- Sinusitis or sinus infection is inflammation of the air cavities within the passages of the nose.
- Sinusitis can be caused by infection, allergies, and chemical or particulate irritation of the sinuses.
- Most people do not spread sinus infections to other people.
- Sinusitis may be classified as acute sinus infection, subacute sinus infection, chronic sinus infection, infected sinusitis, and noninfectious sinusitis.
- Sinusitis signs and symptoms include;
- Sinus headache,
- Facial tenderness,
- Pressure or pain in the sinuses, in the ears and teeth,
- Cloudy discolored nasal or postnasal drainage,
- The feeling of nasal stuffiness,
- Sore throat,
- Cough, and
- Occasionally facial swelling.
- Symptoms of a bacterial sinus infection include;
- Facial pain,
- Pus-like nasal discharge, and
- Symptoms that persist for longer than a week and that are not responding to over-the-counter (OTC) nasal medications.
- Sinus infection is generally diagnosed based on patient history and physical examination.
- Bacterial sinusitis is usually treated with antibiotics. Early treatment of allergic sinusitis may prevent secondary bacterial sinus infections.
- Home remedies for sinusitis and sinus infections include over-the-counter (OTC) medications such as acetaminophen (Tylenol and others), decongestants, and mucolytics. Nasal irrigation can be accomplished with a Neti-pot or rinse kit (nasal bidet).
- Rare fungal infections of the sinuses (for example, zygomycosis) are medical emergencies.
- Complications of a sinus infection that may develop are meningitis, brain abscess, osteomyelitis, and orbital cellulitis.
- There are no fungal vaccines available to prevent fungal sinus infections.
Is a Sinus Infection Contagious?
How Will I Know if I Have a Sinus Infection?
The majority of doctors think that most people do not transmit sinus infections except in rare instances, and conclude that sinus infections are not contagious.
Sinus infections usually begin with the symptoms of a cold (for example, a runny nose, occasional cough, and/or mild fever), and then develop into pain and pressure in the sinus cavities. About 7 to 10 days after initial cold-like symptoms other symptoms develop that suggest you may have a sinus infection. Sinus infection symptoms include
- A yellowish-greenish nasal discharge that may have an odor,
- Bad breathe,
- Puffiness around the eyes,
- Pressure in the sinuses, and
What are the sinuses? How many do we have?
A sinus is a hollow, air-filled cavity. For this article, a sinus will refer to those hollow cavities that are in the skull and connected to the nasal airway by a narrow hole in the bone (ostium). Normally all sinuses are open to the nasal airway through an ostium. Humans have four pair of these cavities each referred to as the:
- Frontal sinus (in the forehead),
- Maxillary sinus (behind cheeks),
- Ethmoid sinuses (between the eyes), and
- Sphenoid sinus (deep behind the ethmoids).
The four pairs of sinuses are often described as a unit and termed the “paranasal sinuses.” The cells of the inner lining of each sinus are mucus-secreting, epithelial cells, and some cells that are part of the immune system (macrophages, lymphocytes, and eosinophils).
Functions of the sinuses include humidifying and warming inspired air, insulation of surrounding structures (eyes, nerves), increasing voice resonance, and as buffers against facial trauma. The sinuses decrease the weight of the skull. If the inflammation hinders the clearance of mucous or blocks the natural ostium, the inflammation may progress into a bacterial infection.
18 signs and symptoms of sinus infection or sinusitis
There are many signs and symptoms of sinusitis and sinus infections. The following is a summary of predominant ones (18 total) that may occur. Most patients have several signs and symptoms at the same time. Others may have some intermittent symptoms; most do not have all symptoms at once. The signs and symptoms of a sinus infection or sinusitis include the following:
- Headache due to pressure in partially or completely blocked sinuses. The pain may increase when the person bends down.
- Facial tenderness and/or swelling when facial areas over sinus areas are touched.
- Pressure or pain due to mucus pressing on sinus tissue or inflammation of sinuses.
- Fever due to inflammation of sinus tissues and infection.
