Have you ever had a cold or allergy attack that wouldn't go
away? If so, there's a good chance you actually had sinusitis.
Experts estimate that 37 million people are afflicted with
sinusitis each year, making it one of the most common health
conditions in America. That number may be significantly
higher, since the symptoms of bacterial sinusitis often mimic
those of colds or allergies, and many sufferers never see a
doctor for proper diagnosis and treatment with an
What is sinusitis?
Acute bacterial sinusitis is an infection of the sinus
cavities caused by bacteria. It usually is preceded by a cold,
allergy attack, or irritation by environmental pollutants.
Unlike a cold, or allergy, bacterial sinusitis requires a
physician's diagnosis and treatment with an antibiotic to cure
the infection and prevent future complications.
Normally, mucus collecting in the sinuses drains into the
nasal passages. When you have a cold or allergy attack, your
sinuses become inflamed and are unable to drain. This can lead
to congestion and infection. Diagnosis of acute sinusitis
usually is based on a physical examination and a discussion of
your symptoms. Your doctor also may use x-rays of your sinuses
or obtain a sample of your nasal discharge to test for
When Acute Becomes Chronic Sinusitis
When you have frequent sinusitis, or the infection lasts
three months or more, it could be chronic sinusitis. Symptoms
of chronic sinusitis may be less severe than those of acute;
however, untreated chronic sinusitis can cause damage to the
sinuses and cheekbones that sometimes requires surgery to
Bacterial sinusitis: Therapy for
bacterial sinusitis should include an appropriate antibiotic.
If you have three or more symptoms of sinusitis (see chart),
be sure to see your doctor for diagnosis. In addition to an
antibiotic, an oral or nasal spray or drop decongestant may be
recommended to relieve congestion, although you should avoid
prolonged use of nonprescription nasal sprays or drops.
Inhaling steam or using saline nasal sprays or drops can help
relieve sinus discomfort.
Antibiotic resistance means that some infection-causing
bacteria are immune to the effects of certain antibiotics
prescribed by your doctor. Antibiotic resistance is making
even common infections, such as sinusitis, challenging to
treat. You can help prevent antibiotic resistance. If the
doctor prescribes an antibiotic, it is important that you take
all of the medication just
as your doctor instructs, even if your symptoms are gone
before the medicine runs out.
If your doctor thinks you have chronic sinusitis, intensive
antibiotic therapy may be prescribed. Surgery is sometimes
necessary to remove physical obstructions that may contribute
Surgery should be considered only if medical treatment
fails or if there is a nasal obstruction that cannot be
corrected with medications. The type of surgery is chosen to
best suit the patient and the disease. Surgery can be
performed under the upper lip, behind the eyebrow, next to the
nose or scalp, or inside the nose itself.
Functional endoscopic sinus surgery (FESS) is recommended
for certain types of sinus disease. With the endoscope, the
surgeon can look directly into the nose, while at the same
time, removing diseased tissue and polyps and clearing the
narrow channels between the sinuses. The decision whether to
use local or general anesthesia will be made between you and
your doctor, depending on your individual circumstances.
Before surgery, be sure that you have realistic
expectations for the results, recovery, and postoperative
care. Good results require not only good surgical techniques,
but a cooperative effort between the patient and physician
throughout the healing process. It is equally important for
patients to follow pre- and postoperative instructions.
As always, an ounce of prevention is worth a pound of cure.
To avoid developing sinusitis during a cold or allergy attack,
keep your sinuses clear by:
- using an oral decongestant or a short course of nasal
- gently blowing your nose, blocking one nostril while
blowing through the other
- drinking plenty of fluids to keep nasal discharge thin
- avoiding air travel. If you must fly, use a nasal spray
decongestant before take-off to prevent blockage of the
sinuses allowing mucus to drain
- If you have allergies, try to avoid contact with things
that trigger attacks. If you cannot, use over-the-counter or
prescription antihistamines and/or a prescription nasal
spray to control allergy attacks
Allergy testing, followed by appropriate allergy
treatments, may increase your tolerance of allergy-causing
substances. If you believe you may have sinusitis, see our tips
for sinusitis sufferers.
When to See a Doctor
Because the symptoms of sinusitis sometimes mimic those of
colds and allergies, you may not realize you need to see a
doctor. If you suspect you have sinusitis, review these signs
and symptoms. If you suffer from three or more, you should see
|Duration of Illness
||Over 10-14 days
||Under 10 days|
||Clear, thin, watery
||Thick, whitish or thin|
|Pain in Upper Teeth
A Word about Children
Your child's sinuses are not fully developed until age 20.
can still suffer from sinus infection. Although small, the
maxillary (behind the cheek) and ethmoid (between the eyes)
sinuses are present at birth. Sinusitis is difficult to
diagnose in children because respiratory infections are more
frequent, and symptoms can be subtle. Unlike a cold or
allergy, bacterial sinusitis requires a physician's diagnosis
and treatment with an antibiotic to prevent future
The following symptoms may indicate a sinus infection in
- a "cold" lasting more than 10 to 14 days, sometimes with
- thick yellow-green nasal drainage
- post-nasal drip, sometimes leading to or exhibited as
sore throat, cough, bad breath, nausea and/or vomiting
- headache, usually not before age 6
- irritability or fatigue
- swelling around the eyes
If despite appropriate medical therapy these symptoms
persist, care should be taken to seek an underlying cause. The
role of allergy and frequent upper respiratory infections
should be considered.
Learn your sinusitis
score and review 20
questions and answers about your
© 2004 AAO-HNS/AAO-HNSF
Please read our disclaimer. Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with Dr. Hector N. Hernandez or other healthcare professional. If you have a medical problem, contact us for diagnosis and treatment.