Sinusitis

What is sinusitis?
Sinusitis is an infection or inflammation of the lining of the air-filled cavities in the skull. These air-filled cavities are located above the eyebrows in the forehead, behind the nose, and just below the eyes. They drain into the nose. The most common cause of acute sinus pain is a viral infection of the respiratory tract leading to obstruction of the drainage of these sinuses.

The key distinction between a cold and sinusitis is that the nasal congestion and other symptoms of a cold begin to improve within 5 to 7 days. The symptoms of sinusitis, however, last longer and may even worsen with time.

What are the symptoms of sinusitis?
Sinusitis symptoms begin with fullness of the involved sinuses, nasal discharge and cold symptoms. The obstruction of the sinuses leads to a bacterial infection in the sinuses themselves. When this happens, symptoms typically become more severe and may include fever, chills, increased pain and tenderness over the involved sinuses. This is often accompanied by a thick, yellow/green and sometimes blood streaked nasal discharge. Sometimes the pain over the sinus changes in intensity with changes in position. There may also be a loss of taste and smell, and aching of the upper teeth if the infection is severe.

How is sinusitis treated?
Acute bacterial sinusitis is usually treated with antibiotics, anti-inflammatories (Advil), decongestants, mucolytics, steroid nasal sprays and hot compresses on the sinuses. It also helps to elevate the head and use humidifier while sleeping. Prevention of sinusitis can sometimes be accomplished by treating a cold early on with fluids, humidified air, a hot compress to the sinuses and rest.

Chronic sinusitis is often more difficult to diagnose. Symptoms are less severe, and post-nasal drip or drainage is often the only symptom of chronic sinusitis. Chronic frontal headaches, obstruction of the nasal airway and tenderness over any of the sinuses may also indicate chronic infection. In many instances, a patient has a background of allergies or exposure to cigarette smoke, and the treatment of chronic sinusitis is often directed towards treatment of the underlying allergies with steroid nasal sprays. Long-term antibiotics may be required to eliminate a chronic sinus infection.

Once treatment for sinusitis has begun, you should return to Health Services if you have increased headache or facial pain, continuing high fever, or if symptoms are not improving after 4 or 5 days of treatment.

Is there a way to prevent sinusitis?
Nasal irrigation, with a salt-water spray such as "Ocean" or a Neti Pot is very helpful in both the prevention and the treatment of sinusitis. A Neti Pot is a small teapot shaped vessel that can be purchased at pharmacies, including our Health Services pharmacy.

Why is nasal irrigation helpful?
Irrigating or spraying the nose with salt water-such as with saline nasal sprays that are purchased in the pharmacy without prescription-is useful for cleaning mucous out of the nasal passages and relieving nasal congestion. With proper use of an inexpensive device called a Neti Pot, it is possible to irrigate the sinus cavities. When a strong salt-water solution is used, the sinuses are stimulated to expel mucous that is trapped and stagnating. This results in a "runny nose" that may last for 10 or 15 minutes, after which the sinuses are relatively empty with less material to drain out and cause postnasal drip. In addition, germs tend to breed in this mucous, so the less mucous there is, the less likely it is that you will get a sinus infection. The whole process is simple, comfortable and quick. After you do it once or twice, it should require no more than a few minutes to complete an irrigation from start to finish.

One or 2 minutes a day spent performing nasal irrigation is often more effective than weeks and weeks of antibiotics, decongestants, and cortisone nasal sprays, and has none of the side effects of these medications. Even if you do require medications or surgery, the improved cleanliness of the sinuses makes it more likely that these treatments will be effective.

How do I irrigate?
First, it is important not to use common table salt to irrigate the nose on a regular basis, because it contains certain chemicals such as iodine and "anti-clumping" additives that can be harmful if used frequently. You can use Kosher salt (found in most groceries right along with the table salt) or sea salt found in health food stores.

With a measuring spoon, add 1 teaspoon of salt to the Neti Pot and fill it with warm tap water. Stir very thoroughly. The salt water usually doesn't sting but the salt particles will if they are not dissolved well. You can use a little less than a teaspoon at first if it feels more comfortable, but after a few days there should be no discomfort at all and you can mix it a little stronger.

Lean over the sink, tilt your head to one side (it should be almost flat-one ear up and one ear down), and put the spout of the Neti Pot into the upper nostril. Pour the salt water slowly into your nose while you continue breathing through your mouth. The water will flow into the upper nostril, turn the corner at the back of the nose, and trickle back out the lower nostril. When the pot is about half empty, stop, turn your head the other way and repeat the process.

Let the water drip out, then gently blow your nose. You will probably need to blow it several times in the next few minutes as your sinuses drain.

How often should I irrigate?
After you do this a while, you'll find what works best for you (and it does vary from one person to the next). Start off irrigating once in the morning and once in the evening. There is no harm in doing it 3 to 4 times a day and it may be useful to do so if you have a lot of drainage. If after a week or so your nose seems much clearer and you are not having much drainage during the day, reduce it to just one irrigation in the morning. You may continue this indefinitely, or you may only irrigate when you feel the congestion or postnasal drip is recurring.

Hot Compresses
Hot compresses to the sinuses also help as they promote movement of the tiny hairs that line the nasal cavity, cleaning mucus and pus. Simply moisten a facecloth with warm water and lay across forehead (above the eyes) and/or cheekbones for 5 minutes three times a day. Placing a dry facecloth over the heated wet one will help retain heat for the full 5 minutes.

Links you can use
To learn more about sinusitis, you can visit:

last modified: March 19, 2009