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Acute sinusitis (sinus infection) symptoms, causes, and treatment.

Acute sinusitis, or sinus infection, is a common upper respiratory tract infection. In the following article, we’ll review the basics of it.

Sinusitis is a widespread infection. In fact, around 0.5% of all upper respiratory tract infections end up in sinusitis. In the United States, 1 out of 7 adults get diagnosed every year. This translates to more than 30 million people getting sinus infections every year. Sinusitis is also the cause of more than 16 million visits to the doctor each year. 

In the following reading, you’ll find everything you need to know about sinusitis. Its causes, types, symptoms, and of course, diagnosis and treatment. All of this, in simple words, directly from a doctor. I invite you to keep reading if you want to know more about this common respiratory infection.

What is a sinus?

The sinuses are hollow cavities filled with air. These cavities are located inside the skull and are connected to the nasal airway. We have four pairs of different sinuses: frontal sinus (in the forehead), maxillary sinus (behind cheeks), ethmoid sinus (between the eyes), and sphenoid sinus (behind the ethmoids).

All sinuses together can be referred to as a unit, the paranasal sinuses. The sinuses have a lining that contains cells that secrete mucus and some cells of the immune system. The sinuses have many functions that include: 

  • Warming and humidifying the air we breathe: They do this because the airflow in the sinuses becomes slower.
  • Insulate delicate structures of the skull, like the eyes and some nerves.
  • Buffers facial trauma and makes the skull lighter in weight.
  • Increase the voice resonance through the skull
  • Act as a sensory system of air signals since they respond to changes in environmental pressure.

What is a sinus infection (acute sinusitis) or sinusitis?

Sinusitis is no more than the inflammation of the lining that covers the paranasal sinuses. People commonly call it a sinus infection. This is not incorrect since most of the time, the inflammation of the sinuses is the result of an infection. However, there are other reasons why the sinuses can become inflamed. We’ll review this aspect later in the article.

Usually, sinusitis is a short-term inflammation (acute sinusitis) but can last for many weeks too (chronic sinusitis). Typically, the mucosal lining of the nose gets inflamed as well. So, don’t be surprised if you see the term rhinosinusitis. This only means that both the mucosa of the nose and the paranasal sinuses are affected simultaneously. 

The sinuses are sterile in normal conditions. This means that no bacteria are colonizing them. The secretions produced in the sinuses flow towards the nasal cavity. These secretions only flow in one direction; this prevents the contamination of the sinuses.

When the mucosa is inflamed, it can block the passage of the secretions. This causes fluid build-up and potential contamination with germs. It’s the retained mucus that becomes infected that causes sinusitis. It’s important to mention that there are cells that are in charge of the mucus flow.

These latter cells have little cilia or prolongations that help move mucus. An impaired cilia function can also cause sinusitis. An altered quantity or quality of mucus can also end up causing sinusitis. 

Is sinusitis the same as a sinus infection?

Not precisely, the term sinusitis is for describing an inflammation, and this can have multiple causes. One of them is a sinus infection.

What are the types of sinusitis and sinus infections? 

Sinusitis can be classified according to many characteristics. We’ll briefly mention each one of them, like according to: 

  • The anatomic site: Or which specific sinus cavity is affected. It can be frontal, maxillary, ethmoidal, or sphenoidal. 
  • The germ that’s causing the infection; can be viral (most of the cases), bacterial or fungal sinusitis.
  • Evolution time; can be acute (lasting less than a month) or chronic (lasting up to 12 weeks or more). The causes for acute and chronic sinus infections can also be different. 
  • There are complications or other associated factors: Like nasal polyps and other anatomic variations that may cause nasal obstruction. 

What can cause sinus infections? 

Like we mentioned before, the inflammation of the sinus lining primarily causes a sinus infection. This inflammation causes blockage of nasal drainage. This results in fluid and mucus build-up where bacteria can grow. Still, the inflammation of the mucosa can be caused by various factors: 

  • Viral infections: This is the most common one. A viral infection can cause mucosal thickening that results in associated bacterial infection. Also, a viral infection on its own can cause increased nasal discharge and swelling of the nasal mucosa. This can result in sinusitis too. The most common viruses that cause this are rhinoviruses. 
  • Bacterial infections: As we said before, they can be associated with a previous viral infection. Some of the most common bacteria to cause sinusitis are staphylococcus and streptococcus. This is also known as acute bacterial sinusitis. 
  • Fungal infections: This is rare but can happen too. 
  • Allergies: They are a major reason that people can develop sinusitis. In patients with allergies, the mucus production is increased, and the mucosa can be permanently inflamed. This is the perfect combination to get a sinus infection, 
  • Anatomic variations: Like a deviated nasal septum, the presence of nasal polyps or other tumors, and inflamed adenoids. 

