Sinusitis

Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the mucous membrane that lines the sinuses resulting in symptoms. Common symptoms include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, and a cough. The cough is often worse at night. Serious complications are rare. It is defined as acute sinusitis if it lasts less than 4 weeks, and as chronic sinusitis if it lasts for more than 12 weeks.CT of chronic sinusitisCT scan of chronic sinusitis, showing a filled right maxillary sinus with sclerotic thickened bone.MRI image showing sinusitis. Edema and mucosal thickening appears in both maxillary sinuses.Maxillary sinusitis caused by a dental infection associated with periorbital cellulitisFrontal sinusitisX-ray of left-sided maxillary sinusitis marked by an arrow. There is lack of the air transparency indicating fluid in contrast to the other side. Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the mucous membrane that lines the sinuses resulting in symptoms. Common symptoms include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, and a cough. The cough is often worse at night. Serious complications are rare. It is defined as acute sinusitis if it lasts less than 4 weeks, and as chronic sinusitis if it lasts for more than 12 weeks. Sinusitis can be caused by infection, allergies, air pollution, or structural problems in the nose. Most cases are caused by a viral infection. A bacterial infection may be present if symptoms last more than 10 days or if a person worsens after starting to improve. Recurrent episodes are more likely in persons with asthma, cystic fibrosis, and poor immune function. X-rays are not usually needed unless complications are suspected. In chronic cases, confirmatory testing is recommended by either direct visualization or computed tomography. Some cases may be prevented by hand washing, avoiding smoking, and immunization. Pain killers such as naproxen, nasal steroids, and nasal irrigation may be used to help with symptoms. Recommended initial treatment for acute sinusitis is watchful waiting. If symptoms do not improve in 7–10 days or get worse, then an antibiotic may be used or changed. In those in whom antibiotics are used, either amoxicillin or amoxicillin/clavulanate is recommended first line. Surgery may occasionally be used in people with chronic disease. Sinusitis is a common condition. It affects between about 10 and 30% of people each year in the United States and Europe. Women are more often affected than men. Chronic sinusitis affects about 12.5% of people. Treatment of sinusitis in the United States results in more than US$11 billion in costs. The unnecessary and ineffective treatment of viral sinusitis with antibiotics is common. Headache or facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis. This pain is usually localized to the involved sinus and may worsen when the affected person bends over or when lying down. Pain often starts on one side of the head and progresses to both sides.Acute sinusitis may be accompanied by thick nasal discharge that is usually green in color and may contain pus or blood. Often, a localized headache or toothache is present, and these symptoms distinguish a sinus-related headache from other types of headaches, such as tension and migraine headaches. Another way to distinguish between toothache and sinusitis is that the pain in sinusitis is usually worsened by tilting the head forwards and with valsalva maneuvers. Infection of the eye socket is possible, which may result in the loss of sight and is accompanied by fever and severe illness. Another possible complication is the infection of the bones (osteomyelitis) of the forehead and other facial bones – Pott's puffy tumor. Sinus infections can also cause middle-ear problems due to the congestion of the nasal passages. This can be demonstrated by dizziness, 'a pressurized or heavy head', or vibrating sensations in the head. Postnasal drip is also a symptom of chronic rhinosinusitis. Halitosis (bad breath) is often stated to be a symptom of chronic rhinosinusitis; however, gold-standard breath analysis techniques have not been applied. Theoretically, several possible mechanisms of both objective and subjective halitosis may be involved. A 2004 study suggested that up to 90% of 'sinus headaches' are actually migraines. The confusion occurs in part because migraine involves activation of the trigeminal nerves, which innervate both the sinus region and the meninges surrounding the brain. As a result, accurately determining the site from which the pain originates is difficult. People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection.