Sinusitis

What it is

This article applies to adults with sinusitis, so go here if you want to read about it in children (although or children over 10, it's basically the same thing).

Sinusitis is an infection of the sinuses caused (usually) by bacteria.  The sinuses are hollow cavities in the bones of the skull that serve several purposes:

  1. They give resonance to the voice (think of how you sound with a stuffy nose)
  2. They probably help filter the air going through the nose
  3. They get infected a lot - mainly the maxillary and frontal sinuses.

While sinusitis is not dangerous, it is uncomfortable, with pain generally on the face over where the sinus cavities are located.  The pain is caused by a difference between the pressure inside the sinuses and that of the outside world.  The usual mechanism of this is as follows:

  1. The sinuses are filled with mucous cells, producing mucous to sweep away any air particles that enter the sinus cavity.  The mucous then drains into the nasal passages and on to the stomach.
  2. The holes out of which the mucous drains get plugged, so the sinus mucous does not drain.  This plugging usually starts with inflammation (swelling) caused by:
    1. Allergies
    2. An upper respiratory infection (caused by a virus)
    3. Smoking
  3. The non-draining mucous sits around in the warm, dark, wet sinus cavity, which is a perfect place for bacteria to grow.
  4. Bacteria, which are always present in small numbers, binge on the "all you can eat buffet" of mucous in the sinus, causing the mucous to thicken.
  5. The thickened mucous makes drainage of the sinuses even more difficult.

Symptoms

The symptoms of sinus infections are varied, but the most common symptoms include:

  • Pain or tenderness over the sinuses
    • The top of the cheeks between the eyes and the mouth, for the maxillary sinuses
    • The forehead area just above the eyes for the frontal sinuses
    • The ethmoid and sphenoid sinuses don't usually get infected, so we'll ignore them for now.
  • Painful teeth (caused by maxillary sinus pressure)
  • Headache

"Green Mucous" is not a classic symptom of sinusitis, and nasal congestion or runny nose are usually caused by the virus infection or allergy that started the trouble in the first place.

Other symptoms that may suggest a sinus infection include:

  • Cough
  • Bad Breath
  • Fever

Treatment

If left untreated, sinus infections will usually get better on their own.  There are two reasons to treat a sinus infection:

  1. People don't like to feel bad and get really grumpy
  2. Grumpy people make the lives of others around them miserable.

Really.  The chance of a sinus infection turning into something serious is quite low, so it's really a quality of life issue more than anything else.  

The treatments for sinus infections include:

Non-medication treatments

The use of saline nasal spray or humidifiers can loosen phlegm and reduce pain.  This is often the quickest way to feel better.  Some people go to the extreme, using nasal irrigation (such as a neti pot), which does help a person feel better, but does have the disadvantage of pouring a liquid into your nose.

Over-the-counter medications

These relieve the symptoms and can restore the mucous flow.  These medications include:

  • Expectorants - Like Mucinex (Guaifenacin) or Robitussin - These thin the phlegm and let it drain easier.
  • Oral Decongestants - Phenylephrine and Pseudoephedrine (and others) are related to adrenaline, and work on receptors in the nose that open up the sinus passages and allow drainage.  They also decrease the flow of mucous.  The do, however, cause some problems (due to their being related to adrenaline), such as rapid heart rate, palpitations, elevated blood pressure, dry mouth, and difficulty urinating.  For healthy people this is OK, but be careful with these medications.  Most medicines containing decongestants have the letter "D" after their name (Mucinex-D, Robitussin-D, for example).
  • Nasal decongestants - Nasal sprays like Afrin contain the same kind of medications in the oral decongestants, but are more effective and have fewer side effects.  They can provide nearly instant relief, but should be used with caution for two reasons:
    • Some medical conditions, such as Glaucoma, can be aggravated by them.
    • Use of them for over 5 days can cause a rebound effect when they are stopped, increasing congestion significantly.  Some people refer to this as an "addiction", but there are no nasal spray 12-step groups that I know of.
  • Antihistamines - These are not usually useful in sinus infections, but can help with the allergies which brought the infection on in the first place.  They also tend to make you sleepy, which may not be all bad if you are kept awake by sinus symptoms.

Prescription Medications

Prescriptions are used when appropriate (see below for guidelines).  These medications include:

  • Nasal steroids - these decrease inflammation and may help a person avoid antibiotic use if started early.
  • Oral steroids - medications such as prednisone also decrease nasal inflammation and can prevent antibiotic usage, but they do have side effects if used too often, and some folks go crazy when they take them (not many, but it's impressive when it happens).
  • Antibiotics - These are the first thing people ask for and yet are the last resort.  They kill the bacteria which thicken the phlegm, but studies are not clear if they really make you get better faster.  Please read the antibiotic section of this website if you haven't done so yet to learn the risks and benefits of their usage.

Preventing sinus infections

An ounce of prevention is worth a pound of antibiotics, plus it makes you a lot less grumpy.   Here are some things to do to prevent sinus infections, or at least to minimize your need for antibiotics:

  • Don't get sick.  Taking precautions to prevent getting sick in the winter is a good move.  Get a flu shot, get lots of sleep, eat well, and don't let people sneeze on you.
  • Treat allergies.  Since allergies (cats, molds, pollens) are often the first step down the road toward grumpiness, taking antihistamines or using nasal steroids if you have allergies can keep your sinuses flowing.
  • Keep mucous moving.  If you do get sick, use nasal saline, neti pots, or hot showers to loosen the phlegm.  Expectorants may be helpful as well.

A reasonable approach to sinusitis

Here is a reasonable approach to dealing with sinusitis:

  1. Only treat if you are having enough symptoms to merit treatment (or are grumpy enough).
  2. Start with nasal saline when you do get sick, using the other over-the-counter medicines if needed.
  3. Use antibiotics only if you have been sick for about a week or are intolerably grumpy.
  4. Especially avoid antibiotics if you are a "frequent flyer" with sinus infections or antibiotics.
  5. If you keep getting sinus infections, figure out what is at the root of your trouble.  Stop smoking, get rid of the cat, get allergy tested, or avoid aunt Harriet who sneezes on you if you need to.