- A cloudy, discolored nasal drainage is often seen in bacterial sinus infections.
- Congestion is a feeling of nasal stuffiness and occurs with both infectious and non-infectious sinusitis.
- Postnasal drip is mucus overproduction from sinusitis that flows to the throat and irritates throat tissue.
- Sore throat is inflammation of throat tissue by postnasal drip.
- Cough is a response to post nasal drip and the body’s attempt to clear out throat tissue irritants.
- Tooth pain caused by pressure on surrounding nerves and tissues
- Ear pain caused by pressure on surrounding nerves and tissues
- Eye pain caused by pressure on surrounding nerves and tissues
- Fatigue due to fever, immune response and/or coughing
- Bad breath usually is due to bacterial infections
- Itching/sneezing – In noninfectious sinusitis, other associated allergy symptoms of itching eyes and sneezing may be common but may include some of the symptoms listed above for infectious sinusitis.
- Nasal drainage usually is clear or whitish-colored in people with noninfectious sinusitis.
- Ulceration can occur with rare fulminant fungal infections with sharply defined edges and a black, necrotic center in the nasal area. Some fungal infections cause dark, black-appearing exudates. This requires immediate medical evaluation.
- Multiple chronic (over one to three months) symptoms usually are a sign of subacute or chronic sinusitis
What is a sinus infection or sinusitis?
Inflammation of the air cavities within the passages of the nose (paranasal sinuses) is referred to as sinusitis. Sinusitis can be caused by infection (sinus infection), but also can be caused by allergy and chemical irritation of the sinuses. A sinus infection (infectious sinusitis) occurs when a virus, bacterium, or a fungus grows within a sinus.
Sinusitis is one of the more common conditions that can afflict people throughout their lives. Sinusitis commonly occurs when environmental pollens irritate the nasal passages, such as with hay fever. Sinusitis can also result from irritants, such as chemicals or the use and/or abuse of over-the-counter (OTC) nasal sprays, and illegal substances that may be snorted or inhaled through the nose. About 30 million adults have “sinusitis.” Colds differ from sinusitis and are only caused by viruses and last about seven to 10 days while sinusitis may have many different causes (infectious and non-infectious), and usually last longer with more pronounced and variable symptoms.
What causes sinus infections or sinusitis?
Sinus infections or sinusitis may be caused by anything that interferes with airflow into the sinuses and the drainage of mucus out of the sinuses. The sinus openings (ostea) may be blocked by swelling of the tissue lining and adjacent nasal passage tissue, for example with
- Common colds,
- Allergies, and
- Tissue irritants such as OTC nasal sprays, cocaine, and cigarette smoke.
Other causes of sinus infections or sinusitis
Tumors or growths also can block the sinuses if they are near the sinus openings.
Dehydration, disease, drying medications, and lack of sufficient humidity can cause sinusitis or sinus infection. The drainage of mucous from the sinuses can also be impaired by thickening of the mucous secretions, by a decrease in hydration (water content) of the mucous brought on by disease (for example, cystic fibrosis), drying medications (antihistamines), and lack of sufficient humidity in the air. The epithelial cells have small hair-like fibers, called cilia, which move back and forth to help the mucus move out of the sinuses. These small cilia may be damaged by many irritants, especially smoke. This can prevent them from assisting the mucus in draining from the sinuses, and thus results in sinus infections or sinusitis.
Stagnated mucus provides an environment for bacteria, viruses, and in some circumstances, (for example, AIDS or immunosuppressed people) fungus, to grow within the sinus cavities. Also, the microbes themselves can initiate and exacerbate sinus blockage. The most commonly infected sinuses are the maxillary and ethmoid sinuses.
Rarely, immunosuppression or victims of multiple traumas in disasters such as tsunamis, hurricanes, earthquakes, or tornadoes may breathe in fungi from the soil or water. Eventually, in a few days to over a week, the fungi can grow and cut off blood supply to almost any type of tissue, especially in the nose and eyes. These infections, although rare, are serious and can be deadly and require immediate medical and surgical care. Although the fungal infection may resemble common bacterial sinusitis initially, it is a disease termed zygomycosis or mucormycosis.
