) of the nasal cavity and the sinuses. They are typically benign semi-transparent grape-like lesions that originate from the sinuses and the nose. The exact pathophysiology leading to the development of nasal polyposis is not well known. It is linked to chronic inflammation and genetic pre-disposition. Patients with underlying sinus infections, allergy, allergic fungal sinusitis, aspirin sensitivity, alcohol intolerance, non-allergic rhinitis, cystic fibrosis and autoimmune conditions are more likely to develop nasal polyps.

How does a sinus infection typically present?

The common signs and symptoms of a sinus infection may include nasal congestion, thick and discolored nasal discharge, a decreased sense of smell or taste, facial pressure or fullness and fatigue. Other less common features include headaches, bad breath, fever, upper dental pain, cough, sore throat, and ear pressure. In rare cases, sinusitis can spread to the eyes or the brain.

In patients with nasal polyps, the symptoms may present much more insidiously. Common initial symptoms may include nasal congestion, runny nose, loss of smell, and chronic cough. With flare-up of the disease, classic symptoms of sinus infections will develop.

There are many types of nasal and sinus conditions with overlapping signs and symptoms. As a result, the timing, specific combination of symptoms, and other tests such as laboratory culture, allergy testing, fiberoptic nasal endoscopy and radiographic imaging can often help to find the correct diagnosis for your problem.

How are sinus infections classified?

A sinus infection is considered acute if it lasts up to 4 weeks and considered chronic if it lasts more than 12 weeks. Acute sinusitis often reflects a viral or bacterial etiology whereas chronic sinusitis often reflects a prolonged inflammatory state. Chronic sinusitis may have periodic infectious flare-ups with worsening of sinus symptoms.

What are the different types of sinusitis?

1. Acute Viral Sinusitis

   • Symptoms typically presents during an upper respiratory infection such as the common cold and usually do not last more than 7-10 days.

2. Acute Bacterial Sinusitis

   • Symptoms usually do not improve within 10 days or the symptoms gets worse after a short period of improvement. The symptoms may last up to 4 weeks.

3. Chronic Sinusitis

   • May presents with or without nasal polyps. The symptoms last more than 12 weeks with possible intermittent flare-ups.

4. Allergic Fungal Sinusitis

   • Symptoms resemble chronic sinusitis and typically do not improve with antibiotics. It is characterized by non-invasive fungal element and secretion of allergic cells (eosinophils).

5. Invasive Fungal Sinusitis

   • Includes fungal ball, allergic fungal sinusitis, acute invasive fungal sinusitis, and chronic invasive fungal sinusitis.

What can you expect during your ENT doctor visit for a sinus infection?

There are multiple causes sinus infection and sinus symptoms. During your visit, your ENT doctor will perform a complete history and physical exam to determine the exact cause of your sinusitis. A procedure called a nasal endoscopy with a fiberoptic endoscope may be performed to further evaluate the nasal anatomy and sinus pathology deep inside your nose. Depending on your history and examination, your physician may refer you to obtain additional studies including blood testing, allergy testing, a sleep study, and radiographic exams.

How is a sinus infection treated?

The treatment for sinus infections depends on the underlying cause. In general watchful waiting with supportive treatment such as nasal saline irrigation (sinus rinse or neti pot), topical nasal steroid spray, short-term nasal decongestant and oral decongestants can alleviate symptoms with most types of sinusitis.

In cases of chronic sinus infections or acute bacterial sinus infection that is not improving with watchful waiting (after 7 days), antibiotics and possible oral steroid can be considered.

Antifungal therapy has a role in the treatment of invasive fungal sinus infection, but not allergic fungal sinusitis and a fungal ball.