Sinusitis

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    Last Updated: August 16, 2023

    Sinus infection happens when fluid builds up in the sinuses (air-filled pockets in the face), promoting the growth of germs. It is most commonly caused by a cold and can also be caused by allergies. Symptoms include facial pressure, fever, nasal congestion, and postnasal drip.

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    Sinusitis falls under the Ear, Nose & Throat category.

    What is sinusitis?

    Sinusitis is the inflammation of the air cavities inside the skull (sinuses), usually due to a virus or a bacterial infection. Acute sinusitis is often caused by the common cold virus and normally goes away on its own in less than 4 weeks. Viral sinusitis is one of the most common reasons for improper prescription of antibiotics. Chronic sinusitis lasts for longer than 8 weeks and affects up to 12% of the general population.[1]

    What are the main signs and symptoms of sinusitis?

    Common symptoms of sinusitis include nasal blockage, congestion, discolored nasal discharge, facial tenderness/pain, reduced sense of smell, cough, fever, toothache, and bad breath. Viral sinusitis from the common cold typically resolves in 7-10 days. Bacterial sinusitis may be suspected when symptoms are severe, last more than 10 days without improvement, or worsen after starting to improve initially.[1][2]

    How is sinusitis diagnosed?

    Uncomplicated sinusitis is diagnosed by clinical presentation. Major factors to indicate sinusitis include facial pain, nasal congestion, nasal blockage, discolored mucus, loss of smell, and fever. Minor factors that indicate sinusitis include headache, bad breath, tooth pain, ear pain, fatigue, cough, and otalgia (earache).[3] Additional testing (e.g., cultures) and imaging (e.g., computed tomography) may be done if a bacterial or fungal infection or a chronic or complex disease is suspected.[1] [3]

    What are some of the main medical treatments for sinusitis?

    Common medical treatments for sinusitis are for symptom relief. Nasal irrigation with saline water is commonly used to reduce nasal congestion and help clear mucus. Also, for reducing congestion, nasal sprays such as oxymetazoline (which should not be used for more than 3 days to avoid rebound congestion) or oral pills such as pseudoephedrine may be used. Antihistamines (diphenhydramine, cetirizine, loratadine, etc.) are not beneficial in viral or bacterial sinusitis, but can help in allergic sinusitis (allergic rhinitis). Topical steroid sprays are best left for chronic and allergic sinusitis. Antibiotics (e.g., amoxicillin-clavulanate) are used sparingly due to concerns of resistance, but can alleviate bacterial sinusitis which does not improve after watchful waiting.[4][3]

    Have any supplements been studied for sinusitis?

    European guidelines hold that supplements with some benefit for the common cold can also be tried for acute sinusitis, for example zinc, vitamin C, and probiotics.[1] Other supplements with limited evidence for improving sinusitis symptoms include umckaloabo (Pelargonium sidoides), bromelain (pineapple enzyme), cod liver oil, horseradish root, and andrographis. [5] Combination herbal products, often containing Flos magnoliae and Siberian cocklebur fruit, have been studied in China and Taiwan, showing benefit for sinusitis symptoms. However, the generalizability of these results to other geographic locations is unknown.[6]

    What's the connection between diet and sinusitis?

    Specific dietary modifications have not been studied for sinusitis. However, some researchers propose that increasing foods high in polyphenols, such as ginger and green tea, may reduce inflammation and mucus production and therefore moderate symptoms in sinusitis. Following an anti-inflammatory diet, and avoiding refined sugars and processed foods (high in artificial colors, preservatives, histamine) may be helpful, as they may increase inflammation and exacerbate sinusitis symptoms.[5][7][8] Also, because milk allergy is common in chronic sinusitis, its intake can worsen symptoms in some people.[9]

    Are there any other treatments for sinusitis?

    Regular exercise, stress management, adequate hydration, good sleep quality and avoidance of environmental toxins (pollution, smoke, etc.) are lifestyle modifications that may help to prevent sinusitis. Also, acupressure and acupuncture have been used to alleviate sinusitis-related symptoms such as facial pain. Although nasal washes with saline are most common, nasal washes containing manuka honey or the herb Cyclamen europaeum have also been studied, but did not seem promising.[5]

    What causes sinusitis?

    The common cold virus is the most common cause of acute sinusitis. Bacterial sinusitis is usually caused by Haemophilus influenzae, and less commonly by Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, or anaerobic bacteria. Chronic sinusitis is most commonly caused by Staphylococcus aureus or multiple bacteria, while fungal sinusitis is most commonly seen in immunocompromised patients and caused by Aspergillus.[3] Physiologically, sinusitis develops when clearance of mucus is impaired and and the nasal cavity is abnormal or not functioning properly.[10]

    Examine Database: Sinusitis

    Frequently asked questions

    What is sinusitis?