What are the types of sinusitis and sinus infections?
Sinusitis may be classified in several ways, based on its duration (acute, subacute, or chronic) and the type of inflammation (either infectious or noninfectious). The term rhinosinusitis is used to imply that both the nose and sinuses are involved and are becoming the preferred term over sinusitis.
- Acute sinus infection (acute sinusitis or acute bacterial rhinosinusitis) usually lasts less than 3-5 days.
- Subacute sinus infection lasts one to three months.
- Chronic sinus infection is greater than three months. Chronic sinusitis may be further sub-classified into chronic sinusitis with or without nasal polyps, or allergic fungal sinusitis.
- Recurrent sinusitis has several sinusitis attacks every year.
There is no medical consensus on the above periods.
- Infected sinusitis usually is caused by uncomplicated virus infection. Less frequently, bacterial growth causes sinus infection and fungal sinus infection is very infrequent. Subacute and chronic forms of a sinus infection usually are the result of incomplete treatment of an acute sinus infection.
- Noninfectious sinusitis is caused by irritants and allergic conditions and follows the same general timeline for acute, subacute, and chronic as infectious sinusitis.
What tests diagnose the cause of sinus infections and sinusitis?
Sinus infection is most often diagnosed based on the history and examination of a doctor. Because plain X-ray studies of the sinuses may be misleading and procedures such as CT and MRI scans, which are much more sensitive in their ability to diagnose a sinus infection, are so expensive and not available in most doctors’ offices, most sinus infections are initially diagnosed and treated based on clinical findings on examination. These physical findings may include:
- Redness and swelling of the nasal passages,
- Purulent (pus-like) drainage from the nasal passages (the symptom most likely to clinically diagnose a sinus infection),
- Tenderness to percussion (tapping) over the cheeks or forehead region of the sinuses, and
- Swelling about the eyes and cheeks.
Occasionally, nasal secretions are examined for secreted cells that may help differentiate between infectious and allergic sinusitis. Infectious sinusitis may show specialized cells of infection (polymorphonuclear cells) while allergic sinusitis may show specialized white blood cells of allergy (eosinophils). Physicians prescribe antibiotics if a bacterial infection is suspected. Antibiotics are not effective against viral infections; many physicians then treat the symptoms.
If sinus infection fails to respond to the initial treatment prescribed, then more in-depth studies such as CT or MRI scans may be performed. Ultrasound has been used to diagnose sinus infections in pregnant women but is not as accurate as CT or MRI. Rhinoscopy or endoscopy, a procedure for directly looking in the back of the nasal passages with a small flexible fiberoptic tube, may be used to directly look at the sinus openings and check for blockage of these openings by either swelling or growths.
It may sometimes be necessary to perform a needle aspiration (needle puncture) of a sinus to get infected material to culture to determine what microbe is causing the sinus infection. Cultures of the nasal passages are rarely helpful in determining what bacteria or fungus is causing a sinus infection since the nasal passages are often normally colonized by non-infecting bacteria. The needle puncture procedure is usually done by an otolaryngologist when treatments have failed to alleviate the disease. The procedure requires local anesthesia to minimize any discomfort; some patients require general anesthesia. The sinus is aspirated, the contents sent for culture and staining, and the sinus may be flushed with a saline solution. This is technically the most accurate way to diagnose infectious sinusitis.
Besides, both rigid and flexible endoscopy has been used to obtain diagnostic material from sinuses. These procedures are usually done by an otolaryngologist under topical and local anesthesia. Occasionally, there may be a need to sedate the patient. Some investigators suggest that endoscopy specimens are comparable to those obtained by needle puncture.
