Published: Sunday January 1, 2012 MYT 12:00:00 AM
Updated: Monday August 19, 2013 MYT 4:32:55 PM

When sinuses attack

We actually have air-filled spaces in the skull located behind the forehead, cheeks, nose, and between and behind the eyes. These are called sinuses, and they can be problematic when infection sets in.

YOU’RE sneezing and coughing. You’ve used up an entire box of tissues and your nose is bright red and sore from all the wiping and blowing. Are you down with the seasonal cold? Is it the flu? Perhaps not ... it could be an attack on your sinuses.

Sinusitis is a common problem worldwide. The estimated prevalence of sinusitis in Malaysia is 12.8%. This means that around three million Malaysians are suffering at any one time. Sinusitis is one of the leading forms of chronic disease, with an estimated 18 million cases and at least 30 million courses of antibiotics prescribed each year.

In one study, 55% of patients with sinusitis also had a history of allergic rhinitis.

What are sinuses?

The sinuses are air-filled spaces in the skull located behind the forehead, cheeks, nose, and between and behind the eyes. Usually, mucous is able to drain out of these sinuses and air is able to circulate. However, when the sinus cavities around your nose become inflamed and swollen, this will interfere with the drainage, causing mucous build-up. This is sinusitis.

Acute sinusitis is a sinus infection that lasts between seven and 10 days and is most often caused by the common cold.

Chronic sinusitis is long term sinus inflammation of about 12 weeks or more, and keeps recurring despite treatment.

Sinusitis can be caused by viral (common cold), bacterial or fungal infection. However, your risk of sinusitis may increase with some health conditions such as allergies (hay fever/food allergies/pollutants), nasal polyps or tumours, deviated nasal septum, enlarged or infected adenoids in children, tooth infection and immune system disorders.

The classic symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that worsens after five to seven days of symptoms. Symptoms include:

Bad breath or loss of sense of smell Cough, often worse at night Fatigue and generally not feeling well Fever Headache – pressure-like pain, pain behind the eyes, toothache, or facial tenderness Nasal congestion and discharge Sore throat and postnasal drip Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder (fever is not common) and last longer than 12 weeks.

Contact your doctor if your symptoms do not improve, if they recur, or if there are signs of serious infection such as pain and swelling around the eyes, swollen forehead, severe headache, confusion, double vision, stiff neck or shortness of breath.

How do I know it’s sinusitis?

Your doctor will use several methods to help screen for sinusitis, such as looking in the nose for signs of polyps, shining a light against the sinus for signs of inflammation or even tapping over a sinus area to find infection.

An ear nose and throat (ENT) specialist will diagnose sinusitis by viewing the sinuses using a fibreoptic scope (endoscopy). A computerised tomography (CT) or magnetic resonance imaging (MRI) can help identify a deep inflammation or a physical obstruction.

Laboratory tests are generally unnecessary for diagnosing acute sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial agent. Sometimes a skin allergy test may be necessary.

How is sinusitis treated?

Some self-help remedies to relieve symptoms include rest, drinking plenty of fluids, steam inhalation, warm compress on the face, rinsing your nasal passages and sleeping with your head elevated to help drain the sinuses.

To help relieve symptoms, your doctor may prescribe a saline nasal spray to rinse your nasal passages. Nasal corticosteroids will help prevent and treat inflammation (e.g. fluticasone, mometasone, budesonide).

Nasal decongestants are available in liquid form, nasal sprays (e.g. oxymetazoline) and tablets (e.g. pseudoephedrine). These generally are taken for only a few days at most.

Pain relievers such as aspirin, acetaminophen or non-steroidal anti-inflammatory drugs may also be given.

Antibiotics won’t help when acute sinusitis is caused by a viral or fungal infection. Although rare, acute sinusitis may be due to a fungal infection, which is then treated with antifungal medication.

The vast majority of cases of sinusitis is caused by viruses and can be resolved without antibiotics. If your doctor prescribes antibiotics, it is critical to take the entire course of medication even after your symptoms get better.

Antibiotic treatment is generally needed only if the infection is of bacterial origin, with the most common causative agents being Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. An initial outpatient treatment may include orally administered antibiotics such as amoxicillin, amoxicillin/clavulanate or moxifloxacin.

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) may help reduce your body’s reaction to specific allergens and help alleviate symptoms.

Endoscopic surgery to clean and drain the sinuses may also be necessary, especially in patients whose symptoms persist after three months despite medical treatment, or in patients who have more than two or three episodes of acute sinusitis each year (chronic sinusitis).

What are the possible complications?

Acute sinusitis can trigger an asthmatic attack or it could flare into a chronic problem. It sometimes occurs with an ear infection, or if an infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

The close proximity of the brain to the sinuses makes an infection of the brain the most dangerous complication of sinusitis. Infection of the brain by the invasion of anaerobic bacteria through the bones or blood vessels can cause abscesses, meningitis, and other life-threatening conditions.

It is good to take measures to reduce the risk of getting sinusitis. Avoid upper respiratory infections by minimising contact with people who have colds. Wash your hands frequently with soap and water, especially before meals. Carefully manage your allergies. Work with your doctor to keep symptoms under control. Avoid cigarette smoke and polluted air. Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.

To quote Franklin Pierce Adams, a witty American columnist and a prolific writer: “Health is the thing that makes you feel that now is the best time of the year.” Let’s all mark the turn of the new year with better health and celebrate healthy living. Happy New Year!


1. Visual informatics: Bridging Research and Practice: First…(page 202)

2. American Academy of Allergy Asthma & Immunology

3. The Mayo Clinic

4. A.D.A.M Medical Encyclopedia

5. Leung, R.S.; Katial, R. (2008). “The Diagnosis and Management of Acute and Chronic Sinusitis

This article is contributed by Dr Kalpana Nayar, Medical Advisor with Bayer HealthCare. This information is provided for educational purposes only and should not be taken in place of a consultation with your doctor. Bayer HealthCare and The Star disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.

Tags / Keywords: Health, Lifestyle, Health, sinuses, sinusitis, treatment, cause and effects


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