Sinusitis: Symptoms, Causes & Treatment

Sinusitis is inflammation of the tissues lining the paranasal sinuses — small air-filled cavities around the nose, forehead, and cheeks. When inflamed, these tissues swell and produce thick secretions that block normal nasal passages and impair mucus drainage. The condition is classified as acute (less than 4 weeks) or chronic (more than 12 weeks).

Sinusitis is very common in the Middle East and Jordan, influenced by environmental factors such as dust, climate changes, and air pollution. Studies indicate that approximately 10-15% of the population experiences sinusitis at some point in their lives. The condition can result from viral, bacterial, or fungal infections, allergic rhinitis, or anatomical abnormalities like deviated septum.

While acute sinusitis often resolves spontaneously, chronic sinusitis requires long-term management and can significantly impact quality of life. Diagnosis relies on symptoms and clinical examination, with imaging studies in complex cases.

Sinusitis symptoms vary by severity and duration. In acute cases, symptoms develop quickly after viral or bacterial infection. In chronic cases, symptoms persist long-term with fluctuating periods of improvement and deterioration.

• Nasal congestion: Sensation of blocked nostrils making nasal breathing difficult.
• Frontal headache and facial pain: Pain above eyebrows or around eyes and cheeks, worsened by bending forward.
• Yellow or green nasal discharge: Indicator of bacterial infection.
• Cough: Especially at night from post-nasal drip.
• Halitosis (bad breath): Due to accumulated secretions and bacteria.
• Low-grade fever: Usually under 38-38.5°C in mild cases.
• Fatigue and malaise: Especially in acute and chronic forms.
• Toothache: May occur with maxillary sinus involvement.
• Loss of smell and taste: From nasal passage obstruction.
• Ear fullness and earache: When inflammation extends to ears.
• Redness and swelling around eyes: In severe cases and complications.
• Pressure sensation behind eyes: Especially in mornings.

• Viral infection: Usually follows common cold or influenza, accounting for over 90% of acute sinusitis cases.
• Bacterial infection: Occurs when bacteria (such as Streptococcus pneumoniae or Haemophilus influenzae) infect sinuses, requiring antibiotic treatment.
• Seasonal allergies and allergic rhinitis: Exposure to allergens causes inflammation and swelling of sinus tissues.
• Deviated nasal septum: Curvature of the wall separating nasal passages impairs natural mucus drainage.
• Nasal polyps: Benign tissue growths that obstruct nasal passages.
• Immunosuppression: Weakened immunity (HIV, cancer) increases risk of fungal infections.
• Smoking and environmental pollutants: Smoke and air pollutants damage the cilia responsible for sinus clearance.
• Fungal infection: Rare but serious, especially in immunocompromised patients.

• Personal history of allergies: Those with chronic nasal allergies are more susceptible.
• Active and passive smoking: Reduces ciliary function and sinus clearance.
• Work in dusty environments: Construction, industrial, and agricultural settings increase pollutant exposure.
• Chronic lung diseases: Asthma and COPD elevate risk.
• Immunosuppression: Cancer, HIV, and chemotherapy increase infection risk.
• Age: Adults more affected than children, though young children may develop severe cases.
• Pregnancy: Hormonal changes may increase nasal congestion.
• Uncontrolled asthma: Increases chronic inflammation risk.
• Gastroesophageal reflux: May cause secondary sinus inflammation.
• Mechanical ventilation: May increase infection risk.

Diagnosis relies initially on symptoms and clinical examination, confirmed by imaging in complex cases or suspected complications. The physician will inquire about symptom duration, severity, and triggers.

• Clinical examination: Doctor examines nasal cavity with nasal speculum for redness, swelling, and discharge. Palpates sinuses (pressing forehead and cheeks) to assess tenderness.
• X-ray imaging: Simple and quick to show fluid accumulation in sinuses, but limited accuracy.
• CT scan (Computed Tomography): Gold standard for diagnosing chronic sinusitis, shows tissue inflammation with high precision and excludes complications.
• Nasal endoscopy: Thin illuminated scope allowing direct visualization of sinuses and tissues, with ability to obtain samples if needed.
• Cultures and microbiological testing: Samples of secretions identify bacterial type and antibiotic sensitivity.
• Allergy testing: If allergy is suspected as primary cause.
• Immunological assessment: In recurrent or severe chronic cases, tests may evaluate immune function.

