There are four hallmark symptoms of sinusitis:
- Nasal blockage or congestion, which people sometimes describe as stuffiness or inability to breathe well through the nose.
- Facial pain and pressure, which is usually around the eyes – either above, in between, or below the eyes where the sinuses are located. This can be sometimes associated with generalized headaches.
- Nasal drainage, which can occur in the form of constant runny nose or the need to blow the nose all the time, and post-nasal drip, when the secretions of the mucus from the nose drain down into the throat. This can lead to cough, throat clearing, scratchy or sore throat, and hoarseness. It’s important to note that the mucous drainage doesn’t always have to be discolored, such as yellow or green, in patients with sinusitis, and that we sometimes see thick, clear mucous drainage as well.
- Changes in sense of smell and taste. Usually, patients describe a decreased sense of smell and taste, but any alteration is abnormal.
It’s important to note that patients don’t always have all of these symptoms that I just described, and they may have a combination of these symptoms along with other symptoms, including low grade fevers, tooth pain, eye pressure, bad breath, fatigue, and even trouble concentrating.
The cause can be due to infection. However, this is not always the case. Infectious causes are very common. An upper respiratory viral infection like the common cold or flu can cause sinusitis and these typically resolve on their own after just a few weeks.
However, in many cases, infection of the sinuses can be due to bacterial infection, which may require antibiotics to resolve. Some of these infections can linger on for months or longer without proper treatment, and even have the potential to spread to important surrounding areas like the eyes or the brain, in very rare instances. In some cases we also find other organisms such as mold or fungus behind the cause of patients’ sinusitis.
Non-infectious causes of sinusitis are common as well. For instance, environmental allergies, where your body may be overreacting to harmless substances in the environment with increased swelling and mucus production, as if these substances were threatening invaders like a bacteria or virus as a common cause. Problems with sinus drainage anatomy due to blockage or narrowing of the small openings to the sinuses can also lead to sinusitis.
Similarly, if a patient’s sinus lining – which has the natural ability to clear mucus – is not functioning properly, the sinuses can get backed up and sinusitis may develop. Lastly, for unknown reasons some patients exhibit increased levels of inflammation in their sinuses leading to sinusitis and even nasal polyp formation, in some instances.
The treatment depends on the cause. Utilizing information from the history of the patient’s symptoms in conjunction with information from the highly specialized office diagnostic nasal endoscopy, we can often narrow down the possible causes.
When we think of ways to treat sinusitis, we like to categorize them into nonsurgical treatment options and surgical treatment options. We always try non-surgical treatments first. This can include over the counter medications, such as decongestants, antihistamines, and nasal sprays or irrigations. These are commonly used for viral sinusitis or allergic sinusitis. Prescription medications, such as topical antihistamine or steroid nasal sprays or irrigations may be used as well.
When severe inflammation or polyps are identified, short courses of oral steroids may be prescribed. When bacterial infections are identified, oral or topical antibiotics are commonly utilized as well. The diagnostic nasal endoscopy allows a sinus specialist like me to not only assess a patient’s response to therapies, but address more difficult cases where an infection may not be responding to antibiotics by culturing or growing the bacteria in the lab to figure out which antibiotics are best suited to treat the particular infection.
When we’ve exhausted non-surgical options and symptoms persist, we may consider a procedure to open the sinuses. This accomplishes several goals. Firstly, it widens the drainage pathways for sinuses allowing the sinuses to better clear their contents. Second, it allows us to clean the sinuses by removing disease, thick inflamed tissue and mucus, debris, pus, and whatever else might be stuck inside the sinuses. Lastly, having bigger openings to the sinuses allows many of the medical therapies to penetrate deeper into the nasal and sinus cavities and more effectively control the inflammation.