The human head famously weighs eight pounds, but it could weigh a lot more if it didn’t have sinuses. Nasal sinuses are air-filled spaces in the skull that open into the nasal passages. The sinuses are on either side of the nose just behind the cheeks and between the eyes. In acute sinusitis, the nasal passages and sinuses become inflamed and these spaces fill with fluid, which causes acute sinusitis symptoms.
Acute sinusitis symptoms
Acute sinusitis is commonly known as a sinus infection. People with acute sinusitis usually have a runny nose and stuffy nose at the same time. They may also have a fever, cough, fatigue, and bad breath.1
Unlike regular nasal congestion, a sinus infection causes significant pressure, fullness, and discomfort in the face and ears. In fact, one-way a doctor test to see whether a person has sinusitis is to tap on the bones just below the eyes. Normally this tapping is only slightly uncomfortable, but it can be quite painful for a person with an acute sinus infection.
How do I know if I have acute sinusitis?
Your doctor can perform a detailed examination in the office using an otoscope and a nasal speculum. While acute sinusitis can be definitively diagnosed with X-rays or head CT, most people do not need these studies.
What causes acute sinusitis?
A sinus infection is usually caused by virus. Most people first come down with a cold, then they develop viral sinusitis. While it only happens one time out of 50, bacteria can cause a sinus infection, too.2 Indeed, most people who develop bacterial sinusitis had viral sinusitis, first.2
Acute Sinusitis Treatment
Antibiotics can speed up recovery for bacterial sinusitis, but they are not helpful for viral sinusitis. Unfortunately, nothing can speed up recovery in viral sinusitis. Instead, the goal of acute sinusitis treatment is to treat the symptoms.
Some patients find nasal irrigation helpful. Nasal irrigation is flushing the nasal passages with clean, sterile saline solution (i.e. salt water). Using sterile saline solution is important because tap water, while seemingly clean, still contains viruses and bacteria. Tap water nasal irrigation can cause serious and, in rare cases, deadly infections.
Steroid nasal sprays reduce the severity of sinus infection symptoms.3 Some patients may find benefit from antihistamines, saline nasal spray, or decongestants, but there is little scientific evidence that they are actually helpful in an acute sinus infection.
When to see a doctor for acute sinusitis?
If you have been struggling with sinusitis symptoms for more than a few days, it is probably a good idea to seek medical attention. You may be dealing with bacterial sinusitis rather than simple viral sinusitis. “Red flag” symptoms include swelling around the eyes, severe headache, or a high fever. “Red flag” symptoms suggest complicated bacterial sinusitis or infection that has spread beyond the sinuses themselves. People with “red flag” symptoms should seek medical treatment.
Acute vs. Chronic Sinusitis
Acute sinusitis usually lasts a few days to weeks and then resolves. Even complicated bacterial sinusitis only lasts a few weeks. Chronic sinusitis, on the other hand, is sinus inflammation that lasts 12 weeks or more. While bacteria and viruses may contribute to chronic sinusitis, they are usually not the main cause. In fact, the same bacteria that is found in the sinuses of healthy people are also found in people with chronic sinusitis.4 Allergens and irritants also contribute to chronic sinusitis. Nasal polyps—benign growths on the surface of nasal passages and sinuses—are a major factor in chronic sinusitis in some people. Simply put, chronic sinusitis not only lasts longer than acute sinusitis, but it has different causes and the treatments are different.
Chronic Sinusitis Symptoms
The classic symptoms and signs of chronic sinusitis are:
- Facial pain/pressure/fullness
- Runny nose and/or post-nasal drip
- Nasal obstruction/congestion/blockage
- Impaired sense of smell and taste3,5
Chronic sinusitis may also cause throat irritation, bad breath, fatigue, and sleep disturbances. In children, cough is more likely to occur than a loss of taste or smell.
How do I know if I have chronic sinusitis?
As with acute sinusitis, your doctor can usually diagnose chronic sinusitis after a detailed history and physical examination. However, nasal endoscopy can provide considerably more information about the extent and cause of disease. X-ray or CT scans of the head and sinuses may be necessary in some cases. You may also need to have allergy testing.
Chronic Sinusitis Treatment
As with acute sinusitis, people may find relief from chronic sinusitis symptoms with nasal irrigation and intranasal steroids. Unless there is clear evidence of bacterial infection, antibiotics are not helpful for chronic sinusitis.
Sinus surgery can rapidly reduce symptoms of chronic sinusitis. An otolaryngologist (ENT doctor) can surgically remove nasal polyps. The ENT can also increase the size of the sinus openings to help promote fluid drainage. In some cases of severe inflammation, areas of the nasal or sinus tissue may need to be removed.