Medications

• Saline nasal rinses: Spray or drops 2-4 times daily cleanse sinuses from secretions and reduce inflammation. Very safe, suitable for children and pregnant women.
• Nasal corticosteroids: Such as fluticasone or mometasone, reduce inflammation and swelling quickly. Use 1-2 sprays per nostril once or twice daily. Safe for long-term use when necessary.
• Oral antihistamines: For allergy-related cases. Help reduce congestion and sneezing but have limited efficacy in frank sinusitis.
• Antibiotics: Only prescribed for suspected bacterial infection (yellow/green discharge, fever, symptoms >7-10 days). Common choices: amoxicillin-clavulanate or azithromycin for 7-10 days.
• Pain relievers: Acetaminophen or ibuprofen relieve headaches and facial pain. Do not treat the cause but provide temporary relief.
• Nasal decongestants: Such as phenylephrine sprays provide short-term relief for only 2 days. Avoid prolonged use to prevent rebound congestion.
• Leukotriene receptor antagonists: Such as montelukast (Singulair) beneficial for asthma- or allergy-associated cases.

Procedures and Interventions

• Sinus irrigation: Office procedure using pressurized saline to flush sinuses. Used in severe chronic cases.
• Functional Endoscopic Sinus Surgery (FESS): Minimally invasive procedure using high-quality endoscope to widen natural sinus drainage openings. Used after medical treatment failure (3-4 weeks minimum) or with septal deviation/tumors.
• Polypectomy: Surgical removal of nasal polyps obstructing passages. Often a cause of chronic inflammation.
• Septoplasty: Corrects deviated nasal septum to improve drainage and reduce chronic congestion.

Lifestyle Changes and Tips

• Steam inhalation: 2-3 times daily for 10-15 minutes (from hot water or warm shower) humidifies tissues and facilitates mucus drainage.
• Stay hydrated: Drink 2-3 liters water daily to make secretions less viscous and easier to drain.
• Avoid environmental triggers: Dust, smoke, pollutants, and strong odors.
• Control allergies: Avoid allergens and take allergy medications as needed.
• Avoid excessive NSAIDs: In some cases, may worsen condition.
• Sleep with elevated head: Use two pillows to improve nighttime mucus drainage.
• Avoid cigarette smoke completely: Both active and passive smoking.
• Manage gastroesophageal reflux: If present, treat to reduce secondary inflammation.

• Meningitis: Occurs when infection spreads to brain membranes. Life-threatening, requires hospitalization and immediate IV antibiotic therapy.
• Brain abscess: Pus accumulation in brain tissue from infection. Can cause seizures and loss of consciousness, requiring emergency surgery.
• Orbital cellulitis: Infection spreading to tissues around eyes causing redness, swelling, and severe pain. May lead to vision loss if untreated promptly.
• Periorbital abscess: Pus collection around eye causing severe pain and swelling. May require surgical drainage.
• Cavernous sinus thrombosis: Blood clot in large vein behind eyes. Rare but fatal complication causing eye paralysis and death.
• Osteomyelitis: Infection spreading to sinus bones causing bone tissue breakdown. Requires prolonged treatment.
• Vision impairment and blindness: Rare cases when inflammation extends to optic nerve tissue.

• Maintain hand and nasal hygiene: Wash hands thoroughly with soap and water, especially after sneezing, coughing, and before touching face.
• Avoid infected persons: Keep distance from people with cold and flu symptoms during contagious periods.
• Get annual flu vaccine: Especially for high-risk groups (elderly, children, pregnant women).
• Control allergies: Avoid allergens (dust, pet dander, pollen) and use air purifiers.
• Quit smoking: Cigarette smoke damages cilia responsible for sinus clearing.
• Improve indoor air quality: Use humidifiers in winter and dry weather. Avoid harsh air conditioning.
• Drink adequate water: Hydration facilitates natural mucus drainage.
• Avoid running and swimming in polluted water: Water and contaminants may enter sinuses.
• Treat oral and dental infections promptly: Dental infections can spread to maxillary sinuses.
• Maintain normal blood pressure: Hypertension may increase nasal congestion.