Sinus Infections


Has your cold or allergies turned into a sinus infection? Nearly one in seven people are diagnosed with a sinus infection each year.


What is a Sinus Infection?

Sinuses are hollow cavities in the facial bones of a person’s skull. They rest above the brow, on the bridge of the nose and beneath either cheek bone. These chambers are lined with a mucus membrane, and this membrane helps to provide moisture to the sinus cavity. Aside from the mucus membrane, sinuses are generally filled only with air. Any fluid that passes through them will drain out through the nasal cavity or into the back of the throat as a post-nasal drip. It is believed that the main purpose of sinuses is to help filter and moisturize the air we breathe.

A sinus infection, or sinusitis, occurs when the mucus membrane of the sinuses become infected. Once infected, the mucus membranes become swollen and tender. This usually occurs when the sinuses become blocked or filled with fluid. The swelling inside the sinuses can then lead to additional pressure and more fluid retention. Sinusitis can occur for many reasons, and the symptoms can range from mild irritation to severe pain and congestion. Sinusitis can be caused by viral or bacterial infections, and secondary infections can develop as well.

Although most sinus infections are not serious, they can lead to severe infections if left untreated. Some people are especially prone to sinus infections, and preventative care can prevent these individuals from unnecessary suffering. Correctly identifying sinus infection symptoms and receiving adequate treatment is crucial to bringing relief to sinusitis sufferers.

Types of Sinusitis

In general, sinus infections are classified according to the duration of the symptoms. In some cases, one infection may lead to secondary infections of a different type than the initial illness. Below are the primary classifications of sinusitis:

  • Acute: This is an infection that sets in quickly and generally lasts for 10 to 14 days. The symptoms present suddenly and include facial pain and a stuffy or runny nose. The symptoms may be confused for a cold when they first present. Acute sinusitis is often viral in nature due to the short lifespan of most respiratory viruses.
  • Chronic: Chronic sinusitis is a sinus infection lasting for eight weeks or longer. Chronic sinus infections may be caused by bacterial or fungal infections. What appears to be a chronic infection may actually be a series if primary and secondary infections that lead into one another. Certain conditions, such as nasal polyps or allergies, may make chronic sinusitis more likely to occur.
  • Recurrent: If a patient presents with sinus infection symptoms multiple times in a year, he or she is said to have recurrent sinus infections. These are most common in people with one or more of the risk factors covered in detail below. Frequent sinus infections can in turn make future infections more likely, so recurrent sinus attacks can achieve a snowball effect.

In addition to these basic classifications, sinus infections can be further divided by the underlying cause of infection. A large number of viral, fungal and bacterial infections can cause sinusitis, and treatment options will vary from one pathogen to the next. In many cases, identifying the exact pathogen is unnecessary. Because there are so many strains of bacteria that can cause infections, for example, doctors will usually prescribe a broad-spectrum antibiotic that is known to be effective against a wide number of bacterial infections. If the infection does not respond to this sort of general treatment, a doctor may take a culture to identify the best method of handling the pathogen.

What causes a Sinus Infection?

Sinus infections occur when pathogens like bacteria, viruses or fungi gather and breed in a person’s sinus cavity. This generally happens because the cavity becomes blocked, which causes it to fill with mucus that cannot drain normal into the nasal cavity. The result is congestion as mucus becomes backed up within the sinus.

These warm, damp conditions create an ideal breeding ground for germs. Once the infection takes hold, the inflammation in the sinuses can cause them to become even more blocked, which in turn improves conditions for the pathogens. Infection can spread to all of the sinus cavities in the patient’s face; severe infections can also spread to nearby areas including the throat or brain. For this reason, it’s important to treat sinusitis aggressively and quickly before the disease spreads.

Many sinus infections occur as secondary infections. A person with a cold or the flu, for example, may experience an increase in mucus production as part of his or her body’s immune system response. The resulting stuffy nose could cause the sinuses to become blocked, which in turn would create the environment necessary for sinusitis to develop. The germs that infect the sinuses may be the same as those that caused the initial infection, but they may be a different strain of virus or bacteria entirely. When a person’s immune system is compromised by fending off one infection, it is less effective at stopping additional germs from entering the body and causing illness.