Why do bacteria grow in this infection?

Bacteria grow by one particular mechanism in the sinus cavity, which many factors can trigger.

Basically, there is mucus production by the sinus, including all of them, such as the frontal sinus, sphenoid sinus, ethmoid sinus, and maxillary sinus. This mucus should pass through a little hole called the sinus ostium to the nasal passage to get out of the body.

Nevertheless, when there is a blocked sinus or some diseases impair the mucus clearing mechanisms within the cells, that mucus becomes stationary, and the levels of oxygen decrease. This situation is a perfect scenario for bacteria to grow.

All the sources of nose inflammation or sinus blockages, such as allergic rhinitis or allergic sinusitis, nasal polyps, and viral infections, can promote this pathological mechanism.

Why is this bacterial infection (acute sinusitis) essential for me to know?

That is very clever for you to ask, and the answer is the whole purpose of this article. All bacterial sinusitis is the one requiring antibiotic treatment.

Additionally, you now know that bacterial sinusitis accounts for a much lesser number of infections than viral infections. And that is great because the vast number of viral sinusitis only require treatment of their symptoms till it passes. While bacterial sinusitis indeed requires both antibiotic and symptoms treatment.

Please remember that nearly all of them are viral infections, and antibiotics don’t eliminate at any time the viral microorganisms. Besides, if bacterial sinusitis is without identification and treatment, it progresses over time and could cause serious complications. But that isn’t an excuse to start taking antibiotics because of your own suspicion of having acute sinusitis.

What are the risk factors for acute sinusitis? 

Anyone can get sinusitis. In fact, it’s a widespread condition. However, certain people are more likely to develop it. Among them, we can mention people that:

  • Frequently have close contact with other people: This spreads the germs that cause sinusitis much more likely. 
  • Who suffer from intranasal allergies.
  • Have abnormalities in the nasal passage, like polyps or a deviated septum. 
  • With large or inflamed adenoids due to allergies or other conditions. 
  • Who smoke or are exposed to inhaled irritants can impair the cilia’s function that moves mucus.
  • Who perform activities that result in pressure changes: like scuba diving or flying. 
  • With a weakened immune system
  • Have other health conditions: Like cystic fibrosis, a condition in which your body’s secretions become thicker and heavier. 

What are the symptoms of acute sinusitis? 

Acute sinusitis symptoms can be very uncomfortable. They may vary according to which sinus is affected. The most common sinus symptoms include: 

  • Nasal congestion: Due to increased mucus production. You can also have a runny nose. 
  • A thick green or yellow discharge comes through your nose. 
  • Cough: That usually worsens at night.
  • Drainage of mucus on the back of your throat. 
  • Sore throat: Usually caused by this drainage of mucus. 
  • Sinus pain: Location may vary according to which sinus is affected. You can feel pressure or tenderness behind your nose, eyes, cheeks, or forehead.
  • Headache.
  • Ear pain.
  • Tooth pain: Especially in cases of acute maxillary sinusitis.
  • Bad breath or perceiving a bad smell in your nose.
  • Fever and chills.
  • Fatigue.
  • Altered sense of smell and taste.

What causes a musty smell in the nose? 

A musty smell in the nose is one of the many symptoms that a sinus infection can cause. It’s produced by the accumulation of bacteria and increased mucus production. It is most commonly seen in bacterial sinus infections. 

What color is your mucus when you have this infection?

Nasal discharge can be from any color and consistency. What do I mean by this? It would depend on the microorganism. The mucus could be white, yellow, or green and still be acute bacterial rhinosinusitis. Also, the consistency could be thin or thick; what is more important is the timeline of the presentation of the symptoms.

How long does acute sinusitis last?

An acute sinus infection usually lasts from 2 to 4 weeks. It usually starts with cold-like symptoms, like a runny nose and mild facial pain. For a lot of patients, acute sinusitis can resolve on its own after 10 days. This mostly happens when it’s viral sinusitis. If this doesn’t happen, then a bacterial infection should be considered.

Moreover, there is another term you may find, subacute sinusitis. This is when a sinus infection lasts between 4 to 12 weeks. Usually, this will happen when patients don’t get the correct treatment early.

Other terms are chronic sinusitis, which lasts for more than 12 weeks, and recurrent acute sinusitis. The term recurrent sinusitis is used when a patient gets several sinus infections a year. Getting one or 2 sinus infections a year can be considered normal. Yet, if you suffer from 3 or more a year, you should go to the doctor. 

What are the complications of sinusitis?

