Sinus Infection (Sinusitis): Symptoms & Treatment

Sinus Infection (Sinusitis): Symptoms & Treatment

The typical sinus infection symptoms (sinusitis) include a persistent cold, difficulty breathing through the nose, pressure and throbbing pain in the cheek, forehead and eye area, and increased secretion in the nose and throat. This can lead to different symptoms, depending on whether the sinusitis is acute or chronic. What are the symptoms? What can you do if you have a sinus infection? We provide information about the causes, signs and treatment of sinusitis.

What is sinusitis?

Inflammation of the paranasal sinuses (sinusitis) is an inflammation of the mucous membranes in the paranasal sinuses (sinus paranasales) starting from the nose. The paranasal sinuses are air-containing cavities in the adjacent bones of the nose.

A distinction is made between the paranasal sinuses:

  • The frontal sinuses  (sinus frontalis), which lie behind the forehead to the right and left of the nose
  • The maxillary sinuses  (sinus maxillary), which are to be found on the right and left of the nose behind the cheeks
  • The sphenoid sinus  (sphenoidal sinus), which is located quite far inside the skull and abuts the pharyngeal wall at the back
  • The ethmoid cells  (sinus ethmoidales), which border the frontal sinus in front and the sphenoid sinus behind

While in most cases, there is an inflammation of the maxillary sinus or an inflammation of the ethmoid cells; frontal sinusitis is less common and sphenoid sinusitis is the least common.

The paranasal sinuses are lined with the same mucous membrane as the nasal cavity (cavitas nasi). They are in constant contact via fine openings on the lateral and rear walls of the nasal cavity. The inhaled air is warmed and moistened in the sinuses and then enters the lower respiratory tract.

This close connection is why sinusitis often occurs due to rhinitis – an inflammation of the nasal mucosa, better known as a cold. When sinusitis and rhinitis co-occur, which is often the case, it is called rhinosinusitis.

Sinusitis is one of the most common diseases – many adults are affected by it at least once a year. Depending on the course, a distinction is made between acute and chronic sinusitis.


Sinus infection: causes

Acute sinusitis is often triggered by respiratory infections such as colds. If the mucous membranes in the nose are swollen and attacked by a cold, the nasal secretion that the body produces to clean the nose can no longer drain properly. If this blocks the transition between the nasal cavity and the paranasal sinuses, the paranasal sinuses are no longer adequately ventilated. The secretion accumulates in them, and the pathogens find ideal conditions in the humid and warm climate to multiply. This leads to inflammation of the paranasal sinuses.

Acute sinusitis is usually initially caused by viruses. However, an additional bacterial infection often sets in and triggers a purulent inflammation. In both cases, a sinus infection can also be contagious.

A chronically dry nasal mucosa can also lead to sinusitis because the self-cleaning function of the nose is impaired when the mucous membranes are dry. The nasal secretion can no longer be transported away; bacteria can accumulate and lead to inflammation. This inflammation of the nasal mucosa can then spread to the sinuses. This form of sinusitis is sometimes called “dry sinusitis”.

A weakened immune system is generally considered a risk factor for developing sinusitis. The pathogens can also enter the nose when swimming, known as swimming sinusitis. In rare cases, acute sinusitis is also triggered by strong pressure fluctuations (e.g. when flying or diving).

Other possible causes of sinusitis are anatomical constrictions, especially in the area of ​​the sinus openings (e.g. a crooked nasal septum or nasal polyps ), tooth inflammation or allergies – in these cases; however, chronic sinusitis usually occurs. Chronic sinusitis can also result from an acute one if it does not heal properly.

Symptoms of acute sinusitis

Symptoms of sinusitis can vary from person to person. Typical symptoms of an acute sinus infection are:

  • Runny nose with initially watery, later viscous nasal secretion (often yellowish-green if purulent course)
  • Difficulty breathing through your nose due to a stuffy or swollen nose
  • impairment of the sense of smell
  • Severe headache, pain in the face and feeling of pressure in different places, depending on the sinus affected (e.g. temples, eyes, cheeks), especially in the first half of the day and worse when bending over
  • Percussion pain over the maxillary and frontal sinuses
  • flow of secretions in the back of the throat
  • Sometimes, there may also be swelling of the face.
  • red and swollen eyelids (indicating a spread of inflammation)
  • a general feeling of illness
  • Fever (can rise to 40 degrees Celsius)
  • Cough (due to mucus running into the bronchi)
  • Toothache is possible with inflammation of the maxillary sinuses.

As a rule, the signs of the disease are more pronounced in acute sinusitis than in chronic ones.


Symptoms of chronic sinusitis

One speaks of chronic sinusitis when the symptoms last longer than twelve weeks. If a sinus infection occurs more than four times a year, but the symptoms subside entirely in between, this is referred to as recurrent sinusitis.

The signs of a chronic sinus infection are similar to those of the acute form but are usually weaker and do not subside entirely over a long period. Typical symptoms of chronic sinusitis are:

  • increased formation of nasal mucus
  • obstructed nasal breathing
  • slight pressure over the affected cavity
  • tapping the maxillary and frontal sinuses is often painful, but this symptom does not necessarily occur
  • Headaches and sore throats are possible
  • Disturbance of smell and taste
  • Fatigue and reduced performance
  • Cough

Chronic sinusitis often affects the maxillary sinus and the ethmoid cell system. Sinus infections are often associated with chronic bronchitis. This is called sin bronchitis. In these cases, both must be treated.