Fungal infections are usually diagnosed by such biopsy procedures and tissue removed by a surgeon, or by fungal culture and microscopic identification by a microbiologist or pathologist trained to identify fungi. Allergic fungal sinusitis (emphasis on allergic) is an inflammatory response to fungal elements in the sinus cavity and is suspected based on certain CT imaging characteristics as well as the history and physical exam.
Which types of doctors treat sinusitis and sinus infections?
Many sinus infections can be treated by your primary care physician or an Internal Medicine doctor. However, it is not unusual to consult an ENT (Eye, Ears, Nose, and Throat) specialist, Infectious disease specialist, Allergist, or Immunologist. With some complex sinus infections, a surgeon who specializes in sinus surgery may be necessary to consult.
What antibiotics and drugs treat and cure sinus infections and sinusitis (list)?
Antibiotics are not necessary for sinusitis caused by a virus. Frequently recommended treatments include pain and fever medications, for example:
- Acetaminophen [Tylenol])
- Decongestants and mucolytics dissolves are medications that dissolve or breakdown mucous, for example, guaifenesin.
Bacterial infection of the sinuses is suspected when facial pain, nasal discharge resembling pus, and other symptoms last longer than a week and are not responding to over-the-counter (OTC) nasal medications.
Acute sinus bacterial infection usually is treated with antibiotics aimed at treating the most common bacteria known to cause a sinus infection. It is unusual to get a reliable culture without aspirating the sinuses.
The five most common bacteria causing sinus infections are:
- Streptococcus pneumonia
- Haemophilus influenzae
- Moraxella catarrhalis
- Staphylococcus aureus
- Streptococcus pyogenes
Antibiotic treatment for sinus infections must be able to kill these five types of bacteria.
Amoxicillin (Amoxil) is acceptable for uncomplicated acute sinus infections; however, many doctors prescribe amoxicillin-clavulanate (Augmentin) as the first-line antibiotic to treat a possible bacterial infection of the sinuses. Amoxicillin usually is effective against most of the strains of bacteria.
Penicillin allergies and treatment for sinusitis
Other antibiotics may be used as a first choice if you are allergic to penicillin, for example,
- Cefaclor (Ceclor)
- Loracarbef (Lorabid)
- Clarithromycin (Biaxin)
- Azithromycin (Zithromax)
- Sulfamethoxazole (Gantanol)
- Trimethoprim (Bactrim, Septra)
- Ciprofloxacin (Cipro)
Generally, an effective antibiotic needs to be continued for a minimum of 10-14 days. However, it is not unusual to treat sinus infections for 14-21 days.
Some antibiotics now are thought to reduce inflammation, independent of the antibacterial activity.
What decongestants and nasal sprays soothe or cure sinus infections or sinusitis?
Taking decongestants (pseudoephedrine) and mucolytics (guaifenesin) orally may help assist the drainage of sinus infection.
The treatment of chronic forms of sinus infection requires longer courses of medications, such as Augmentin, and may require a sinus drainage procedure. This drainage typically requires a surgical operation to open the blocked sinus under general anesthesia. In general, antihistamines should be avoided unless it is felt that the sinusitis sinus infection is due to allergies, such as from pollens, dander, or other environmental causes.
The use of a topical nasal steroid spray will likely help reduce swelling in the allergic individual without the drying that is caused by using antihistamines although both are occasionally used. Oral steroids may be prescribed to reduce acute inflammation and to help with chronic inflammation in cases with or without polyps and allergic fungal sinusitis.
In many people, allergic sinusitis develops first, and later, bacterial infection occurs. For these individuals, early treatment of allergic sinusitis may prevent the development of secondary bacterial sinusitis.
In rare instances or natural disasters, fungal infections (termed zygomycosis or mucormycosis) may develop in debilitated people. Death rates of 50%-85% have been reported for patients with these sinus infections. Treatment relies on early diagnosis followed by immediate surgical debridement, antifungal drugs, (mainly Amphotericin B), and stabilizing any underlying health problem such as diabetes.
What home remedies help soothe sinus infection or sinusitis symptoms?