Most of the time, acute sinusitis will have an excellent prognosis. Around 40% of all sinus infection cases will resolve spontaneously, even without antibiotic treatment. However, like any other condition, it can lead to complications if left untreated. For untreated or poorly treated sinusitis, the complications include: 

  • Meningitis or brain abscess: Infections of the central nervous system can happen as a complication of sinusitis. This is due to the proximity of these two anatomic structures. Both meningitis and brain abscess can cause death if not treated. 
  • Osteomyelitis (or bone infection). This can happen to the bones of the skull and the face. 
  • Orbital cellulitis: An infection of the tissue around the eye. 

What tests diagnose the cause of sinus infections and sinusitis? 

If you think you have sinusitis, you should go to the doctor. There, a doctor will ask about your symptoms, as well as your medical history. They’ll probably ask about the previous record of allergies or other similar episodes. Then, they will continue to perform a physical exam.

When doctors suspect a sinus infection, they can check your nose. By doing this, they can find redness or swelling of your nasal passages or even pus drainage. Also, they can tap your cheeks and forehead, looking for tenderness caused by the infection.

Furthermore, your doctor can prescribe some imaging studies. A simple x-ray of the paranasal sinuses may not be enough to diagnose sinusitis. A CT scan or an MRI is a much better study to observe any blockage or fluid build-up in the sinuses.

Sometimes, a doctor might want to get a sample of your nasal secretions. This will help them determine what germ is causing the infection. They can also tell if allergies are causing your symptoms.

In some cases, a needle aspiration may be necessary. This is used to drain and to obtain a sample of the fluid building up in the sinuses. In sporadic cases, surgery may be required to biopsy the tissue to really know what’s causing the problem. This is primarily done in the case of fungal sinus infections. 

What is the treatment for acute sinusitis? 

The treatment for sinus infections will depend on the cause of it. For example, antimicrobial therapy won’t be helpful if the virus causes the infections. Keep in mind; sinusitis can get better without receiving any treatment. Still, your doctor can prescribe some medications and give you some valuable recommendations:

  • Stay hydrated: This helps with fluidity of the mucus and to recover faster from the infection.
  • Nasal sprays: Including saline solution or intranasal corticosteroids. The saline solution helps hydrate the sinuses and helps break up the congestion. On the other side, nasal steroids help with the inflammation of the mucosa. However, they should be prescribed by a doctor. 
  • Keep sinuses hydrated: With the help of tools like a humidifier or steam from a shower. This helps with fluid build-up and congestion. 
  • Nasal irrigation: Your doctor can recommend you irrigate (rinse) your nostrils with saline solution to help ease the symptoms of sinusitis.
  • Use warm towels on your face: This can help clear the nasal passages from the outside. Also, the warmth can help relieve sinus pain. 
  • Use over-the-counter medications: Like acetaminophen or ibuprofen. They can help ease other symptoms of a sinus infection like pain and fever. 
  • Antibiotics: Once your doctor determines bacteria cause your sinusitis, they will prescribe antibiotic treatment.

What types of doctors treat sinusitis and sinus infections? 

For most cases, any primary care physician or internal medicine doctor can treat a sinus infection. However, you can also get help from an ENT (ears, nose, and throat) doctor, especially if you often suffer from sinus infections.

Infectious disease, Immunology, and Allergology doctors are also capacitated to treat a sinus infection. Depending on your case, your primary care or internal medicine doctor can have you referred to one of these specialists. In the event of a severe case, a doctor specialized in sinus surgery can also be consulted.  

When should I call a healthcare provider about sinusitis?

Like we mentioned before, most cases of sinusitis will get better spontaneously. However, keep an eye out for any possible complications you may have. You should see a doctor about a sinus infection if: 

  • You have severe symptoms: Like a severe headache or severe facial pain.
  • Symptoms improve but then start to worsen
  • Symptoms last more than 10 days without having an improvement. 
  • You have a fever that lasts more than 4 days.
  • You have had multiple sinus infections in the past year

How do you prevent acute sinusitis? 

There is no specific way to prevent acute sinusitis. However, there are some things. You can do to lower the chance to develop it. 

  • Prevent viral respiratory infections that may cause sinusitis: You can do this by adopting some simple measures. Keep away from close contact with potentially infected people, wash your hands, and clean potentially contaminated surfaces.
  • Avoid smoking, secondhand smoke, and other respiratory irritants: This irritates the sinuses mucosa and can damage cilia that move mucus. 
  • Avoid dry environments: You can use a humidifier to moisten the air and prevent your sinuses from drying out and blocking. 
  • Use antihistamines or decongestants to keep inflammation and congestion under control. 
  • Use nasal irrigation techniques regularly to keep your sinuses clean and moistured. 

What can I do if I am presenting acute sinusitis symptoms?

This tool is an Acute Sinusitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the ailment. Therefore, the tool will tell anybody who uses it if their symptoms are likely because of acute sinusitis.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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