Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 16, 2016

Millions of people in the US suffer through at least one case of sinusitis every year and spend over a billion dollars on over-the-counter medications to relieve the symptoms. Sinusitis symptoms can be so difficult to deal with that up to 16 million people will make a visit to their doctor to get a diagnosis and receive a prescription for medication. People who have a stuffy nose, facial pressure, thick nasal discharge and a cough that lasts for more than a week may have sinusitis which is also called a sinus infection.


Definition & Facts

Sinuses are air-filled cavities that are located within and behind the cheekbones, forehead, and nose. Sinusitis is the swelling of the sinus tissue inside the sinus cavities that is usually the result of a common cold or allergies.

A shift in the nasal cavity (deviated septum) or nasal polyps, which are growths on the sinus tissue, can also cause sinusitis. There are three types of sinusitis that are based on the length of the symptoms, and one type that is based on the frequency of the symptoms. These are:

  • Acute sinusitis - occurs with a cold and lasts 2 to 4 weeks.
  • Subacute sinusitis - lasts 4 to 8 weeks.
  • Chronic sinusitis - lasts 8 weeks or longer
  • Recurrent sinusitis - occurs several times during a year.

Symptoms & Complaints

Symptoms and complaints include facial pain and pressure, thick green or yellow nasal discharge, loss of smell and congestion. Other symptoms and complaints may include headaches, a fever, fatigue, dental pain and bad breath.

People will typically have two or more of these sinusitis symptoms, and the symptoms can last longer than the cold or the allergies that brought on the sinusitis.


Anybody can get sinusitis, and colds and allergies are the two most common causes of this condition. When a person comes down with a cold or allergies, their sinuses produce excessive mucus which blocks the sinuses. The mucus traps germs and bacteria inside the sinus cavity where they can grow and cause a viral or bacterial infection. Viral infections last two weeks or less, but if the sinusitis lasts for more than two weeks, then it is likely a bacterial infection, and the person should schedule a doctor’s appointment.

Nasal bone spurs, nasal polyps and a shift in the nasal cavity from an accident or broken nose can contribute to sinusitis as well as a weakened immune system, smoking, airplane travel and dental problems. People who have cystic fibrosis are also at a high risk of developing sinusitis because of the large amount of mucus that develops in their lungs.

Diagnosis & Tests

A doctor can usually make a sinusitis diagnosis based on the patient’s symptoms and a physical examination that includes pressing on the patient’s sinuses to feel for any tenderness. If the patient is dealing with chronic or recurring sinusitis, the doctor may take a mucus culture, a blood sample or an X-ray of the sinuses.

A mucus culture is taken to identify the type of bacteria that is causing the infection, and a blood sample may be taken to check for immune deficiencies or a condition like cystic fibrosis. An X-ray may be taken to check for bone spurs, polyps or structural abnormalities of the nasal cavity.

A doctor may also use a nasal endoscope to diagnose sinusitis. A nasal endoscope is a thin tube that can be flexible or firm with a light and a camera on the end of it that allows the doctor to check the inside of the nose. The doctor will be able to see the drainage pathways of the sinuses and view the bone structure of the nasal cavity.

An allergy skin test may be conducted if allergies are suspected in cause a patient’s sinusitis. Allergy skin tests are used to diagnose a variety of allergic conditions such as hay fever and allergies to food, bees, latex, and more. It involves a skin prick or scratch on the forearm of adults or upper back in children, and it can immediately detect up to 40 kinds of allergies at once.

Treatment & Therapy

Sinusitis treatment and therapy can differ based on the type of sinusitis a person has. A person with acute or subacute sinusitis may only need a non-prescription decongestant, nasal drops or spays to alleviate the symptoms. If a person has a bacterial sinusitis infection, then their doctor may prescribe antibiotics. Whether a person uses non-prescription or prescription medication, it is important for them not to use the medication beyond the recommended use.

A person suffering from chronic sinusitis may already be using medication, nasal drops and sprays, but they may also benefit from vaporizers, inhaling warm steam and using warm compresses because chronic sinusitis is more of an inflammation problem than an infection problem.

If there are bone spurs, polyps or structural problems with the nasal cavity, then a doctor may need to perform surgery to correct the problem in order to minimize the recurrence of sinusitis. Surgery is only conducted as a last resort when medications and all other methods of relieving the sinusitis symptoms have proven to be ineffective. Surgery allows the doctor to correct any structural problems, open closed passages, and in most cases, patients can go home the same day. The doctor will also use an endoscope to perform the surgical procedure.

Prevention & Prophylaxis

There are several things a person can do to lessen their chances of getting sinusitis such as avoiding tobacco usage and second-hand smoke, using a humidifier at home and work to avoid dry air, and avoid other people who have a cold or upper respiratory tract infection.

It is important to treat cold and allergies at the onset of the symptoms in order to minimize the chances of getting sinusitis. It is also essential for a parent to get all the recommended immunizations for their child, including the pneumococcal conjugate vaccine, which is known to be beneficial in preventing nasal infections.