Division of Rhinology, Allergy and Anterior Skull Base Surgery

What are sinuses?

Sinuses are air-filled spaces within your skull.  The sinuses are lined with mucosa which secrete mucus.  The lining of the mucosa has small hairs or “cilia” which beat the mucus to the natural opening of the sinus in order to drain the mucus out of the sinus and into the nose. Most people have four sinuses on each side for a total of eight sinuses.  This includes the maxillary sinuses (cheek sinuses), the ethmoid sinuses (between your eyes), the frontal sinuses (along your forehead) and the sphenoid sinuses (behind your eyes).  You are born with your maxillary and ethmoid sinuses, while your sphenoid and frontal sinuses develop as you age.  Some people do not develop certain sinuses as their skull grows and this is a variant of normal and not cause for concern. 

What is a sinus infection? 

A sinus infection is when the tissue that lines your sinuses becomes inflamed. The most common reason sinus infections occur is from a virus. These infections typically last under seven days and are characterized by a runny or blocked nose, thickened or discolored nasal discharge, cough, facial pressure or pain and/or a headache. These infections typically get better on their own.  A small percentage of sinus infections are caused by bacteria.  These infections typically last over 10 days and antibiotics may be useful in treating these bacterial sinus infections.   

How do I treat a sinus infection? 

Most sinus infections will improve on their own within 7 days.  Symptomatic treatments are available over the counter to reduce symptoms.  A combination of Tylenol or NSAIDs to reduce fever and offer pain relief in addition to intranasal steroid spray (such as fluticasone) and salt water nasal rinses often help to make the symptoms of a sinus infection more manageable. It is important to use distilled or boiled water when making the salt water nasal rinses.  A NeilMed sinus rinse bottle is an over the counter product which makes it easy to make and use salt water nasal rinses. 

Other products that may be useful include oral decongestants (ex Sudafed) and nasal decongestants (ex Afrin nasal spray) which may be particularly helpful if your ears are popping or have a full feeling in addition to your sinus infection.  It is important to only use these medications for a maximum of 3-5 days to avoid tolerance and long term damage to the lining of your nose. Another over the counter medication that may be helpful if you have thick mucus is Mucinex (generic name – guaifenesin) to help break up the mucus.  

If your symptoms last longer than 10 days or you develop redness or swelling around your eye, changes to your vision, severe headache or high fever, you should reach out to your doctor to be evaluated for a bacterial sinus infection.  

What should I do if I have persistent sinus symptoms? 

If you are suffering from constant or recurrent sinus symptoms such as nasal congestion, stuffiness, nasal obstruction, nasal discharge, post nasal drip, decreased sense of smell or facial pain that does not go away, consider talking to your primary care doctor about going to see a doctor who specializes in sinus care (link to UC contact). A sinus doctor will listen to what symptoms you are having and for how long you have suffered from your symptoms and then may perform a nasal endoscopy.  A nasal endoscopy involves placing a small camera in your nose to better evaluate the lining of your nose and sinuses.   This nasal endoscopy is done while you are awake and does not cause pain. Your doctor may also order a CT scan to better evaluate the areas of the sinuses they cannot see on nasal endoscopy. 

What is Recurrent Acute Rhinosinusitis? 

Recurrent acute rhinosinusitis (RARS) is a syndrome where a patient experiences recurrent sinus infections with complete resolution of symptoms in between infections.  People with this pattern of sinus infections may benefit from a daily sinus regimen including intranasal topical steroids (such as fluticasone) and salt water nasal rinses.  The evidence shows when a patient experiences more than 4 infections in 12 months, that patient may benefit from sinus surgery to improve their quality of life and decrease the amount of sinus infections that person experiences. If you are experiencing recurrent sinus infections, talk to your sinus doctor about if a daily sinus medication regimen or sinus surgery would be beneficial for you. 

What is Chronic Rhinosinusitis? 

Chronic rhinosinusitis (CRS) is a disease characterized by inflammation of the lining of the nose and sinuses.  Patients are diagnosed with CRS when they experience sinus symptoms such as nasal obstruction, nasal discharge, post nasal drip, decreased sense of smell or facial pressure or pain for greater than 12 weeks AND a healthcare provider sees evidence of inflammation of the lining of their sinuses either on physical exam or imaging (such as a CT scan or MRI). Patients may often have reoccurring sinus infections and find their sinus symptoms do not completely go away between infections. Patients with CRS may also notice headaches, ear pain, pressure or popping, poor sleep quality, depressed mood or limitations in their daily activities secondary to their sinus symptoms.