Our sinuses are located within cavities beneath the formation of our cheekbones, called maxillary sinuses, behind the forehead and eyebrows, called the frontal sinus, on both sides of the bridge of the nose, called ethmoid sinuses, and behind the nose, in front of the brain, called the sphenoid sinus.

Each sinus cavity is joined by an opening into a continuous membrane, called the nasal passage, which allows one to inhale and exhale air and to eliminate mucous.  However, the nasal passage may become swollen and eventually blocked, either due to head cold induced inflammation, narrow nasal openings, a deviated septum, nasal polyps, or allergic rhinitis.  This impairs sinus drainage, blood flow and ventilation, and enables bacteria in the sinuses to multiply, causing an infection.

Sinusitis, “itis” meaning inflammation, can or cannot be caused by an infection.  Often caused by bacteria, acute sinusitis usually develops as a result of a viral respiratory infection, or common cold.  Most of the time, the common cold subsides on its own without medical treatment.  However, in a small percentage of cases, the common cold progresses into acute sinusitis.

When sinusitis lasts more than three months, it is considered chronic.  Unfortunately, chronic sinusitis is more complicated and difficult to treat than acute sinusitis.  Also, chronic sinusitis is commonly seen in patients with a medical history of allergic rhinitis, asthma or nasal structural problems.

Typical symptoms of acute sinusitis include cough, sinus pressure, facial pain, toothache, nasal congestion, postnasal drip, yellow-green nasal discharge, or even fever.  For patients with chronic sinusitis, symptoms may be less sudden, but may still include facial pain and pressure, cough, nasal congestion with colored discharge, and may also include reduced sense of smell, loss of taste, foul breath, hoarseness, and recurrent sore throat.

To accurately diagnose the etiology of sinusitis, the allergist will gather a detailed patient history, conduct a physical examination, and may perform allergy skin testing and/or order a sinus x-ray, CT scan, and even an endoscopic examination.

Treatment for acute sinusitis must include a course of antibiotics, oral decongestants, nasal corticosteroid spray, nasal irrigation with salt water, and saline nasal spray.  Prolonged antibiotic treatment for chronic sinusitis may be necessary to completely eliminate bacteria to prevent recurrent sinusitis.  Surgical intervention by an ENT (ear, nose, and throat) specialist is also indicated for patients with chronic and recurrent sinusitis with structural problems.  It is not uncommon patients with recurring or chronic sinusitis to have both allergic rhinitis and structural impairment.  Therefore, addressing only one issue may not be the sole answer in preventing or treating chronic sinusitis.