    Sinusitis is the inflammation of the air cavities inside the skull (sinuses), usually due to a virus or a bacterial infection. Acute sinusitis is often caused by the common cold virus and normally goes away on its own in less than 4 weeks. Viral sinusitis is one of the most common reasons for improper prescription of antibiotics. Chronic sinusitis lasts for longer than 8 weeks and affects up to 12% of the general population.[1]

    What are the main signs and symptoms of sinusitis?

    Common symptoms of sinusitis include nasal blockage, congestion, discolored nasal discharge, facial tenderness/pain, reduced sense of smell, cough, fever, toothache, and bad breath. Viral sinusitis from the common cold typically resolves in 7-10 days. Bacterial sinusitis may be suspected when symptoms are severe, last more than 10 days without improvement, or worsen after starting to improve initially.[1][2]

    How is sinusitis diagnosed?

    Uncomplicated sinusitis is diagnosed by clinical presentation. Major factors to indicate sinusitis include facial pain, nasal congestion, nasal blockage, discolored mucus, loss of smell, and fever. Minor factors that indicate sinusitis include headache, bad breath, tooth pain, ear pain, fatigue, cough, and otalgia (earache).[3] Additional testing (e.g., cultures) and imaging (e.g., computed tomography) may be done if a bacterial or fungal infection or a chronic or complex disease is suspected.[1] [3]

    What are some of the main medical treatments for sinusitis?

    Common medical treatments for sinusitis are for symptom relief. Nasal irrigation with saline water is commonly used to reduce nasal congestion and help clear mucus. Also, for reducing congestion, nasal sprays such as oxymetazoline (which should not be used for more than 3 days to avoid rebound congestion) or oral pills such as pseudoephedrine may be used. Antihistamines (diphenhydramine, cetirizine, loratadine, etc.) are not beneficial in viral or bacterial sinusitis, but can help in allergic sinusitis (allergic rhinitis). Topical steroid sprays are best left for chronic and allergic sinusitis. Antibiotics (e.g., amoxicillin-clavulanate) are used sparingly due to concerns of resistance, but can alleviate bacterial sinusitis which does not improve after watchful waiting.[4][3]

    Do saline rinses help with sinusitis?

    There is no strong evidence that nasal saline rinses help with chronic sinusitis,[11] but they do seem to improve symptoms of allergic sinusitis.[12] Guidelines hold that even though there’s no strong evidence of benefit of nasal saline irrigation, there is also very little evidence of harm.[1]

    Have any supplements been studied for sinusitis?

    European guidelines hold that supplements with some benefit for the common cold can also be tried for acute sinusitis, for example zinc, vitamin C, and probiotics.[1] Other supplements with limited evidence for improving sinusitis symptoms include umckaloabo (Pelargonium sidoides), bromelain (pineapple enzyme), cod liver oil, horseradish root, and andrographis. [5] Combination herbal products, often containing Flos magnoliae and Siberian cocklebur fruit, have been studied in China and Taiwan, showing benefit for sinusitis symptoms. However, the generalizability of these results to other geographic locations is unknown.[6]

    What's the connection between diet and sinusitis?

    Specific dietary modifications have not been studied for sinusitis. However, some researchers propose that increasing foods high in polyphenols, such as ginger and green tea, may reduce inflammation and mucus production and therefore moderate symptoms in sinusitis. Following an anti-inflammatory diet, and avoiding refined sugars and processed foods (high in artificial colors, preservatives, histamine) may be helpful, as they may increase inflammation and exacerbate sinusitis symptoms.[5][7][8] Also, because milk allergy is common in chronic sinusitis, its intake can worsen symptoms in some people.[9]

    Are there any other treatments for sinusitis?

    Regular exercise, stress management, adequate hydration, good sleep quality and avoidance of environmental toxins (pollution, smoke, etc.) are lifestyle modifications that may help to prevent sinusitis. Also, acupressure and acupuncture have been used to alleviate sinusitis-related symptoms such as facial pain. Although nasal washes with saline are most common, nasal washes containing manuka honey or the herb Cyclamen europaeum have also been studied, but did not seem promising.[5]

    What causes sinusitis?

    The common cold virus is the most common cause of acute sinusitis. Bacterial sinusitis is usually caused by Haemophilus influenzae, and less commonly by Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, or anaerobic bacteria. Chronic sinusitis is most commonly caused by Staphylococcus aureus or multiple bacteria, while fungal sinusitis is most commonly seen in immunocompromised patients and caused by Aspergillus.[3] Physiologically, sinusitis develops when clearance of mucus is impaired and and the nasal cavity is abnormal or not functioning properly.[10]