Allergies can also lead to sinus infections. When a person is allergic to something, his body responds to harmless allergens the same way as it would normally react to germs. This means that the immune system will deploy its defenses, such as increased mucus production or sneezing, against environmental irritants like pollen or pet dander. When this occurs, the patient’s immune system is weakened and thus unable to protect her from infection. Since congestion is a common symptom of allergies, sinus infections frequently follow these allergy attacks.

Additionally, some people are at an increased risk of developing sinusitis due to the shape of their sinuses or other unique qualities. These risk factors are detailed more below. Certain lifestyle habits can contribute to the likelihood of developing a sinus infection. While smoking, for example, will not directly cause a sinus infection, the nasal cavity irritation that results from it may be enough to trigger the necessary conditions for sinusitis.

In most cases, sinus infections themselves are not contagious, but the cold or flu that led to the sinus infection can be transmitted from one person to another.

Risk Factors for Sinusitis

While anyone can suffer from sinusitis, some people are more likely to develop sinus infections than others. People with especially high risk factors may become victims of recurring sinus attacks. Depending on the patient’s situation, long-term or aggressive medical treatment may be necessary to solve the underlying cause of the recurrent sinus infections.
Here are some of the most common risk factors:

  • A compromised immune system: People with weakened immune systems or those taking certain medications have a heightened risk of contracting sinus infections. They may be more prone to respiratory diseases that can develop into sinusitis, and their immune systems have a difficult time combating the pathogens that gather and breed in blocked sinus cavities. People with compromised immune systems also tend to take longer to recover from illness, which may make more aggressive treatments necessary.
  • Facial trauma or abnormality: People who have sustained trauma to the facial bones may have irregularly shaped or unusually narrow sinuses. This can lead to poor drainage, which in turn will create an environment for pathogens to multiply. This can also occur in people who naturally have oddly-shaped sinuses or other facial abnormalities that could cause poor nasal drainage.
  • Severe seasonal allergies: Allergies can mimic the symptoms of infectious diseases, and some allergy sufferers can be plagued for several weeks or months out of the year. Allergies can cause increased mucus production, which in turn may lead to congestion. People who suffer from severe allergy symptoms are the most likely to develop secondary infections due to the stress placed on their immune systems.
  • Frequent exposure to irritants: Even people without traditional allergies may develop allergy-like symptoms as a result of dealing with various environmental or chemical irritants. Individuals working in construction jobs, for example, or whose who spend a substantial amount of time near aerosols, may begin experiencing enhanced mucus production and congestion. Dust, mold and various chemical fragrances can have a similar effect. Smokers, too, have an increased risk of contracting sinusitis due to the irritants inherent in cigarette smoke.
  • Nasal polyps: These polyps are sac-like growths in the nasal cavity and sinuses. They generally begin growing at the top of the nasal cavity and branch upward and outward into the open sinuses in the forehead and cheeks. When they grow large enough, these polyps can prevent all air circulation and mucus drainage in the nasal cavity. People with polyps sometimes report cold-like symptoms that last for months, and they sometimes lose their sense of smell. Mouth-breathing and snoring are common symptoms of nasal polyps due to the nasal cavity blockage. Polyps can develop as a result of chronic sinusitis; they also develop in people with hay fever, asthma and cystic fibrosis.

People with any of the above risk factors should be especially aware of the possibility of developing a sinus infection. Because sinus infection symptoms can sometimes mimic those felt by allergy sufferers or people with nasal polyps, the patient may not immediate realize that an infection has occurred. Prompt attention can help relieve symptoms and cure the infection before it becomes too severe.

