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You’re coughing and sneezing and tired and achy. You think that you might be
getting a cold. Later, when the medicines you’ve been taking to relieve the
symptoms of the common cold are not working and you’ve now got a terrible
headache, you finally drag yourself to the doctor. After listening to your
history of symptoms, examining your face and forehead, and perhaps doing a
sinus X-ray, the doctor says you have sinusitis.
Sinusitis simply means your sinuses are infected or inflamed, but this gives
little indication of the misery and pain this condition can cause. Health
experts usually divide sinusitis cases into • Acute, which last for 4 weeks or
less • Subacute, which lasts 4 to 8 weeks • Chronic, which usually last up to 8
weeks but can continue for months or even years • Recurrent, which are several
acute attacks within a year, and may be caused by different organisms
Health experts estimate that 37 million Americans are affected by sinusitis
every year. Health care providers report nearly 32 million cases of chronic
sinusitis to the Centers for Disease Control and Prevention annually. Americans
spend $5.8 billion each year on health care costs related to sinusitis.
What are sinuses?
Sinuses are hollow air spaces in the human body. When people say, “I'm having a
sinus attack,” they usually are referring to symptoms in one or more of four
pairs of cavities, or sinuses, known as paranasal sinuses . These
cavities, located within the skull or bones of the head surrounding the nose,
over the eyes in the brow area
inside each cheekbone
just behind the bridge of the nose and between the eyes
Sphenoid sinuses behind the ethmoids in the upper region of the nose
and behind the eyes
Each sinus has an opening into the nose for the free exchange of air and mucus,
and each is joined with the nasal passages by a continuous mucous membrane
lining. Therefore, anything that causes a swelling in the nose—an infection, an
allergic reaction, or another type of immune reaction—also can affect the
sinuses. Air trapped within a blocked sinus, along with pus or other
secretions, may cause pressure on the sinus wall. The result is the sometimes
intense pain of a sinus attack. Similarly, when air is prevented from entering
a paranasal sinus by a swollen membrane at the opening, a vacuum can be created
that also causes pain.
SOME CAUSES OF ACUTE SINUSITIS
Most cases of acute sinusitis start with a common cold, which is caused by a
virus. These viral colds do not cause symptoms of sinusitis, but they do
inflame the sinuses. Both the cold and the sinus inflammation usually go away
without treatment in 2 weeks. The inflammation, however, might explain why
having a cold increases your likelihood of developing acute sinusitis. For
example, your nose reacts to an invasion by viruses that cause infections such
as the common cold or flu by producing mucus and sending white blood cells to
the lining of the nose, which congest and swell the nasal passages.
When this swelling involves the adjacent mucous membranes of your sinuses, air
and mucus are trapped behind the narrowed openings of the sinuses. When your
sinus openings become too narrow, mucus cannot drain properly. This increase in
mucus sets up prime conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as Streptococcus pneumoniae and
, in their upper respiratory tracts with no problems until the body's defenses
are weakened or drainage from the sinuses is blocked by a cold or other viral
infection. Thus, bacteria that may have been living harmlessly in your nose or
throat can multiply and invade your sinuses, causing an acute sinus infection.
Sometimes, fungal infections can cause acute sinusitis. Although fungi are
abundant in the environment, they usually are harmless to healthy people
because the human body has a natural resistance to fungi. Fungi, such as Aspergillus
, can cause serious illness in people whose immune systems are not functioning
properly. Some people with fungal sinusitis have an allergic-type reaction to
Chronic inflammation of the nasal passages also can lead to sinusitis. If you
have allergic rhinitis, also called hay fever, you can develop episodes of
acute sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol,
perfumes, and other environmental conditions, also may be complicated by sinus
infections. (Rhinitis simply means runny nose.)
Acute sinusitis is much more common in some people than in the general
population. For example, sinusitis occurs more often in people who have reduced
immune function (such as those with primary immune deficiency diseases or HIV
infection) and with abnormality of mucus secretion or mucus movement (such as
those with cystic fibrosis).
CAUSES OF CHRONIC SINUSITIS
It can be difficult to determine the cause of chronic sinusitis. Some health
experts think it is an infectious disease, but others are not certain. It is an
inflammatory disease that often occurs in people with asthma. If you have
asthma, which is an allergic disease, you may have chronic sinusitis which may
make it worse. If you are allergic to airborne allergens, such as house dust
mites, mold, and pollen, which trigger allergic rhinitis, you may develop
chronic sinusitis. An allergic reaction to certain fungi may be responsible for
at least some cases of chronic sinusitis. In addition, people who are allergic
to fungi can develop a condition called "allergic fungal sinusitis."
If you are prone to getting chronic sinusitis, damp weather, especially in
northern temperate climates, or pollutants in the air and in buildings also can
If you have an immune deficiency disorder or an abnormality in the way mucus
moves through and from your respiratory system (for example, primary immune
deficiency, HIV infection, or cystic fibrosis), you might develop chronic
sinusitis with frequent bouts of acute sinusitis due to infections. In
addition, if you have severe asthma, nasal polyps (small growths in the nose),
or a severe asthma attack caused by aspirin and aspirin-like medicines such as
ibuprofen, you might have chronic sinusitis.
The location of your sinus pain depends on which sinus is affected.
Headache when you wake up in the morning is typical of a sinus problem.
Pain when your forehead over the frontal sinuses is touched may mean that your
frontal sinuses are inflamed.
Infection in the maxillary sinuses can cause your upper jaw and teeth to ache,
and your cheeks to become tender to the touch.
The ethmoid sinuses are near the tear ducts in the corner of your eyes.
Therefore, inflammation of these cavities often causes swelling of the eyelids
and tissues around your eyes, and pain between your eyes. Ethmoid inflammation
also can cause tenderness when you touch the sides of your nose, a loss of
smell, and a stuffy nose.
Infection in the sphenoid sinuses can cause earaches, neck pain, and deep
aching at the top of your head, although these sinuses are less frequently
Most people with sinusitis, however, have pain or tenderness in several
locations, and their symptoms usually do not clearly show which sinuses are
Other symptoms of sinusitis can include
A cough that may be more severe at night
Rhinitis or nasal congestion
In addition, the drainage of mucus from the sphenoid or other sinuses down the
back of your throat (postnasal drip) can cause you to have a sore throat. Mucus
drainage also can irritate the membranes lining your larynx (upper windpipe).
Not everyone with these symptoms, however, has sinusitis.
On rare occasions, acute sinusitis can result in brain infection and other
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