Complications of a paranasal sinus infection: effects on eyes, ears & Co.

Sinusitis can have complications if not treated properly. It can happen that the bony sinus wall also becomes inflamed and breaks through. As a result, the inflammation can spread to the surrounding organs, bones and soft tissues and cause inflammation of the frontal bone, for example. In rare cases, a possible consequence is purulent meningitis (meningitis purulenta) or brain inflammation ( encephalitis ).

If the inflammatory process spreads to the orbit, lid oedema occurs, and later, the eyeball protrudes (protrusion bulbs). Eyelid oedema occurs more frequently in children and is expressed by externally visible eye symptoms. In particular, it comes here to reddened and swollen eyes, more precisely, swollen eyelids. In many cases, visual disturbances require immediate surgery of the causative sinus. Especially in young children, the disease can also spread to the ear, resulting in a middle ear infection or an inflammation of the auditory tube.

Chronic sinusitis can lead to long-term enlargement of the sinuses by encapsulating fluid build-up. These so-called cells must be removed by surgery.

How long does sinusitis last?

The duration of an acute sinus infection is usually 8 to 14 days with appropriate treatment.

But when should you seek medical advice? The following applies here: At the latest, if the illness lasts longer or if you do not feel any improvement in the symptoms during this period, you should visit an ear, nose and throat doctor (ENT) practice or go to your family doctor. You should also seek medical advice if you have a high fever or very pronounced symptoms if children are affected or if the symptoms suddenly worsen after an initial improvement. This also applies if you regularly suffer from sinusitis.


Sinusitis: how is it diagnosed?

Acute sinusitis is usually very easy to recognize from the apparent symptoms. The usual diagnostic procedures include tapping the paranasal sinuses and examining the inside of the nose for inflammatory swelling of the mucous membrane or pus. A more detailed insight into the excretory ducts is possible with magnifying instruments (rhinoscopy).

If there is a suspicion of a bacterial infection, a nasal swab can be taken to determine the pathogen and, thus, the appropriate therapy.

In exceptional cases, other examination methods are used, such as an ultrasound examination or a measurement of the inflammation levels in the blood.

Computed tomography (CT) or magnetic resonance imaging (MRI) of the sinuses is performed in the event of complications and before surgery. Chronic sinusitis also often requires further examinations, such as a CT scan or allergy tests.

Important differential diagnoses – i.e. other diseases that should be ruled out – are migraine and other headache disorders, as well as trigeminal neuralgia.

Treatment for sinus infections: home remedies and medication

Since swelling of the mucous membrane in the nose in the case of a cold impedes access to the paranasal sinuses, the treatment of sinusitis, first of all, requires a reduction in swelling of the mucous membrane so that the sinuses can be ventilated and the mucus can drain off.

Well-suited for this are decongestants in the form of nasal drops or sprays, available in pharmacies without a prescription. However, they must not be used for more than a week; otherwise, a nasal spray addiction may occur. In addition, expectorant or supportive medication (for example, Myrtol) can be used.

Home remedies such as local heat treatment using steam inhalation or red light lamps are also often used. Rinsing the nose with a nasal douche can also help to soothe the irritated nasal mucosa. You can find more home remedies for treating a sinus infection here.

If the pain is severe, it is advisable to administer a suitable painkiller. The administration of antibiotics can positively influence the course of purulent sinusitis caused by bacterial pathogens.

When is an operation necessary?

Surgery is only necessary in exceptional cases of acute sinusitis. First, the doctor will try inserting swabs soaked in decongestant nose drops or flushing out the sinuses with an antibiotic solution. The middle nasal meatus can also be spread open under local anaesthesia.

Only in rare cases does the frontal sinus have to be drilled open to suck out the mucus and pus. In the event of complications such as eyelid oedema, surgery may also be necessary.


Treatment of chronic sinusitis

In the case of chronic sinusitis, the causes and extent must first be determined to select the right therapy. In milder forms, preparations with cortisone can be used as drug therapy, but they should be used under medical supervision. Here, too, expectorant and decongestant medication and home remedies can be used.

In principle, an operation is only considered if the conservative (non-surgical) therapy fails. During an operation, for example, anatomical constrictions are eliminated (widening of the openings of the paranasal sinuses towards the nose), and pathologically altered mucous membranes are removed.

In any case, the focus is on combating the causes, both in the case of recurring acute and chronic sinusitis. For example, an undetected allergy can be identified and treated with an allergy test. Problematic anatomical conditions such as nasal polyps or a deviated nasal septum can be surgically eliminated with the help of an endoscopy.

How can you prevent a sinus infection?

All measures that strengthen the immune system are advisable, such as a vitamin-rich, balanced diet and lots of exercise in the fresh air. In addition, it can help, among other things, to blow your nose only gently when you have a cold so as not to push the mucus into the sinuses. Drinking fluids can help moisten dry nasal mucous membranes, thereby thinning mucus. Nasal sprays with sea salt or rinsing with the nasal douche can also help to moisten the mucous membranes.

You should seek medical advice to determine the cause and eliminate chronic or frequently recurring sinus infections. Correctly treating acute sinusitis is essential to prevent the development of chronic sinusitis.

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