Introduction
What should I know about Sinusitis?
If you have ever had a real sinus headache, you know how much trouble a sinus infection can give you. Our sinus cavities are strong defenders of the body, yet are sensitive to many pathogens that may come their way. The sinuses maintain a sterile atmosphere and although we do not fully understand how this occurs, we assume that it is because of the clearing away of mucus, the immune system and possibly antibacterial concentrations of nitric oxide gas in the sinus cavity. (1) Sometimes we might have a sinus infection that accompanies a cold and without even treating the sinus infection, it goes away on its own without our having to seek medical treatment. (2) There are different types of sinusitis that vary according to the cause and location of the infection. These also vary from acute to chronic, mild to severe, and in some cases, even life threatening.
Sinusitis may result from a viral, bacterial, or fungal infection. The most common precursor to sinusitis is a viral upper respiratory tract infection. The development of sinusitis occurs most frequently from some type of obstruction. When an obstruction of any kind occurs, the mucous that contains the pathogens is not removed quickly enough to keep an infection from occurring. Viral infections also increase the amount of mucous in the sinuses, which may cause damage to some of the cells that line the sensitive tissues and thereby increase the time that it takes for the sinuses to clear away excess mucous.
Acute sinusitis can be classified into various categories on the basis of several characteristics including whether it occurs in the hospital or community setting; the immune status of the patient; its infectious or noninfectious cause; and its viral, bacterial, or fungal cause. (3) For example, in a non-hospitalized patient with normal immunity, sinusitis may be viral, bacterial, a combination of both viral and bacterial, or non-invasive fungal. It may also be allergic or non-allergic. In a hospitalized patient, sinusitis is usually bacterial or fungal. Non-infectious causes include allergic or toxic sinusitis. There are several strains of bacteria that are responsible for causing sinus infections. These pathogens have been identified by tests such as direct sinus puncture and aspiration. (4) The most common pathogens seem to be Streptococcus pneumonia, Haemophilus influenzae and Moraxella catarrhalis. Since the use of antibiotics, the risk of complications from a sinus infection occurs less frequently. However, since the type of bacteria causing sinusitis has not changed over the last several decades, there is now an increasing resistance to antibiotics. It is the responsibility of the healthcare professional to determine what type of invading organism is causing the infection, and then to match that with the most effective treatment.
Fungal sinusitis may be either invasive or non-invasive, meaning that it exists separately from the tissue or it has actually penetrated, or invaded the tissue. It is more common to see the non-invasive type which in one form presents itself with a fungus ball (aspergilloma) inside the sinus cavity without invading the surrounding tissue. A second form is seen mainly in patients with asthma and nasal polyposis. It is described as allergic fungal sinusitis and is characterized by extremely thick mucous, but with no evidence of tissue invasion. Invasive fungal sinusitis, on the other hand, can be life threatening.
There are a variety of risk factors associated with sinus infections which can be environmental or physical. Some of the most common environmental risk factors include the inhalation of chemical irritants and cigarette smoke. Besides the common cold and allergies, other physical risks include nasal polyps, deviated septum, and mucous abnormalities such as those that occur in cystic fibrosis. While not as common, other potential risk factors include deep sea diving and airplane travel.
It is important to seek diagnosis and treatment for a sinus infection. A trained healthcare professional will be able to identify the specific pathogen and then determine the best treatment for each individual case. They will also be able to determine if the infection is acute or chronic and will be able to provide more information to the patient on how to manage the infection.
Statistic
National Center for Health Statistics, CDC.
- Number of noninstitutionalized adults with diagnosed sinusitis: 29.2 million (2002)
- Percent of noninstitutionalized adults with diagnosed sinusitis: 14.2 (2002)
- Number of visits to office-based physicians: 14.1 million (2002)
Signs and Symptoms
The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.
The signs and symptoms of sinusitis may be difficult to differentiate from allergies or upper respiratory tract infections. Sometimes, even the age of the patient affects the types of symptoms displayed.
Sneezing, nasal discharge, nasal obstruction, facial pressure, and headache are common. Fever and/or persistent cough may also occur.
Nasal discharge
- Nasal congestion
- Facial pain
- Maxillary toothache
- Fever
- Persistence of a cough and nasal discharge for more than 10 days following a viral upper respiratory tract infection
- Poor response to nasal decongestants
In children
- presence of halitosis in the absence of a sore throat
- Headaches that respond poorly to analgesics
Treatment Options
Conventional
Many symptoms of sinusitis will resolve without medical treatment within 48 hours. When they persist, the goals of treatment include relieving the symptoms, restoring and improving sinus function, preventing complications, and eliminating the cause. (5) A physician will usually recommend amoxicillin. There is a good rate of success with amoxicillin. Other antibiotics that may be recommended might include amoxicillin-clavulante, loracarbef, azithromycin, clarithromycin, cefuroxime axetil, cefaclor, cefixime, and erythromycin-sulfoxizole. All of these seem to be equally effective.
In addition to antibiotics, decongestants are often recommended to relieve the congestion and related symptoms. Along with the usual oral decongestants, nasal spray decongestants, such as phenylephrine hydrochloride (0.5%) or oxymetazoline hydrochloride (0.05%) may be recommended to help facilitate drainage. (6) Antihistamines are usually only recommended when allergies are present because they might actually thicken the mucous secretions which would slow down the outflow. Local application of heat may be soothing and inhalation of steam is beneficial. In some serious cases, surgery may be recommended.
Nutritional Suplementation
Vitamin C
Studies have not directly evaluated the effectiveness of vitamin C in the treatment of sinusitis. However, numerous studies have documented that relatively large doses of vitamin C (above 1,000 mg/day) are effective at reducing the duration of symptoms in the common cold. (7) In the 1940’s, Fred Klenner, M.D. was one of the first physicians to recognize that vitamin C was a powerful anti-viral agent. (8) , (9) For these reasons, Vitamin C might be helpful in sinusitis.
Herbal Suplementation
This category contains no therapies clinically applicable to this disease state.
References
- Gwaltney JM, et al. In: Mandell Gl, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. Philadelphia: Churchill-Livingstone Inc: 2000:676-683.
- Simon HB. Approach to the patient with Sinusitis, in: Goroll AH, May LA, Mulley AG, eds. Primary Care Medicine, Office Evaluation and Management of the Adult Patient, 3rd ed. Philadelphia: Lippincott-Raven; 1995:1004-1007.
- Gwaltney JM, et al. In: Mandell Gl, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. Philadelphia: Churchill-Livingstone Inc: 2000:676-683.
- Durand M, et al. Infections of the upper respiratory tract, In: Fauci AS, et al. eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill; 1998:179-181.
- View Abstract: Osguthorpe JD. Adult rhinosinusitis: Diagnosis and Management. Am Fam Physician. Jan2001;63(1):69-76.
- View Abstract: Malow JB, Creticos CM. Nonsurgical treatment of sinusitis. Otolaryngol Clin North Am. Aug1989;22:809-818.
- View Abstract: Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.
- Klenner F. Virus pneumonia and its treatment with vitamin C. Southern Med Surg. Feb1948.
- Klenner F. Massive doses of vitamin C and the virus diseases. J So Med & Surg. Apr1951;4:113.
