Sinusitis occurs when your sinuses -- air filled cavities around your nose, eyes, and cheeks -- get inflamed. The inflammation is often due to an infection, caused by a virus (such as a cold), bacteria, or fungus. When your sinuses are inflamed, mucus can't drain. Eventually, the sinus cavities become blocked, making it harder for your body to heal the infection.
Sinusitis can be acute (with symptoms lasting fewer than 8 weeks), chronic (with symptoms recurring or lasting longer than 8 weeks), or recurrent (with three or more acute episodes a year). Most cases of sinusitis are acute and caused by a cold. Sinusitis is very common. Each year, more 30 million people (adults and children alike) get sinusitis in the United States.
The symptoms of acute and chronic sinusitis are similar. Chronic sinusitis usually does not cause fever, and its symptoms last longer. Chronic sinusitis is most common in people who have allergies.
Sinusitis usually follows an upper respiratory infection (such as a cold) or an allergic reaction (such as hay fever or allergic rhinitis). These can cause inflammation and swelling that keeps the sinuses from draining properly. When sinuses become blocked, they provide a place for bacteria, viruses, and fungus to live and grow rapidly. Although a cold is most often the culprit, anything that prevents the sinuses from draining can cause sinusitis.
Other common causes for sinusitis include:
Risk factors for sinusitis include:
Although chronic sinusitis can be hard to diagnose because the symptoms are similar to that of a cold, your health care provider can generally diagnosis sinusitis from your medical history and by examining you. If your health care provider suspects chronic sinusitis, he or she may order imaging tests, including an x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI). If your health care provider suspects allergies may be causing your sinusitis, he or she may suggest an allergy test. Sometimes, a referral to a specialist -- known as an ear, nose and throat (ENT) doctor or an otolaryngologist -- is necessary. This specialist may perform a nasal endoscopy using a fiber optic scope to look at your sinuses.
The best way to prevent sinusitis is by:
Treatment of sinusitis aims to reduce inflammation and clear your sinuses. Your doctor may prescribe antibiotics or corticosteroids. Lifestyle changes, such as using a humidifier or irrigating your nasal passages with salt water, may also help. Several dietary supplements and herbs may help prevent colds and flu, shorten their duration, or work together with antibiotics to treat your infection and support your immune system.
These measures can help reduce congestion in your sinuses:
Antibiotics -- Your health care provider may prescribe antibiotics if your health care provider suspects you have a bacterial infection. To treat acute sinusitis, you may take from 10 - 14 days of antibiotics. Treating chronic sinusitis may take longer, usually 3 - 4 weeks.
Nasal corticosteroids -- These prescription sprays reduce inflammation of the nose and help relieve sneezing, itching, and runny nose. They are most effective at reducing symptoms, although it can take from a few days to a week after you start using them to see improvement.
Antihistamines -- Antihistamines are available in both oral and nasal spray forms, and as prescription drugs and over the counter remedies. Over the counter antihistamines are short acting and can relieve mild to moderate symptoms. All work by blocking the release of histamine in your body.
Decongestants -- Many over the counter and prescription decongestants are available in tablet or nasal spray form. They are often used with antihistamines. Oral and nasal decongestants include Sudafed, Actifed, Afrin, Neo-Synephrine. Some decongestants may contain pseudoephedrine, which can raise blood pressure. People with high blood pressure or an enlarged prostate should not take drugs containing pseudoephedrine. Nasal decongestants can cause "rebound congestion," where the nasal passages swell. Avoid using nasal decongestants for more than 3 days in a row, unless your health care provider tells you to, and do not use them if you have emphysema or chronic bronchitis.
For chronic sinusitis that doesn' t respond to medication, your doctor may recommend endoscopic sinus surgery, which may be done to remove polyps or bone spurs. Enlarging the sinus opening is also sometimes recommended. A newer procedure called balloon rhinoplasty involves inserting a balloon inside the sinus cavity and then inflating it. Your health care provider may suggest other alternatives.
Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.
Although studies are few and have found conflicting results, some people may find that acupuncture helps relieve symptoms of sinusitis. Acupuncturists usually describe sinusitis as "dampness," which creates inflammation and congestion in the mucus membranes. This dampness is cleared by strengthening the spleen meridian and by working with the stomach meridian. Practitioners often perform needling therapy or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for this condition.
A 2009 double-blind, randomized, controlled study found that acupuncture significantly improved nasal air flow and decreased congestion in participants with chronic sinusisits. These benefits also increased 30 minutes after treatment.
Although no studies have examined using chiropractic to treat sinusitis, some practitioners suggest that it may decrease pain and improve sinus drainage for some people.
There have been few studies examining the effectiveness of specific homeopathic remedies in general. In one study of homeopathy for sinusitis, however, more than 80% of the 119 participants had significant improvement in their symptoms after taking the homeopathic remedy for 2 weeks without antibiotics or other medications. Professional homeopaths may recommend one or more of the following treatments for sinus congestion based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
If you are not better in a few weeks, your doctor may refer you to an ENT specialist for tests to find the cause of your sinus infection.
