Do you have a cold that won't go away? Headache? Fever? Nasal congestion and discharge? Sore throat and postnasal drip? Fatigue? Cough? Bad breath? Loss of sense of smell? The National Institute of Health's PubMed web site lists all these as symptoms of sinusitis. You may need an antibiotic, since the cause can be a bacterial infection. Other causes are viral infection, fungal infection, allergies, and irritation. It is important to know the source of the problem before taking drugs, since different drugs work on different pathogens.
Inflammation is the common factor in almost all types of sinus problems. If it goes on for more than 12 weeks, the diagnosis is chronic sinusitis, or chronic rhinosinitis. Dr. Bruce K. Tan and colleagues at Northwestern University, Chicago, Ill., provided a review of what happens to produce long-term inflammation. The nose and sinuses have the job of protecting our lungs from irritants and pathogens. Barrier exclusion, innate immunity, and acquired immunity are all mechanisms that can fail because of genetic predisposition and environmental factors.
Two primary hypotheses have been developed to explain chronic rhinosinusitis:
1. The fungal hypothesis stated that the common airborne fungus Alternaria produces immunological sensitization. However, Tan noted that “we still lack convincing in-vitro or in-vivo evidence indicating that fungal antigens are the targets.”
2. The superantigen hypothesis blames toxins from Staphylococcus aureus. Tan reported that nasal colonization by this common bacteria is more likely to be a disease modifier rather than the actual cause.
Secondhand smoke is another possibility, according to Dr. C. Martin Tammemagi and colleagues in Ontario, Canada, and Detroit, Mich. They found a significant association between secondhand smoke and chronic rhinosinusitis in a case-control study of 612 patients at the Henry Ford Health System in Detroit.
Bacteria, viruses, and fungi grow more easily in the sinuses when the openings are blocked or too much mucus builds up, according to National Institute of Health's information page. Conservative treatment includes breathing air with high water vapor content (as from the shower), and saline nasal spray. An ear, nose, and throat specialist (otolaryngologist) can perform an endoscopy exam to check for nasal polyps and for the extent of inflammation.
Prescription drug treatments include antimicrobial drugs, decongestants, anti-allergy drugs, and anti-inflammatories. Sinus surgery is an option for patients who do not respond to medical treatment.
1. National Institute of Health's PubMed information on sinusitis:
2. Tan BK et al, “Perspectives on the etiology of chronic rhinosinusitis”, Curr Opin Otolaryngol Head Neck Surg. 2010 Feb; 18(1): 21-26. http://www.ncbi.nlm.nih.gov/pubmed/19966566
3. Tammemagi CM et al, “Secondhand smoke as a potential cause of chronic rhinosinusitis”, Arch Otolaryngol Head Neck Surg 2010 Apr; 136(4): 327-34.
Reviewed July 5, 2011
by Michele Blacksberg R.N.
Edited by Alison Stanton
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.