Signs and Symptoms of Sinus Infections

Symptoms will vary between patients, and adults and children sometimes display symptoms in different ways. Additionally, the underlying cause of a sinus infection will affect the symptoms that present. For example, viral infections may present with higher fevers than bacterial sinusitis. In general, however, there are some tell-tale signs that can help distinguish a sinus infection from other types of respiratory disease.

In Adults

  • Facial pain
  • Headache
  • Nasal congestion or discharge
  • Toothache
  • Fever
  • Bad breath from infected post-nasal drip
  • Pus in the nasal cavity

Identifying a Sinus Headache

One of the most well-known symptoms of sinusitis is a sinus headache. These headaches are signified by a piercing pain in the forehead. It may be accompanied by facial pain, swelling or tenderness around the eyes and nose. The pain tends to worsen when the patient tilts his or her head forward; this increases the pressure in the sinus cavity.

Sinus headaches are not always caused by sinusitis, but they are a common symptom of the infection. Patients with recurring sinus headaches should follow up with a physician to confirm whether a sinus infection is present and requires treatment.

Sinuses and Teeth

The roots of the upper teeth are aligned close to the sinuses, which can cause sinus inflammation to be felt in the teeth and gums. Tenderness in the teeth, especially the upper rear molars, can be a good indication of sinusitis. Additionally, impacted teeth, cavities, abscesses and other mouth problems can cause sinus infections. If pathogens from the mouth travel upward into the sinuses, a sinus infection can result.

These infections can be particularly dangerous as bacteria from infected teeth can enter the bloodstream from the mouth and spread to other areas of the body. Patients experiencing dental problems should be particularly careful to address sinus problems before they become severe.

Sinus Infection Diagnosis

Patients with the above sinus infection symptoms can speak with a doctor to confirm the diagnosis and treat the symptoms.The doctor will ask about the symptoms, ask if there is a fever and have the patient tap on his forehead, cheek bones or bridge of the nose to test for painful inflammation in the sinuses. Tapping the patient’s teeth can also help a doctor determine whether the sinuses are inflamed.

In the case of chronic or recurring sinus infections, a doctor may wish to complete additional diagnostic tests to reveal the underlying cause of the sinus infection. These tests may include facial x-rays or CT scans in addition to allergy testing, mucus cultures and blood work. A nasal endoscopy may also be performed. This is a procedure where a small camera mounted on a tube is inserted into the patient’s nostril in order to obtain a clear picture of the patient’s nasal cavity and sinuses.

The purpose of these tests is to identify conditions that may be causing the recurring sinus infections, such as irregularly shaped sinuses or the presence of nasal polyps. Such tests are not common diagnostic tools for simple sinusitis, but they may provide valuable insight to patients with frequent upper respiratory concerns.

Treatment for Sinus Infection

Sinusitis treatments will vary depending on the cause and severity of the infection. Here are some of the most common treatments that may be recommended by a physician:

Antibiotics: The first line of defense against bacterial infection is antibiotic drugs. Different types of antibiotics will be effective against the various pathogens that can cause sinus infections. If antibiotics are not effective in treating sinus infection symptoms, the doctor may recommend a different type of antibiotic. Infections that continue to resist antibiotic treatment may be viral or fungal in nature. Anti-fungal drugs are available, but there are no anti-viral drugs currently on the market. Instead, patients with viral sinusitis can simply treat their symptoms and allow the virus to run its course.

Anti-inflammatory Drugs: Over-the-counter or prescription anti-inflammatory medication can be used to reduce the swelling in and around the sinuses. Non-steroidal anti-inflammatory drugs like ibuprofen can help reduce pain and swelling. These drugs can also control fever caused by infection. In more severe cases, doctors may recommend oral steroids like prednisone to reduce inflammation. Steroidal nasal sprays can also provide relief from congestion and reduce the swelling of nasal tissues.

Antihistamines: When sinusitis is caused by allergies, treating those allergies is crucial in preventing sinus infections from recurring. Allergy medication may focus on antihistamines or histamine blockers, which prevent the body from deploying its defenses against harmless allergens. This helps decrease mucus production and allow nasal swelling to go down.

