Sinusitis Season (Late Summer/Fall) Is Upon Us!

Do your sinuses hurt? Here's what to do.

Allergies
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Late summer and fall is allergy season. Allergies can cause sinusitis (rhinosinusitis) a painful inflammation of your sinuses. Many people think that they have a cold when in reality they have sinusitis.  In fact, about 14 to 16 percent of Americans develop sinusitis each year—mostly women (although lots of men develop sinusitis, too). Of note, less than half of all people with sinusitis have ​a bacterial infection.

In other words, if you have sinusitis it's likely that you don't need antibiotics.

What Is Sinusitis?

Sinus cavities are normal anatomic "holes" in your skull and face. These sinuses are lined with epithelium that secretes mucus. This mucus is transported through openings (ostia) into the nasal cavity. Sometimes these openings get blocked and mucus builds up. When this happens, infection with viruses (influenza), bacteria (most commonly S. pneumoniae and Haemophilus influenzae) or even fungi can happen.  Noninfectious causes of sinusitis, which don't need antibiotic treatment, include polyps, allergies, barotrauma (think pressure injury from airplane flights or scuba diving) and polyps.

Sinusitis mostly effects the maxillary sinus followed by the ethmoid, frontal and sphenoid sinuses. Often, more than one sinus is affected. 

How Is Sinusitis Diagnosed?

The diagnosis of acute sinusitis is based on a mix of history and physical exam findings.

Typically, symptoms of sinusitis present for 10 days or longer and get better before they get worse, a phenomenon sometimes called "double worsening." If you have symptoms suggestive of sinusitis, you should make an appointment with a primary care provider.

Here are some symptoms of sinusitis:

  • cough
  • sneezing
  • fever
  • facial tenderness over the sinuses
  • facial fullness
  • purulent nasal drainage (copious yellow or green snot)
  • reduction or outright loss of smell
  • congestion

Oftentimes, people with a viral upper respiratory infection also have sinusitis. Usually, this sinusitis is merely inflammation and not viral infection.

Typically, with acute sinusitis, there's no need for mucus culture unless bacterial resistance is suspected.  Furthermore, CT or x-ray are unneeded when diagnosing acute sinusitis unless a serious complication like orbital abscess or meningitis is suspected. Such life-threatening complications require hospitalization. Furthermore, in the case of cellulitis, surgery is needed.

How Is Sinusitis Treated?

Most people with noninfectious sinusitis improve after about 7 days without treatment. In other words, you don't need to take antibiotics if there's no bacterial source of the infection.

Here are some non-antibiotic treatments for sinusitis:

  • nasal irrigation with saline (shooting salt water up your nose)
  • analgesics (acetaminophen, NSAIDs, and opioids)
  • mucolytics (seems to work but no evidence base for this treatment option)
  • nasal decongestants (avoid using nasal decongestants for more than a few days because rebound congestion may occur, instead try topical corticosteroids for longer-term use)
  • topical corticosteroids.

In adults with severe symptoms or persistent sinusitis, bacterial infection should be suspected and a short course of antibiotics (as short as 3 to 5 days) can do the trick. First-line antibiotic treatment should be narrow spectrum and includes drugs like amoxicillin or macrolides. Bactrim is also sometimes prescribed for sinusitis. If drug-resistant bacterial infection is suspected, and the sinusitis is chronic and doesn't "go away," your physician may do a culture and prescribe a much stronger antibiotic like a fluoroquinolone or higher-order cephalosporin ("gorillacillin").

Please remember that the misuse of antibiotics leads to dangerous patterns of antibiotic resistance. It's our role as members of society to limit antibiotic resistance whenever possible, which means we should (1) only take antibiotics when needed and when instructed to do so by our physician or for a bacterial infection and (2) complete the entire course of antibiotic treatment as prescribed.

If you like complementary medicine and want to try an herbal concoction for the treatment of sinusitis, you may want to consider either Sinupreit or bromelain (made from pineapples) in addition to the above treatments. A smidgen of evidence suggests that Sinupreit and bromelain may be effective when treating sinusitis.

On a final note, smoking often leads to sinusitis—no doubt, another reason to quit.

Sources

Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. Chapter 31. Sinusitis. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. eds. The Color Atlas of Family Medicine, 2e. New York, NY: McGraw-Hill; 2013. Accessed August 15, 2015.

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