Our sinuses are located within cavities beneath our cheekbones, called maxillary; behind the forehead and eyebrows, called frontal; on both sides of the bridge of the nose, called ethmoid; and behind the nose in front of the brain, called sphenoid.
Each sinus cavity is joined to an opening into a continuous membrane, called the nasal passage, that allows inhaling and exhaling of air and the elimination of mucous. However, when the nasal passage becomes swollen because of a cold, narrow nasal openings, a deviated septum, nasal polyps or allergic rhinitis, the sinus openings become blocked, and sinus drainage, blood flow and ventilation are impaired. This occurrence enables bacteria in the sinuses to multiply, causing an infection.
Sinusitis, or inflammation of the sinuses, can be caused by allergies, an infection or both. Often caused by bacteria, acute sinusitis usually develops as a result of a viral respiratory infection or common cold. Most of the time the cold subsides on its own without medical treatment. When sinusitis lasts more than three months, the sinusitis is considered to be chronic. Unfortunately, chronic sinusitis is more complicated and difficult to treat than acute sinusitis. Chronic sinusitis is commonly seen in patients with a medical history of allergic rhinitis, asthma or nasal structural problems. Though uncommon, some chronic sinusitis can be caused by a fungus.
Typical symptoms of acute sinusitis include cough, sinus pressure, facial pain, toothache, a stuffy nose, postnasal drip, yellow-green nasal discharge or even fever. For patients with chronic sinusitis, symptoms may be less sudden but may still include facial pain and pressure, cough, nasal congestion with colored discharge, in addition to reduced sense of smell, loss of taste, foul breath, hoarseness and recurrent sore throat. If you have sinusitis, your allergist may perform allergy skin testing and order a sinus X-ray, CT scan and even endoscopic examination to rule out other possible underlying causes of chronic sinusitis.
While treatment for acute sinusitis includes antibiotics, oral decongestants, corticosteroid spray, nasal irrigation with salt water and saline nasal spray, prolonged antibiotic treatment for several weeks may be necessary to completely eliminate bacteria to prevent reoccurance. Surgical intervention may also be needed for patients with chronic and recurrent sinusitis and structural problems.
Dr. Yong H. Tsai is board-certified in rheumatology, allergy and clinical immunology and has been practicing in this area since 1993.