Sinusitis (Sinus Infection): Types, Symptoms, Diagnosis & Treatment

Introduction to sinusitis

Sinusitis is the respiratory system problem where there is an inflammation in the sinus cavities due to infection. Sinus cavities are hollow spaces present in the skull, which provides insulation to the skull, resonance to the voice, and reduce the weight of the skull. Four pairs of sinuses, also called paranasal air sinuses, are directly connected to the nasal cavities. Sinusitis can affect people of all ages but is rarely seen in children under the age of five.

Sinusitis can be divided as follows:1

·      Acute Sinusitis: This lasts for three weeks or less.

·      Chronic Sinusitis: This may take 3–8 weeks or sometimes, even many months to years.

·      Recurrent Sinusitis: In this case, there are numerous acute sinusitis attacks in a year. 

Symptoms of sinusitis

The following are the symptoms commonly seen in sinusitis.

· Facial pain, heaviness, and congestion

· Nasal discharge, which is yellow or yellow-green

· Nasal congestion

· Absence of the sense of smell

· Fever

· Continuous cough

· Reddish bulged eyes

· Pain and pressure in the ears

· Bad breath

· Fatigue

· Dental pain

Causes and Risk Factors of sinusitis

Sinusitis is caused by viral, bacterial, or fungal infection. The growth of organisms in the sinus cavities is due to a lack of adequate defense mechanisms. 

The risk factors of sinusitis include:2

· Allergic rhinitis

· Upper respiratory tract infections

· Structural deviations like the septal deviation

· Tooth extractions

· Nasal polyps

· Swimming 

· Smoking

· Ear infection in children

· Persons hospitalized with head injuries

· Persons with the weakened immune system

Diagnosis of sinusitis

The diagnosis is based on careful observation of the symptoms. 

The following are some of the points, which help in better diagnosis of sinusitis.3

· A physical examination is done to assess any inflammation and presence of any characteristic secretions.

· X-ray of the sinuses is performed in an upright position to identify the fluid levels. A careful analysis of these is sufficient to diagnose acute sinusitis.

· A bacterial infection can be suspected if the mucosal thickening of more than 6 mm.

· Rhinoscopy is suggested if chronic sinusitis is suspected and has been helpful in knowing the presence of nasal polyps, septal deviations, and other differences.

· Computerized tomography is done in patients with chronic sinusitis to know the exact foci and blockage due to infection.

· A rhinoprobe can be used to detect increased neutrophils with intracellular bacteria, which in turn suggests infection presence. 

· A nasal smear can also be done, and the presence of large quantities of eosinophils indicates an underlying allergy.

Treatment of sinusitis

Acute Sinusitis

This condition is of very short duration, and based on diagnosis, a 10-day course on antibiotics may be administered. Antibiotics should be based on the kind of pathogens infected. Antibiotics like clarithromycin, azithromycin, amoxicillin-clavulanate, second-generation cephalosporins, erythromycin-sulfisoxazole can be prescribed. Amoxicillin should be effective for persons who are not exposed to antibiotics quite often. Apart from these, saline nasal irrigations, decongestant sprays, oral decongestants, mucoevaculants can give temporary relief. 

Chronic Sinusitis

Chronic sinusitis, which persists for several weeks, requires a 21-day course of antibiotics. The antibiotics used are usually different from the ones previously used. The antibiotics used in acute sinusitis can also be considered for chronic sinusitis. Apart from antibiotics, usage of oral steroids has been beneficial to persons having allergies and nasal polyps.4

Surgery can be preferred when drug treatments are not effective and also to treat structural abnormalities and fungal sinusitis. 

Prevention of sinusitis

The following are some of the steps, which can be quite helpful in preventing sinusitis.5

· Effectively treating colds and coughs

· Maintaining good hygiene 

· Preventing transmission washing hands before eating and after going outside

· Preventing cold and influenza

· Getting vaccinated for influenza annually

· Anti inflammatory drugs help prevent allergic attacks

· Antihistamines relieve of sneezing, itching and also prevent nasal congestion before an allergy


1. Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am. 2007; 21(2): 427–448, vii.

2. Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007; 137(3 Suppl): S1–31.

3. Pfister R, Lutolf M, Schapowal A, Glatte B, Schmitz M, Menz G. Screening for sinus disease in patients with asthma: A computed tomography-controlled comparison of A-mode ultrasonography and standard radiography. J Allergy Clin Immunol. 1994; 94(5): 804–809.

4. Senior B, Kennedy D: Management of sinusitis in the asthmatic patient. Ann of Allergy Asthma & Immun.1996; 77: 6–15.

5. Ryan MW, Marple BF. Allergic fungal rhinosinusitis: Diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2007; 15(1): 18–22.