Sinus infections are one of the common conditions with which adults may be diagnosed. Sinus infections affect millions of adults in the United States each year. The sinuses are a group of hollow spaces that surround the nose and are also found above and between the eyes. Sinus infections include cloudy or colored runny nose with nasal blockage or clogging, facial pain/pressure, or both. Other symptoms include fever, cough, loss of energy, lack of or reduced sense of smell, tooth pain, and ear fullness. The symptoms can be severe enough to disturb your quality of life or general well-being.
What Causes Sinus infections?
Sinus infections can be caused by viruses, bacteria, or fungi. A viral sinus infection has similar symptoms as bacterial infections but improves within 10 days and does not get worse. A bacterial sinus infection is defined by how long the symptoms last. The 3 types are acute (short course), recurrent (repeated), or chronic (long lasting). An acute bacterial sinus infection is one that either fails to get better within 10 days or has suddenly gotten worse after an initial period of getting better. Acute bacterial sinus infection lasts less than 4 weeks. See Figure 1 for more information on acute sinus infections. Recurrent bacterial sinus infections are when an acute sinus infection occurs 4 or more times in a 1-year period. A chronic sinus infection is when 2 or more symptoms and swelling lasts for 12 weeks or longer. A fungal sinus infection is one that is linked with chronic symptoms. Fungal sinus infections usually occur with people who have weak immune systems. Fungal sinus infections can also occur with people who have used long-term antibiotics.
What Causes Adult Sinusitis?
A sinus infection is typically caused by a viral upper respiratory infection, like a cold. A viral infection does not get better from taking antibiotics. Acute bacterial sinus infections are caused by a bacterial infection. Some people with bacterial infections can benefit from the use of antibiotics, although antibiotics are not necessary for everyone.
What Can You Do About Sinusitis?
You should see a healthcare provider soon after symptoms occur. Early diagnosis may help avoid misdiagnosis or delayed treatment and worse results. There are several types of sinus infections, so it is important to get the correct diagnosis for proper treatment. Treatment options should be discussed with the healthcare provider after diagnosis. Antibiotics do not work for viral sinus infections. Antibiotics are not recommended for all types of bacterial infections.
How Is Sinusitis Diagnosed?
A healthcare provider can diagnose a sinus infection by reviewing the medical history and doing a physical exam. The exam should review and document the conditions in your medical record. A healthcare provider will take note of how long symptoms have been present.
The healthcare provider should decide between acute bacterial sinus infection from viral sinus infection or noninfectious conditions. Your healthcare provider should diagnose an acute bacterial sinus infection when (1) symptoms (facial pain-pressure-fullness, nasal blockage) or signs (cloudy or colored nasal drainage) or both continue without getting better for at least 10 days after the onset of upper respiratory symptoms like a cold or (2) symptoms or signs of a sinus infection worsen within 10 days after getting better (double worsening).
Other conditions can seem like a sinus infection. For instance, a headache alone may not mean a sinus infection. With a sinus infection, there is usually cloudy or colored nose drainage.
An acute sinus infection is diagnosed when there are up to 4 weeks of colored or cloudy runny nose with nasal blockage, facial pain-pressure-fullness, or both. A healthcare provider should decide between chronic and recurrent sinus infections from single-incident of acute bacterial sinus infections and other causes of sinonasal (nose and sinus) symptoms.
The healthcare provider cannot diagnose chronic sinus infection based on symptoms alone. The healthcare provider will also need to see nasal swelling or inflammation on exam. The healthcare provider may use tools such as cameras (an endoscope or rhinoscope). These types of tools can offer a better view of your sinuses. The healthcare provider may also order a special radiology test called a CT (CAT) scan to view sinonasal swelling. The CT scan may confirm a diagnosis of chronic sinus infections. For chronic sinus infections, the healthcare provider should confirm whether nasal polyps are present. Nasal polyps are harmless growths. Having nasal polyps will modify care of your symptoms.
Instead of prescribing antibiotics right away for your acute bacterial sinus infection, your healthcare provider may suggest a treatment option known as watchful waiting. This option usually includes a 7-day waiting period without antibiotics to see if you get better on your own.
You may be tested for allergies and immune function. This testing will help tell chronic or recurrent sinus infections from allergies.
What Treatments Are Available?
It is important to properly diagnose viral and bacterial sinusitis because antibiotics are not for a viral sinus infection. If you have heart, kidney, or liver disease, your healthcare provider may consider different treatment.
For a viral sinus infection: Talking with your healthcare provider can help you make decisions about the treatment of symptoms. To relieve symptoms, pain relievers, nasal steroid sprays, and/or nasal saline rinse (irrigation) may be recommended. Nasal saline rinse can be purchased or homemade. Nasal saline rinse involves using a bulb, squeeze bottle, or Neti pot with a mixture of water, baking soda, and a noniodized salt.
For an acute bacterial sinus infection: The healthcare provider should offer either watchful waiting without antibiotics or an antibiotic. If a decision is made to treat acute bacterial sinus infection with an antibiotic, amoxicillin will likely be prescribed. A combination of amoxicillin with clavulanate for 5 to 10 days may also be prescribed as a different treatment. If you feel worse or do not improve with the antibiotic treatment after 7 days, you should see your healthcare provider. The healthcare provider will review the diagnosis and will rule out other causes. The healthcare provider may also decide to change the antibiotic. To relieve your symptoms, your healthcare provider may recommend over-the-counter treatments. These treatments may include pain relievers, nasal steroid sprays, and/or nasal saline rinse. Nasal saline rinse can be purchased or homemade. Nasal saline rinse involves using a bulb, squeeze bottle, or Neti pot with a mixture of water, baking soda, and a noniodized salt.
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