Nasal Irrigation Kits: Neti pots and nasal bidets are devices used to irrigate the nasal cavity. A mild saline solution is flushed through one nostril and out through the other while the patient keeps his or her head tilted sideways. This gently clears the nasal cavity and soothes inflamed tissue. Nasal irrigation is especially helpful for allergy sufferers as it can help remove pollen or other irritants from the nasal passages. It can also help moisturize dry mucus membranes.

Many of these treatments are available over the counter, so people suffering from sinus pain and congestion can find relief without visiting the doctor. In the case of viral infections, this type of symptom-management is often the only available treatment. Patients experiencing sinus pain and congestion may wish to try over-the-counter drugs and nasal irrigation before receiving medical care. Be aware, however, that long-lasting sinus infections still require medical intervention, especially in the case of bacterial and fungal infections.

Individuals with severe recurring sinusitis may be candidates for surgery. This is especially true for people who have malformed sinuses or who have sustained injuries to the face, nose and sinus cavities. The surgery can help open up narrow sinus passages to provide additional space for drainage. People with nasal polyps may also benefit from their surgical removal. Sinus surgery is not common, but it is an option for people who suffer from frequent sinusitis and related respiratory problems.

Home Treatment for Sinus Infection

Sinusitis is the third most prescribed condition in the US-despite the fact that many studies show that actual sinusitis requiring antibiotics is about 20% of the cases. Therefore, there are many ways to manage the pain and discomfort from home.

  • Humidify. Start using a humidifier in rooms where you spend most of your time, especially at night.
  • Inhale steam vapor. You can either run the shower and sit in the bathroom and breathe deeply. Or use the old fashion way of boiling water, covering your head in towel and breathing in the steam. The steam vapors may help reduce congested and swollen nasal passages.
  • Apply Heat. Put a warm, wet towel on your face. It might help relieve some of the pressure.
  • Use a nasal saline solution. While they don’t contain medicine, they can help keep your nasal passages moist. There are many available over the counter.
  • Flush out your sinuses. Nasal irrigation, with salt water can clear out mucus and keep your sinuses moist and clearer. There are a number of ways to do it, ranging from bulb syringes and neti pots all available over the counter. Make sure to only use distilled, sterile, or previously boiled water to make up the solution.
  • Drink plenty of water. It will help moisten and thin the mucus, reducing the blockage in your sinuses.
  • Rest. Get plenty of sleep and give your body a chance to recover.
  • Don’t abuse OTC medicines. Decongestants and over the counter pain management can help up to a point. However, do not overuse them as some of these medicines can actually make your symptoms worse.

When should I call a Doctor for a Sinus Infection?

Most sinus infections are not serious, but it’s important to seek treatment for sinusitis early to prevent symptoms from worsening. Infection from a patient’s sinuses can travel to other parts of the body. This in turn can cause severe medical conditions such as meningitis, orbital cellulitis and brain abscesses. These complications are not common, but they are medical emergencies that must be dealt with immediately. Avoiding them by promptly treating all sinus infections is the best protection against these potentially deadly conditions.

In general, receiving medical assistance is smart whenever symptoms persist for more than a week or are very severe. Other symptoms that may be indicative of a sinus infection:

  • Nasal congestion with discharge
  • Fever
  • Postnasal drip (when mucus drips down the throat behind the nose)
  • Sore throat (often as a result of postnasal drip)
  • Pain or pressure around the inner corner of the eye and above the eyebrow or down one side of the nose
  • Headache behind the eyes or on the temple
  • Pain or pressure symptoms are worse when coughing, straining, lying on the back or bending over from the waist and better when the head is upright

Sinus pain or pressure that interferes with daily activities or is accompanied by a high fever, disorientation or vomiting should be dealt with right away as it may be a more serious condition.

By understanding the causes, symptoms, diagnosis and treatment of sinusitis, patients are better-equipped to deal with it when it arises. For additional help or more personalized advice, it might be a good idea to confer with a licensed physician.