Sinus infections are called sinusitis or even more accurately rhinosinusitis by ENT doctors such as myself.  Rhinosinusitis means “inflammation (“-itis”) of the inside of the nose (“rhino”) and sinuses.  For the rest of this article, I will use “sinusitis” to mean the same thing as sinus infection or rhinosinusitis.

Sinusitis can be divided into several different subtypes based on the duration of symptoms.

Acute sinusitis is defined as symptoms lasting less than 4 weeks.  Acute sinusitis can be further split into acute viral and acute bacterial sinusitis.  Subacute sinusitis is defined as symptoms lasting more than 4 but less than 12 weeks.  Chronic sinusitis refers to symptoms lasting longer than 12 weeks.  And finally, there is recurrent acute sinusitis which I define as 3 or more episodes of acute sinusitis in a year with resolution of symptoms in between.

Types of sinusitis

So, what are the symptoms?  You need at least 2 of the following to diagnose sinusitis:

• Thick, green drainage from the nose (can be out the front, down the back, or both)
• Facial pain or pressure
• Nasal congestion/obstruction
• Lessened sense of smell

 

There are other associated symptoms that are less common including cough, tooth pain, ear pain, sore throat, nosebleed, fever, and headache in the top or back of the head.  But without at least 2 of the top 4 symptoms, it is less likely that you have sinusitis.

After talking with you to find out what symptoms you are having and how long you’ve had them, I will examine your nose and face to further support the diagnosis.  The nose is generally congested inside and frequently there is pain when I press on the areas of your face over the sinuses.  I will examine the inside of your nose using nasal endoscopy and look at the middle meatus (the area where the maxillary, frontal, and anterior ethmoid sinuses drain out), and the back of the nose (where the posterior ethmoids and the sphenoid sinuses drain).  In patients with sinusitis, I will generally see swelling of the tissues in these areas, sometimes with thick green mucus or polyps present as well.

Radiographic imaging such as CT scans of the sinuses can be useful in some patients, especially those who might benefit from procedures such as balloon sinuplasty or endoscopic sinus surgery.

Once your sinus infection has been diagnosed, I’ll recommend treatment for you.  As a general rule, I try medicines first and reserve procedures or surgery for patients with chronic sinusitis or recurrent acute sinusitis who continue to have problems despite taking the proper medications.

Acute viral sinusitis does not require antibiotics and usually gets better with time and treatment of the symptoms with decongestants, saline rinses, and medicines to thin the mucus.  For acute bacterial sinusitis, I will add antibiotics and sometimes steroid pills as well.

Chronic sinusitis requires a longer course of antibiotics (usually 3-4 weeks) and steroids, and may require balloon sinuplasty or surgery.  For patients with recurrent acute sinusitis, I’ve found that balloon sinuplasty is really helpful at reducing symptoms and frequency of infections.

I love seeing patients with sinus problems and helping them out.  If you are struggling with lots of sinus infections, come and see me!