    Update History

    References

    1. ^Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Terezinha Anselmo-Lima W, Bachert C, Baroody F, von Buchwald C, Cervin A, Cohen N, Constantinidis J, De Gabory L, Desrosiers M, Diamant Z, Douglas RG, Gevaert PH, Hafner A, Harvey RJ, Joos GF, Kalogjera L, Knill A, Kocks JH, Landis BN, Limpens J, Lebeer S, Lourenco O, Meco C, Matricardi PM, O'Mahony L, Philpott CM, Ryan D, Schlosser R, Senior B, Smith TL, Teeling T, Tomazic PV, Wang DY, Wang D, Zhang L, Agius AM, Ahlstrom-Emanuelsson C, Alabri R, Albu S, Alhabash S, Aleksic A, Aloulah M, Al-Qudah M, Alsaleh S, Baban MA, Baudoin T, Balvers T, Battaglia P, Bedoya JD, Beule A, Bofares KM, Braverman I, Brozek-Madry E, Richard B, Callejas C, Carrie S, Caulley L, Chussi D, de Corso E, Coste A, El Hadi U, Elfarouk A, Eloy PH, Farrokhi S, Felisati G, Ferrari MD, Fishchuk R, Grayson W, Goncalves PM, Grdinic B, Grgic V, Hamizan AW, Heinichen JV, Husain S, Ping TI, Ivaska J, Jakimovska F, Jovancevic L, Kakande E, Kamel R, Karpischenko S, Kariyawasam HH, Kawauchi H, Kjeldsen A, Klimek L, Krzeski A, Kopacheva Barsova G, Kim SW, Lal D, Letort JJ, Lopatin A, Mahdjoubi A, Mesbahi A, Netkovski J, Nyenbue Tshipukane D, Obando-Valverde A, Okano M, Onerci M, Ong YK, Orlandi R, Otori N, Ouennoughy K, Ozkan M, Peric A, Plzak J, Prokopakis E, Prepageran N, Psaltis A, Pugin B, Raftopulos M, Rombaux P, Riechelmann H, Sahtout S, Sarafoleanu CC, Searyoh K, Rhee CS, Shi J, Shkoukani M, Shukuryan AK, Sicak M, Smyth D, Sindvongs K, Soklic Kosak T, Stjarne P, Sutikno B, Steinsvag S, Tantilipikorn P, Thanaviratananich S, Tran T, Urbancic J, Valiulius A, Vasquez de Aparicio C, Vicheva D, Virkkula PM, Vicente G, Voegels R, Wagenmann MM, Wardani RS, Welge-Lussen A, Witterick I, Wright E, Zabolotniy D, Zsolt B, Zwetsloot CPEuropean Position Paper on Rhinosinusitis and Nasal Polyps 2020.Rhinology.(2020-Feb-20)
    2. ^Jaume F, Valls-Mateus M, Mullol JCommon Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020.Curr Allergy Asthma Rep.(2020-Jun-03)
    3. ^Battisti AS, Modi P, Pangia JSinusitisStatPearls.(2023-01)
    4. ^Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MDClinical practice guideline (update): adult sinusitis.Otolaryngol Head Neck Surg.(2015-Apr)
    5. ^Taw MB, Nguyen CT, Wang MBIntegrative Approach to Rhinosinusitis: An Update.Otolaryngol Clin North Am.(2022-Oct)
    6. ^Lee B, Kwon CY, Park MYHerbal medicine for the treatment of chronic rhinosinusitis: A systematic review and meta-analysis.Front Pharmacol.(2022)
    7. ^Sawani A, Farhangi M, N CA, Maul TM, Parthasarathy S, Smallwood J, Wei JLLimiting Dietary Sugar Improves Pediatric Sinonasal Symptoms and Reduces Inflammation.J Med Food.(2018-Jun)
    8. ^Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDCHistamine Intolerance: The Current State of the Art.Biomolecules.(2020-Aug-14)
    9. ^Lill C, Loader B, Seemann R, Zumtobel M, Brunner M, Heiduschka G, Thurnher DMilk allergy is frequent in patients with chronic sinusitis and nasal polyposis.Am J Rhinol Allergy.(2011)
    10. ^He Y, Fu Y, Wu Y, Zhu T, Li HPathogenesis and treatment of chronic rhinosinusitis from the perspective of sinonasal epithelial dysfunction.Front Med (Lausanne).(2023)
    11. ^Chong LY, Head K, Hopkins C, Philpott C, Glew S, Scadding G, Burton MJ, Schilder AGSaline irrigation for chronic rhinosinusitis.Cochrane Database Syst Rev.(2016-Apr-26)
    12. ^Head K, Snidvongs K, Glew S, Scadding G, Schilder AG, Philpott C, Hopkins CSaline irrigation for allergic rhinitis.Cochrane Database Syst Rev.(2018-Jun-22)

    Examine Database References

    1. Mucus Production - Y Majima, M Inagaki, K Hirata, K Takeuchi, A Morishita, Y SakakuraThe effect of an orally administered proteolytic enzyme on the elasticity and viscosity of nasal mucusArch Otorhinolaryngol.(1988)
    2. Nasal Congestion - Bachert C, Schapowal A, Funk P, Kieser MTreatment of acute rhinosinusitis with the preparation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trialRhinology.(2009 Mar)