Allergies, hay fever and other allergic reactions can be triggers for acute or chronic sinus infections (sinusitis). When allergies flare up, it often triggers swelling in the sinus and nasal mucus linings. When these symptoms persist, the sinus passages (ostia) are liable to close up, causing bacteria to be trapped in the upper respiratory tract. With the buildup of bacteria, often comes a sinus infection.
The Biology of Sinusitis and Allergies
The sinuses are air-filled cavities in various places on the head. They are located:
- Sphenoid Sinuses – Just behind the nose, and directly in front of the brain
- Ethmoid Sinuses – Either side of nose, up by the bridge
- Frontal Sinuses – Behind both the eyebrows and the rest of the forehead
- Maxillary Sinuses – Within the structure of the cheekbones
When sinus passages become blocked, the cavities often fill with bacteria, causing swelling and facial pain, amongst other symptoms.
Most instances of acute sinusitis are a mild development of the symptoms caused by allergies, and will disappear in a couple of weeks after the symptoms are first experienced. Other infections that persist are considered to be chronic sinus infections and may take antibiotics to clear up.
When the infected sinuses are close to the brain, chronic sinusitis can cause complications where the infection spreads to the brain.
Sinuses in their normal, healthy state are lined with a thin layer of mucus that has properties to capture and eliminate allergens and certain viruses/bacteria. Tiny hair-like projections (mucosal cilia) within the sinuses sweep all the mucus and other particles towards openings that lead to the back of the throat. From here, it slides into the stomach, which is the final stage in this normal bodily function.
When a sinus infection is present, it prevents the normal flow of mucus that carries it to the back of the throat. The hair-like projections become blocked as a result of swelling, which keeps the mucus trapped in the sinuses. When the cilia are damaged, patients develop chronic sinusitis. Cilia are damaged by viruses, tobacco, genetic illnesses (cystic fibrosis), allergens, bacteria and certain chemicals.
Chronic Sinusitis and Allergies
Chronic sinusitis is a major illness in the USA, affecting around 31 million people across the country. Its prevalence causes costs amounting to $1 billion every year from over-the-counter medication purchases. In addition, each year, around 16 million doctor visits are caused by sinus diseases, and a further $150 million is spent on prescription medications to treat them.
Overview of Chronic Sinusitis
Chronic sinusitis is an ailment that causes the cavities surrounding the nasal passages to swell and become inflamed, the symptoms of which can last up to 12 weeks.
This disease is often caused by allergies or growths, and is most likely to affect those with asthma, structural blockages in the nose or sinuses and those with an already compromised immune system.
Chronic sinusitis (also known as chronic rhinosinusitis) can often be a continuation of acute sinusitis, which is most often treated with over-the-counter medications. If untreated however, or not fully resolved, acute sinusitis can develop into its chronic form, in which case, it should be treated with antibiotics.
The inflammation of chronic sinusitis affects the drainage system in the nasal passages and causes excess build-up of mucus. The results are often difficulty breathing through the nose, swollen areas around the face and eyes, and headaches combined with throbbing facial pain.
Risk Factors for Chronic Sinusitis
Your are at risk of suffering from chronic or recurrent sinusitis if you have any of the following:
- Hay fever or other allergic condition affecting your sinuses
- An abnormal nasal passage, a deviated nasal septum or nasal polyps
- An autoimmune disease, like cystic fibrosis
- Asthma – 1 in 5 sufferers of chronic sinusitis also have asthma
- Sensitivity to aspirin that can cause respiratory symptoms
- Regular exposure to cigarette smoke or other pollutants
Symptoms of Sinusitis
Patients suffering from chronic sinusitis may develop the condition after a prolonged experience with acute sinusitis, but the symptoms can manifest themselves in a more subtle way. It is possible that you may be suffering unknowingly for a while, especially if your acute sinusitis seems like it has mostly resolved itself. This is because a significant number of the acute sinusitis symptoms are no longer present with chronic sinusitis, including a low grade fever that may have reduced over time.
Chronic Sinusitis may produce the following symptoms:
- Fever of an unknown origin
- Aggravated symptoms of asthma
- Sore throat
- Abnormal frequency of sneezing
- Becoming fatigued easily
- Unpleasant taste and bad breath
- Postnasal drip
- Chronic coughing producing no substance (seen mostly in children)
- Nasal discharge (of any description and substance)
- Hyposmia and anosmia (reduced ability and sensitivity to smell)
- Dental pain in the upper mouth
- Stuffy ears
- Visual disturbances such as double vision
- Nasal obstruction, congestion or stuffiness
- Frontal headaches
- Tenderness of the face (especially around the eyes or on the bridge of the nose)
- Ear pain
If you have had several of these symptoms and they have lasted for an extended period of time, schedule a doctor’s appointment.
The following symptoms could relate to a worsened infection or other illnesses, but could be confused with acute sinusitis:
- Stiff neck
- Shortness of breath
- A swollen forehead
- Pain around the eyes
- Severe headache
If you experience any of these symptoms, make immediate contact with your doctor in the case that it could be a more serious infection.
Complications of Sinusitis
- Asthma sufferers can experience asthma attacks in some cases of chronic sinusitis.
- Vision problems: If the sinus infection spreads to the eye socket, it can cause reduced vision and sometimes permanent blindness.