Sinus infections caused by viruses can use homes (over-the-counter, OTC) treatments such as pain and fever medications (acetaminophen [Tylenol]), decongestants, and mucolytics. Also, some health care professionals suggest nasal irrigation or a sinus rinse solution to help relieve symptoms of sinus infections, even chronic sinusitis symptoms. This irrigation is accomplished with a “Neti-Pot” or a sinus rinse kit (sometimes termed a nasal bidet). The last reference to this article shows a video of a sinus rinse procedure. In 2012, the FDA issued a warning about the use of Neti-Pots. The FDA cautions people not to use untreated tap water for rinsing, as contaminated tap water rinses lead to two deaths.
Bacterial and fungal sinus infections usually require antibiotic or antifungal therapy so home treatments without them are often not successful. However, some authors suggest home treatments may reduce symptoms after medical therapy has begun; some health-care professionals recommend nasal irrigation after sinus surgery.
What are complications of sinus infection or sinusitis?
While serious complications do not occur frequently, a sinus infection can cause a direct extension of infection into the brain through a sinus wall, creating a life-threatening emergency (for example, meningitis or brain abscess). Also, other adjacent structures can become infected and develop problems, such as osteomyelitis of bones in the skull and infection around the eye (orbital cellulitis). Rarely, these infections (mainly bacterial and fungal organisms) may cause death. The most susceptible individuals to complications are patients with suppressed immune systems, diabetes, and relatively rarely from multiple trauma injuries that may occur in natural disasters.
Can sinus infections or sinusitis be prevented?
Currently, there are no vaccines designed specifically against infectious sinusitis or sinus infections. However, there are vaccines against viruses (influenza) and bacteria (pneumococci) that may cause some infectious sinusitis. Vaccination against pathogens known to cause infectious sinusitis may indirectly reduce or prevent the chance of getting the disease; however, no specific studies support this assumption. Fungal vaccines against sinusitis are not available, currently.
If you are prone to recurrent bouts of a “yearly sinus infection” it may be important to consider allergy testing to see if this is the underlying cause of the recurring problem. Treatment of the allergy may prevent secondary bacterial sinus infections. Also, sinus infections may be due to other problems such as nasal polyps, tumors, or diseases that obstruct normal mucus flow. Treatment of these underlying causes may prevent recurrent sinus infections.
Sinus Infection Dos and Don’ts
Do: Go to School or Work
If you’re worried that you may spread sinusitis to classmates or co-workers, breathe easy. It isn’t contagious. Go back to your normal activities if you feel well enough.
Don’t Fly if You Can Avoid It
If you do it when you’ve got sinusitis, you raise your chances of ear pain and other complications. But if you really need to take a flight, yawn and swallow when the plane is on the way up after takeoff or heads back down before landing. That will help keep the tubes from your throat to your ears clear. You can also try this: pinch your nostrils, close your mouth, and gently blow your nose.
Do: Choose OTC Drugs Carefully
Do your head and face hurt? Acetaminophen or ibuprofen can make it better. Decongestant nasal sprays can open up your stuffy nose, but don’t use them for more than a few days. Over time they could make your symptoms worse.
Do: Stay Hydrated
Drink plenty of fluids during a bout of sinusitis. Something warm like herbal tea can hit the spot. Studies show a steaming mug isn’t just a psychological comfort. Hot liquids can help break up that stuffiness in your nose.
Don’t Drink Alcohol
You need plenty of fluids, but steer clear of cocktails, wine, and beer. Even though booze is a liquid, it makes you dehydrated. It also can cause your sinuses and the lining of your nose to swell, which makes your symptoms worse.
Do: Use Warm Compresses
Moist heat can relieve your sinus pressure, open up those blocked passages in your nose, and ease the pain. Hold a wet towel against your face or breathe in steam through a cloth. A hot shower will help loosen mucus.
Do: Use a Humidifier
Cool mist can make you less stuffy, but make sure you keep the water clean. Empty the tank every day and wash it out before you refill it. Once a week you’ll need to clean it with diluted bleach or vinegar to keep mold and bacteria away.
