15 Questions You Probably Have About Sinus Infections

Jeffrey Terrell, MD, specializes in treating sinus problems. Here, he offers expert advice on recognizing, treating, and avoiding sinus infections.

Can it be dangerous to ignore sinus infections?

It's best to see your doctor if you think you have a sinus infection. Very, very rarely, sinus infections can spread to the tissues surrounding the sinuses, the eye, or the brain, with consequences including blindness, meningitis, and even death.

What exactly are sinuses?

The sinuses are four paired sets of air-filled cavities in the bones of the head: the frontal sinuses, above the eyes; the maxillary sinuses, in the cheekbones; the ethmoid sinuses, between the eyes; and the sphenoid sinuses, which lie behind the nasal cavity and eyes. The sinuses are lined with mucus membranes and connect to the nasal cavity through tiny holes. When they are working properly, the sinuses help warm and humidify the air that passes through the nose. Along with the nasal cavity, they provide a kind of cushion of bone and tissue that protects the face and brain. They could even have some evolutionary significance; sinuses add resonance to the voice, which might have made it easier to attract a mate millions of years ago. But there's actually no real reason to have sinuses——these days we could survive quite well without them.

What is sinusitis?

Sinusitis is an inflammation of the lining of the sinuses, which can obstruct the normal flow of mucus and air in and out of the tiny holes connecting them to the nasal cavity. Normally, tiny hairs called cilia "beat" mucus and other debris out of the sinuses into the nasal cavity, but inflammation can slow this action, allowing mucus to remain within the sinus and become a bacterial breeding ground. Symptoms can include nasal obstruction, yellow-green nasal discharge, pain in the face over the sinus area, cough, malaise, and mild headache.

Why are some people more prone to sinusitis than others?

People with allergies, especially untreated allergies, are at greater risk of sinus infection because they often have inflammation of the tissue lining the nose, which can block sinus openings. Teachers, parents of young children, and others who develop frequent colds also are at greater risk. About 20% of people with severe asthma have nasal polyps, which are soft, benign growths in the linings of the nasal cavity and sinuses. They may develop frequent sinusitis, although this is a type of inflammation that typically doesn't involve a bacterial infection. More rarely, underlying genetic disorders or immune system problems can make a person more vulnerable to sinus infection.

Are there other conditions that get confused with sinusitis?

Some people with a severe headache think they have a sinus infection, but they may actually be experiencing a migraine. The headaches that can accompany sinus infections are relatively mild. The worse the headache, the more likely it's a migraine. Other migraine symptoms include nausea, vomiting, and sensitivity to light and sound. Twenty percent of patients with migraines will have visual symptoms too, which is very unusual for sinusitis. People with congestion due to allergies may also think they're suffering from sinusitis, but this may just be inflammation and irritation of their nasal passages.

During the winter, when the air gets dry, some people develop crusting in the nose, which brings on a bacterial infection. While these people may have some green or yellow nasal discharge, they do not have sinusitis. Irrigating the nasal passages regularly can be very helpful, and antibiotics probably aren't needed.

Are there any over-the-counter medications that help with sinusitis?

Painkillers like Tylenol and Motrin can help relieve sinus pain. Stronger drugs typically are not necessary or prescribed. Over-the-counter decongestants may also help some people, although there is no scientific evidence that they are of real benefit.

What about home remedies?

Saline irrigation of the nose and sinuses can be helpful for people with chronic sinusitis. Ask your doctor if this might work for you.

I've heard that decongestant nasal sprays can actually make congestion worse if you use them for too long. Is this true? How long can I use them safely?

Some medications can indeed cause something called rebound, in which the congestion returns after a few days of use. People can even become dependent on these products, relying on them for months or even years. To be safe, use products containing oxymetazoline no more than three to five days in a row.

How do I know whether I need to see a doctor for my sinus pain and pressure?

If you've had nasal congestion with green or yellow discharge for five to seven days and you're feeling facial pressure and pain, call your primary care doctor.

How do doctors decide when to prescribe antibiotics for sinus infections?

It's a judgment call. Your doctor will ask you about your symptoms and how long you've had them. If you have had tenderness over your sinuses, nasal obstruction, and yellow or green nasal discharge for more than five to seven days and your symptoms keep getting worse, your doctor may prescribe an antibiotic. Some doctors may want to wait a couple of days to see if your symptoms improve; if they do, you probably had a viral infection, and the antibiotics wouldn't have helped anyway.

When do people need to see a specialist for a sinus infection? Who should they see?

If you're having four or five sinus infections a year, you should see an otolaryngologist. These specialists are also called ear, nose, and throat doctors. Such repeat infections are known as acute recurrent sinusitis and are often a consequence of severe, untreated allergies. Treating the underlying condition should resolve the problem.

Chronic sinus infections, meaning those lasting at least three months that do not clear up with multiple courses of antibiotics, are less common, and also warrant an appointment with an ear, nose, and throat doctor. Again, the specialist will look for an underlying cause, such as scar tissue or some sort of anatomical obstruction of the sinuses, or even a fungal infection.

Experts now agree that chronic infections should be treated with three to six weeks of antibiotics. Patients may also be given steroid nasal sprays to help bring down inflammation in the nasal cavity and sinuses. Rinsing the nose with salt water can also be helpful, but ask your doctor first.

There are some otolaryngologists who specialize in treating sinus problems; you're more likely to find one of these subspecialists, known as rhinologists, at academic medical centers and large group practices.

What is sinus surgery?

People who aren't helped by medical treatment may be candidates for sinus surgery, which involves opening up the sinuses, clearing them out, and enlarging them. Patients undergo a CT scan, which allows the surgeon to map out the procedure beforehand. This imaging test may also be used in diagnosing sinusitis. Timing of the CT scan is important; if it's done while a person is experiencing an acute bout of sinusitis or even suffering from a cold, the tissue lining their sinuses will appear inflamed, making it difficult to get an accurate picture of the underlying problem.

How is sinus surgery performed?

Sinus surgery is done under general anesthesia on an outpatient basis. Tiny instruments are inserted through the nostrils and used to remove bone and tissue through the nose. It's a frequently done procedure, but a delicate one, especially as the surgeon is operating in close proximity to the eyes and brain. Significant or serious complications do happen, but they are rare, ranging from 1 in 100 to 1 in 1,000 surgeries. These complications can include major hemorrhage or cerebrospinal fluid leakage, if the base of the skull is punctured accidentally. As with any operation, surgeons who perform the most sinus surgeries are typically the most skilled at the procedure.

Some surgeons may pack the nose with material to reduce bleeding. Patients typically feel sore for two or three days. Those with packing need to have the material removed, usually about a week after the surgery.

Who should——or shouldn't——have sinus surgery?

While sinus surgery can be very helpful for the right patients, there are a lot of people out there having the operation who don't really need it. Your physician must take the time to carefully evaluate you and rule out any other conditions that might be causing your symptoms, such as migraines or allergies.

What's the best way I can protect myself from sinusitis?

The best strategy is simple: Try to avoid catching colds. Wash your hands frequently, and avoid places where you might be exposed to sneezers and snifflers. If you have allergies, get treatment.

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