- Meningitis.:The spread of the infection can turn into meningitis, which is an inflammation of the membranes and the fluid surrounding the brain and spinal cord.
- Aneurysms or blood clots: Infections can lead to issues in the veins surround the sinuses, which can then interfere with blood supply to the brain, heightening the risk or a stroke or hemorrhage.
Diagnosis and Testing for Sinusitis
There are various tests that can and should be performed to confirm a diagnosis, determine the level of infection and check for other more serious issues.
A physical examination is completed, which includes a full head and neck examination so that more serious issues can be excluded. Swollen lymph nodes (lymphadenopathy) may occur in the neck if an infection is present, which is no different than the swelling of lymph nodes that accompanies an acute sore throat (pharyngitis) or ear infection (otitis media).
Sinus palpation (putting pressure on the sinus areas) is used to determine the level of tenderness or swelling. When pain is experienced caused by the palpation, in the frontal or maxillary sinuses, it will be taken into consideration. A doctor may also use transillumination (shining light into the infected areas) to look at the frontal and maxillary sinuses, though this is not always the most effective test.
The oral cavity and oropharynx (soft palate) is examined to evaluate the palate and condition of dentition, as well as looking for evidence of postnasal drip.
Anterior rhinoscopy, conducted with a nasal speculum, is used to examine the condition of the mucus membranes (mucosa) to look for evidence of purulent drainage (pus) or to look for signs of polyps or other masses. This examination is carried out with the use of a nasal decongestant, with treatments both before and after.
An ear examination may be carried out to inspect for possible middle ear fluid. This could be a sign of a mass or growth in the nasopharynx (above the soft palate).
Another important examination is that of the ocular area. This is to determine the possibility of infection having spread to either the socket or the musculature of the eye. Symptoms of this development can be:
- Conjunctival congestion (excess discharge from and around the eyes)
- Lacrimation (tears)
- Proptosis and visual disturbances
Examination of the cranial nerve is completed to assess for possible sinus malignancy or neurological complications.
A CT scan may be ordered in the case that a doctor suggests this is necessary. The purpose of this is to test the extent of the infection. A patient may also be referred to an allergy and immunology specialist. In this case, the specialist would be looking for hidden problems such as allergies, asthma, structural defects or a compromised immune system.
In serious cases where the sinus disease is fungal, it is possible for the fungus to penetrate nearby bones, and the test for this would be to do a bone biopsy. Doctors also complete sinus tissue biopsies by taking a sample of tissue with a flexible instrument inserted through the nose.
Treatment for Chronic Sinusitis
Antibiotics: The usual method of treatment for bacterial sinusitis is through a prescription for antibiotics. The length of the antibiotics course depends partially on the type of medicine that is taken, and also it depends on how severe or lengthy the case of sinusitis has been. The normal experience for a patient is that the medicine is taken for 3-28 days.
In light of common issues connected with antibiotics, such as abuse and overuse, there has been an obvious decrease in the effectiveness of these medicines. If a patient has only been experiencing symptoms for a few days, it is likely antibiotics will not be prescribed. If the symptoms are persistent (lasting a week or more), or worsening, a patient should then acquire a prescription for antibiotics from their doctor.
The purpose of antibiotics is not to alleviate symptoms, but to attack the bacterium that causes the infection in the first place. Therefore, when the antibiotics are taken, the effects may not be felt for a few days until the bacteria have been fully attacked.
If a patient needs immediate pain or symptom relief, there are various over-the-counter medications that can help.
Nasal Decongestant Sprays: Nasal decongestant sprays are not designed to fix the overall issues pertaining to sinus infections, but as a symptom reliever, to reduce swelling in the nasal passages, helping the flow of bacteria and mucus to be facilitated and clear the sinuses.
It is advised that patients only use this method of self-treatment for a couple of days, otherwise they can experience a condition where the nasal passages swell shut, called rebound phenomenon.
Antihistamines: Patients with allergies often experience swollen nasal passages and sinuses, so taking antihistamines to stop inflammation can reduce infection.
Nasal Saline Washes: Nasal irrigation with a Neti pot helps many people with sinus symptoms from allergies and environmental irritants. Regular use of the Neti pot or other nasal irrigation devices alleviates congestion, facial pain and pressure. For patients who have undergone sinus surgery, it helps to clear away crusting in the nasal passages.
Topical Nasal Corticosteroids:These are prescription nasal sprays that prevent (as well as reverse) inflammation and swelling, which is usually the biggest problem associated with sinusitis. If nasal polyps are present, nasal corticosteroids are effective in shrinking these. These can be used over a long period of time without risk of addiction.
Surgery for Chronic Sinusitis
Surgery is usually a last resort, after the other treatments have failed and symptoms persist. The surgery is normally performed by an otolaryngologist, usually to work on anatomical defects that cause these issues. Surgery is conducted under either local or general anesthesia and often patients will go home the same day.
If you are suffering with chronic and persistent symptoms of a sinus infection, contact Dr. Rohn, Dr. Gamble and Dr. Kubala, ear, nose, throat, and sinus (ENT) surgeons in Plano and Dallas. If you would like to schedule an appointment with our office, please call our Plano office at 972-378-0633 or Dallas office at 214-239-1641.