Don’t Hurry Back to the Pool
Study results are mixed, but it does appear that chlorine in pools can irritate the passageways of your nose. If you feel well enough to exercise and want to swim, use nose clips.
Do: Rinse Your Sinuses
The fancy name for this is “nasal lavage.” You clean the inside of your nose with a sterile solution. You can find squeeze bottles especially sold for this purpose or use a neti pot. Make sure you use distilled or sterile water or boiled water after it’s cooled down.
Don’t Breathe in Irritating Stuff
Your goal is to soothe your sinuses, not inflame them. So avoid places that have cigarette smoke, and stay indoors when air pollution levels are high. If you’re a smoker, quit. Your tobacco habit makes it more likely you’ll get another round of sinusitis.
Do: Work Out Wisely
It’s OK to exercise if you feel up to it but take extra precautions. Sinusitis can cause dizziness and problems with coordination, so don’t lift weights until your symptoms improve. If you feel pressure in your chest, sit out until you feel better. When you have trouble breathing, it can overtax your heart.
How to Relieve Sinus Pressure and Pain Naturally
Sinus Relief the Natural Way
Sinus pressure and pain can be mild or quite severe. The cause of these symptoms is often a cold, allergies, or sinusitis (sinus infection). Regardless of what causes your symptoms, relief may be closer than you think.
In the following slides, learn how to treat sinus problems with natural remedies and home remedies. We provide a variety of strategies to combat nasal congestion, from neti pots and saline nasal sprays to hydration and avoiding irritants, starting with humidifying your air.
Breathe Moist Air
You may be wondering how to relieve sinus pressure. For sinus pressure relief that lasts for hours, try keeping a humidifier on in your bedroom or other rooms where you spend a lot of time. Dry air can irritate your sinuses, but keeping the air moist can help reduce congestion. Inhaling steam two to four times a day may help, too. Sit in the bathroom with the door closed and the shower running. Make sure the water is hot.
Avoid Smoke and Noxious Fumes
The air you breathe could be making your sinuses ache, depending on what that air is carrying. Avoid cigarette smoke and fumes from
- Harsh cleaning products,
- Hair spray, and
With a world full of industrial chemicals and people who smoke, how can you keep your sinus problems at bay? Here are a couple of tips:
- Don’t let friends or family smoke in your home.
- Look for “green” cleaning products in unscented varieties. They’re less likely to contain the harsh chemicals that can kick-start sinus pressure and pain.
Drink More Water
Finding out how to relieve sinus pressure may be as simple as grabbing a glass of cold water or juice. Doing so will help thin out mucus and encourage drainage. Hot tea is another good option.
Not all liquids are created equal, though. To relieve sinusitis symptoms, don’t overdo caffeine or alcohol. Both can make you dehydrated. Alcohol can worsen sinus swelling. Aim for eight or more 8-ounce glasses of water or other healthy drinks each day.
Saline Nasal Wash
It’s also called nasal irrigation, and it can help keep your sinuses clean and clear. To do this right, use a mild, sterile saline solution to flush out the mucus and allergens causing your congestion.
- Lean over the sink.
- Squirt the solution into one nostril.
- Let it drain through your nasal cavity and out the other nostril.
- Keep your mouth open and don’t breathe through your nose.
Nasal Wash: Neti Pots, Saline Nasal Spray and More
Many people find sinus relief through a saline nasal wash, but it does require some preparation. You can find a lot of these supplies at most drug stores, including
- Rinse bottles,
- Bulb syringes, and
- Neti pots.
You can buy a pre-filled container or make your own saline solution.
Nasal Saline Solution Recipe
To make your own nasal saline solution, follow this simple recipe:
- 16 ounces of sterile water (about a pint)
- 1 tsp salt
- ½ tsp baking soda
Simply mix the lukewarm, sterile water with the salt. Some people add ½ teaspoon of baking soda to take the sting out of the salt, but this ingredient is optional.
Sinus Surgery (Endoscopic) Procedure