Sinusitis is one of the most common diagnoses in America. If you have experienced a cold that persisted for longer than 10 days, chances are you have had sinusitis.

Sinusitis

Each person has 4 major sinus cavities on each side of their face known as the frontal, maxillary, ethmoid, and sphenoid sinuses. Each sinus cavity opens into the nose through a narrow passage. When any of these cavities become inflamed or infected, we call this sinusitis.

Frontal Sinuses

  • Located in the forehead above the eyebrows
  • Blockage often causes headaches

Maxillary Sinuses

  • Located in throughout the cheeks
  • Blockage often causes cheek or tooth pain

Sphenoidal Sinuses

  • Located behind the eyes – almost between the ears
  • Blockage often causes pain near the back of the head

Ethmoidal Sinuses

  • Located directly between the eye sockets and extend up to the frontal lobe of the brain
  • Divided into the anterior and posterior portions
  • Blockage often causes pain throughout the nasal region or between the eyes

Causes of Sinusitis

Sinusitis is typically triggered by a viral cold or allergic swelling in the nose. The resulting inflammation of the mucous membrane prevents nasal and sinus mucus from draining properly. If this mucous becomes infected with bacteria, the swelling and blockage worsen, creating facial pressure, pain, and nasal blockage. The mucous may become thick, discolored, and even develop an odor.

Tips to Prevent Sinusitis

  • Rinse your nose daily with salt water (saline) to remove thick mucus and bacteria
  • Use a daily nasal steroid such as Rhinocort, Flonase or Nasacort for allergies
  • Wear a mask if you may be exposed to dust, pollen, colds, flu, or COVID-19
  • Avoid touching your face with dirty hands
  • Follow instructions from your allergy doctor
  • Use decongestants sparingly when sick

Symptoms of Sinusitis

The most common symptoms of sinusitis are:

  • Nasal congestion
  • Loss of smell or taste
  • Discolored nasal drainage
  • Thick drainage in the throat
  • Facial pain or pressure
  • Upper tooth pain
  • Cough

Fever is rare, except in children. Children have small sinuses at birth, and more frequently develop respiratory infections in the tonsils, adenoids, and middle ears.

Diagnosing Sinusitis

Most experts agree that uncomplicated upper respiratory tract infections should be treated as a common cold for the first week. If nasal and sinus symptoms worsen after the first week, or if there is no improvement within 10 days, then it is more likely that a bacterial infection has developed. Guidelines recommend against X-ray studies for the diagnosis of acute, uncomplicated sinusitis. Antibiotics may be prescribed to cover the most likely bacteria.

Seeking Treatment from an ENT

Your primary physician can manage most episodes of acute, uncomplicated sinusitis. A consultation with an ENT specialist (otolaryngologist-head and neck surgeon) may be helpful if you are having recurrent episodes of acute sinusitis, chronic sinusitis, or uncontrolled allergies.

Consult an ENT specialist if you have sinus or allergy symptoms:

  • 3 times per year, or
  • 3 months at a time, or
  • 3 seasons in a row

What should I expect during my ENT appointment?

  • A complete medical history
  • Ear nose and throat examination
  • Nasal endoscopy
  • Thorough explanation

Your primary physician can manage most episodes of acute, uncomplicated sinusitis. A consultation with an ENT specialist (otolaryngologist-head and neck surgeon) may be helpful if you are having recurrent episodes of acute sinusitis, chronic sinusitis, or uncontrolled allergies.

Meet Dr. Armstrong

Treatment for Sinusitis

We typically recommend antibiotics, nasal steroid sprays, and saltwater (saline) rinses as the initial treatment for patients with recurrent or persistent sinusitis. We may prescribe oral steroids if you have severe symptoms or nasal polyps. If you have already completed adequate medical management, then we may offer you a CT scan or allergy test to better understand the cause of your symptoms.

We may recommend endoscopic sinus surgery if you have recurrent or persistent sinus disease despite appropriate medical treatment. In many cases, we can open the sinus drainage pathway under local anesthesia in the office using a balloon or dilating tool. This minimally invasive procedure is called a sinuplasty and most patients are able to return to work or school the next day.

If you have nasal polyps, you likely have severe nasal obstruction and a very poor sense of smell. You may have tried and failed surgery in the past. Do not give up! We have seen tremendous improvements in surgical techniques over the past several years and there are several new methods for delivering steroids into the sinuses. Richmond ENT continues to be a research center for randomized clinical trials involving new biological medications that may be useful for nasal polyps.