Sinus infections trouble many Americans every year. It is a leading cause of Urgent Care visits during the winter months. A bacterial sinus infection is frequently initiated by a viral infection that lingers for too long. Here is some basic information as well as tips to avoid sinus infections.

sinusWhat is a sinus?

A sinus, in medicine, is defined as a small cavity within a bone or other tissue. Mostly when we talk about sinuses in medicine, we are talking about the sinus cavities in the nose. There are numerous sinus pockets throughout the face, including in your cheekbones, inside your brows, between your ears, and behind your eyes. Your sinuses are lined with tissue that constantly produces mucous in order to keep the tissue moist and healthy. They are also responsible for trapping allergens and discarding them in the mucous. You make over one gallon of mucous per day. Gross!

What is a sinus infection (Sinusitis)?

sinusA sinus infection is also called sinusitis. This happens when mucous remains trapped in a sinus for too long. Bacteria are naturally found throughout our nasal passages and sinus cavities since bacteria thrive in warm, moist environments. However, they do not cause infections unless they are allowed to multiply without proper drainage. People with allergies or a viral infection that causes inflammation of the nasal passages often block the small drainage tubes of the sinus cavities thus trapping mucous (see picture). While the mucous remains trapped, bacteria multiply in number and overwhelm the body’s ability to destroy them. The body then begins sending more white blood cells (soldiers) to fight off the invaders. Pressure builds as bacteria multiple and white blood cells arrive. This pressure causes pain in the location of the infected sinus cavity.

What are the symptoms of a sinus infection (sinusitis)?

Symptoms of a sinus infection vary. Common symptoms include fever, facial pain, headache, runny nose, painful lymph nodes in neck, loss of smell, bad breath, fatigue, dental pain, and coughing.

How do I know if I have a sinus infection (sinusitis)?

The main way to diagnose a sinus infection is to be evaluated by a healthcare provider. We offer Urgent Care services throughout our business hours. We also encourage new patients to Walk-In for their Urgent Care needs.

You will usually know that you have a sinus infection if you exhibit most of the symptoms listed above, or if you have had symptoms that have lasted for longer than 10 days. A runny nose and nasal congestion are the main symptoms of a viral upper respiratory infection, so it is important to not take antibiotics when the cause of your symptoms is not a bacterial infection. After all, antibiotics do not treat viral infections.

How is Acute Sinusitis (or acute sinus infection) diagnosed?

Healthcare providers use the symptoms listed above, a careful physical examination of your nasal and sinuses, as well as historical clues. If your symptoms have persisted for longer than 10 days, it is highly likely that you have a sinus infection.

Another clue that healthcare providers use to diagnose sinus infections is called the “Double Worsening.” This means that you became ill with sinus congestion and runny nose, then you began getting better, then you got worse again. The likely cause of “Double Worsening” is that you initially got a viral infection (Rhinovirus) that blocked a sinus passage. You began to recover from the viral infection while the bacteria in the blocked sinus were multiplying. Then, after the pressure in the sinus cavity built to critical mass, you got worse again.

Occasionally, we will use a CT Scan or MRI to further evaluate if a sinus infection is causing your symptoms. These scans are generally reserved for atypical cases with unusual symptoms or for patients who get recurrent sinus infections.

How do I prevent sinus infections (sinusitis)?

sinus3sinus4My preferred method to prevent sinus infections is frequent sinus washing using the “Sinus Rinse” by NeilMed twice daily. The NetiPot is also a great tool for sinus washing, but it is not as good as the “Sinus Rinse” product. Sinus washing prevents sinus infections by allowing saline to get through the narrow sinus passages in order to wash out the bacteria and mucous that is trapped. Bacteria cannot create an infection if its environment is constantly being washed. This is the same idea behind brushing your teeth twice daily instead of once per week for 20 minutes.

We have a saying in medicine: “The solution to pollution is dilution.”

Solution = Treatment

Pollution = Bacteria

Dilution = Sinus wash

This saying applies to many things in medicine. It is why surgeons always wash the area of operation with saline (salt water) before stitching the incision closed – in order to dilute out the bacteria and prevent infection.

Tip:   Do not make your own salt solution. The packets are cheap (around 15 cents each) and found at your local pharmacy and grocery store. I learned this lesson the hard way by incorrectly mixing the recipe. Having the wrong mixture squirted into my sinuses made my entire head feel like it was on fire. Buy the packets – skip the pain!

Nasal steroids like Flonase and Nasonex decrease swelling and allow sinus pockets to drain. The nasal steroids do not always help if you do not have allergies that are causing the inflammation. If you have allergies, be sure that you are using your nasal steroid regularly while you are ill because you have a higher chance of developing a sinus infection.

sinus2What are good over the counter medications for sinusitis?

Decongestants like pseudoephedrine (Sudafed) or phenylephrine. Decongestants work by reducing the amount of blood flow which decreases swelling. When the swelling subsides, the sinuses are allowed to drain their mucous and pus. It is a great idea to wash your sinuses after they have been opened by a decongestant. Caution: Decongestants restrict blood flow everywhere which is why it raises your blood pressure and heart attack risk. Please use these products with care and consult your healthcare provider if you are unsure.

Anti-histamines like diphenhydramine (Benadryl) and Cetirizine (Zyrtec). These products work by decreasing the amount of mucous that your membranes make which is why it also causes dry mouth. One of the side effects of anti-histamine is sedation or fatigue as many people already know. Histamine in the brain is responsible for arousal (being awake). Blocking this receptor causes drowsiness. Diphenhydramine is the agent in Nyquil that makes you sleepy.

Tip: Many people try to combat the drowsiness of anti-histamines with caffeine. Well, the joke is on you. Caffeine actually enhances the drowsiness effect of anti-histamines.

Expectorants like guaifenesin (Mucinex) break up mucous in order for it to drain through nasal passages.

Non-Steroidal Anti-Inflammatory drugs like Ibuprofen (Motrin) and naproxen (Aleve) are great pain killers for sinus infections. Be careful with these medications if you have any other health conditions; please consult your healthcare provider.

Acetaminophen (Tylenol) is generally regarded as the safest pain reliever available as long as you do not have liver failure.

Tip: Watch the listed drugs in each over the counter medication you take. Many brands mix multiple medications per dose. If you are not careful, you can easily overdose. For instance, a Cold and Flu product may already have Tylenol in it. If you then take additional Tylenol, you may be at risk of damaging your liver from too much Tylenol. Max dose of Tylenol per 24 hours is 3,000mg.

What are my treatment options?

Your treatment options for sinus infections include:

Do Nothing – Most sinus infections will clear on their own without antibiotics. This statement is a shocker, and it is also hard for me to believe since antibiotics are prevalent in today’s society. However, penicillin was invented in 1928, and people were not dying very often of sinus infections. Sinus infections generally resolve after 10 – 14 days of symptoms although the symptoms will be more unpleasant without antibiotics.

Antibiotics – If you take antibiotics, your sinus infection will get better quickly, and the severity of your symptoms will be reduced. If your symptoms do not improve while taking antibiotics after 48 hours, then you are likely suffering from a viral infection or you have an antibiotic-resistant bacteria causing the infection.

And remember: Be responsible – don’t abuse antibiotics!

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