Sinusitis often acts up during pregnancy. There are many herbs and medications that pregnant and breastfeeding women should not use, so always ask your doctor before taking any medication, whether prescription, over the counter, or alternative.
Some serious diseases have similar symptoms to sinusitis. Be sure to see your health care provider if you are not feeling better or have new symptoms. Tell your health care provider if you may be pregnant.
Acute sinusitis is usually curable. If you have recurrent attacks, you should be evaluated for underlying causes (such as nasal polyps or another structural problem). Although very rare, complications may include:
Sinus infection; Sinus inflammation
Asher BF, Seidman M, Snyderman C. Complementary and alternative medicine in otolaryngology. Laryngoscope. 2001;111(8):1383-1389.
Audera C, Patulny RV, Sander BH, Douglas RM. Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial. Med J Aust. 2001;175(7):359-362.
Bellavite P, Marzotto M, Chirumbolo S, Conforti A. Advances in homeopathy and immunology: a review of clinical research. [Review]. Front Biosci (Schol Ed).2011;3:1363-89
Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.
Bhattacharyya N. Air quality influences the prevalence of hay fever and sinusitis. Laryngoscope. 2009;119(3):429-33.
Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:33-35, 88-102, 111- 117, 118-123.
Cohen S, Hamrick N, Rodriquez MS, Feldman PJ, Rabin BS, Manuck SB. Reactivity and vulnerability to stress-associated risk for upper respiratory illness. Psychosom Med. 2002;64(2):302-310.
Di Baise JK, Olusola BF, Huerter JV, Quigley EM. Role of GERD in chronic resistant sinusitis: a prospective, open label, pilot trial. Am J Gastroenterol. 2002;97(4):843-850.
Dixon AE. Rhinosinusitis and asthma: the missing link. Curr Opin Pulm Med. 2009;15(1):19-24.
Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.
Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.
Falagas M, Giannopoulou K, Vardakas K, Dimopoulos G, Karageorgopoulos D. Comparison of antibiotics with placebo for treatment of acute sinusitis: a meta-analysis of randomised controlled trials. The Lancet Infectious Diseases. 2008;8(9).
Ferguson BJ, Otto BA, Pant H. When surgery, antibiotics, and steroids fail to resolve chronic rhinosinusitis. [Review]. Immunol Allergy Clin North Am. 2009;29(4):719-32.
Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-334.
Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg. 2006 Oct;135(4):496-506. Review.
Hirt M, Nobel Sion, Barron E. Zinc nasal gel for the treatment of common cold symptoms: A double-blind, placebo-controlled trial. ENT J. 2000;79(10):778-780, 782.
Huang SW, Small PA. Rapid diagnosis of bacterial sinusitis in patients using a simple test of nasal secretions. Allergy Asthma Proc. 2008;29(6):640-3.
Ivker RS, Silvers WS, Anderson RA. Clinical observations and seven-and-one-half-year follow-up of patients using an integrative holistic approach for treating chronic sinusitis. Altern Ther Health Med. 2009;15(1):36-43.
Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 29(2):231-261.
Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet. 2001;357(9262):1076-1079.
Karkos PD, Leong SC, Arya AK, Papouliakos SM, Apostolidou MT, Issing WJ. 'Complementary ENT': a systematic review of commonly used supplements. J Laryngol Otol. 2007 Aug;121(8):779-82. Review.
Kliegman: Nelson Textbook of Pediatrics, 18th ed. Philadelphia, PA: Saunders Elsevier; 2007; Ch. 377.
Leung R, Katial R. The diagnosis and management of acute and chronic sinusitis. Primary Care: Clinics in Office Practice. 2008;25(1).
Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-334.
Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.
Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001;58(9):1234-1245.
Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;(2):CD000530.
Min YD, Choi CH, Bark H, Son HY, Park HH, Lee S, et al. Quercetin inhibits expression of inflammatory cytokines through attenuation of NF-kappaB and p38 MAPK in HMC-1 human mast cell line. Inflamm Res. 2007 May;56(5):210-5.
Prasad AS, Fitzgerald JT, Bao B, Beck FW, Chandrasekar PH. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245-252.
Pynnonen MA, Mukerji SS, Kim HM, Adams ME, Terrell JE. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg. 2007 Nov;133(11):1115-20.
Rössberg E, Larsson PG, Birkeflet O, Söholt LE, Stavem K. Comparison of traditional Chinese acupuncture, minimal acupuncture at non-acupoints and conventional treatment for chronic sinusitis. Complement Ther Med. 2005 Mar;13(1):4-10.
Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:221-225.
Sertel S, Bergmann Z, Ratzlaff K, Baumann I, Greten HJ, Plinkert PK. Acupuncture for nasal congestion: a prospective, randomized, double-blind, placebo-controlled clinical pilot study. Am J Rhinol Allergy. 2009;23(6):e23-8.
Takkouche B, Regueira-Mendez C, Garcia-Closas R, Figueiras A, Gestal-Otero JJ. Intake of vitamin C and zinc and risk of common cold: a cohort study. Epidemiology. 2002;13(1):38-44.
Ullman D, Frass M. A review of homeopathic research in the treatment of respiratory allergies. [Review]. Altern Med Rev. 2010;15(1):48-58.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885