Sinusitis, or "sinus", is simply an inflammation or swelling of the sinuses surrounding the nose. In most cases the swelling is due to infection and can be classified as either acute or chronic, the latter if it has persisted for longer than 3 months. Sinus problems are one of the leading causes of visits to the doctor, accounting for over 16 million doctor visits annually. Living with one sinus infection after another can be miserable, interfering with both work and life at home. What people need to understand is that sinusitis is easy to prevent and treat.

What are sinuses?: Your sinuses are a maze of air-filled cavities located under your cheek bones (maxillary), between your eyes (ethmoid), behind the nose (sphenoid) and above your eyebrows (frontal). These cavities are lined with nasal mucous membranes having millions of tiny hair-like extensions called "cilia". The small amount of fluid made within the sinus is swept out through a small opening into the nose by movement of the cilia. Once the fluid is in the nose it is then swallowed as post-nasal drainage into the stomach.

When the nose is congested or stuffy two things happen: 1) mucous membranes in the sinuses also swell keeping the cilia from working properly, and 2) the opening into the nose where sinus fluid normally passes becomes blocked by the nasal swelling. Both of these events disrupt sinus drainage allowing fluid to accumulate causing pressure and/or pain. The mucus builds up, and bacteria and viruses multiply, causing sinus infections.

Symptoms: The symptoms of an acute sinus infection are pretty obvious: fever, severe sinus area pain, teeth pain, and yellow or green post-nasal drainage. On the other hand, a chronic sinus infection without proper treatment, can linger for months, causing one or more of the following symptoms: stuffy nose, intermittent yellow or green nasal drainage (maybe only seen in the shower), occasional sinus area pressure or headache, bad breath, decreased sense of taste and smell, earaches, fatigue, and coughing, especially with lying down. The pain in your sinuses may get worse when you bend over or cough, or it may intensify in the evening, making a good night's rest nearly impossible.

What causes sinusitis?: Sinusitis almost always involves a bacterial infection. Mucus provides a "breeding ground" for bacteria, so anything that causes mucus to collect in your sinuses can cause sinusitis. For example, nasal congestion from a simple cold can result in the bacterial growth that causes sinusitis. Other factors that increase your risk of getting sinusitis include:

1. Allergies and/or Asthma: The majority of cases of chronic or recurring sinusitis occur in people with allergies and/or asthma. The nasal congestion of hay fever predisposes these people to developing sinus infections. In addition, an acute asthma attack may be precipitated by sinusitis.
2. Environment: There are numerous environmental conditions that can aggravate your respiratory tract. Take care to minimize prolonged inhalation of freezing cold air, poorly ventilated indoor air, cigarette smoke, high levels of smog, and car exhaust. These conditions irritate the nose causing swelling and should not be confused with allergies.
3. Nasal polyps: Polyps are small, fleshy growths of tissue that can develop within the sinus or nostril and obstruct nasal passageways. These benign growths differ from polyps in the bowel that can become cancerous. Nasal polyps appear to be more common in patients with asthma.
4. Deviated nasal septum: The wall of bone and cartilage dividing your nose into left and right sides is called the nasal septum. If this bony structure is excessively crooked, it can interfere with how well your sinuses drain mucus into your nose.
5. Tonsils/Adenoids: In children, in particular, enlarged tonsils or adenoids can block mucus drainage from the sinuses and the Eustachian tube of the ear.
6. Medications: Various drugs, such as beta-blocker heart medicine, oral contraceptives, anti-inflammatory medicine for arthritis problems, and continual use of nasal decongestant sprays, can lead to nasal congestion and subsequent sinus obstruction.
7. Hormones: Disease, unmanaged mental or physical stress, and hypothyroidism can cause hormone fluctuations in estrogen or low thyroid levels, occasionally leading to nasal membrane swelling and sinusitis.

Treatment: Allowing the sinuses to drain properly is the first step in curing sinusitis. Americans purchase more than $1.5 billion worth of over-the-counter sinus medications each year, but these remedies don't work for everyone. Drug treatment involves a combination of nasal saline, antihistamines (for sneezing, itchy and watery symptoms), oral decongestants (over the counter nose spray decongestants can cause worsening congestion if used regularly), intranasal cromolyn and intranasal corticosteroids (do not have side effects found with oral steroids).

Because sinusitis rarely clears up on its own, antibiotic treatment and careful follow-up by your doctor may be necessary. The simple 10-day course of antibiotics is fine for an acute sinusitis, an infection having begun only a few days earlier. A chronic sinusitis, on the other hand, requires antibiotics for 4-6 weeks to resolve. Your doctor may look into your nose with a fiberoptic scope or ask that you have a computed tomography (CT) scan of your sinusitis to prove that a chronic infection is present. Endoscopic sinus surgery, in resistant cases, is the treatment of last resort.

"Irrigating" the sinuses can effectively restore drainage. Nasal saline soothes irritated nasal mucosal tissue, liquefies tenacious mucus, augments natural flow of nasal secretions, reduces nose bleeding and improves the sense of smell. Saline can be administered as follows:

As with most diseases, the easiest and most affordable action you can take is prevention. Finding out whether allergies are causing your problem can start you on your way to preventing further episodes of sinusitis. If allergies are not the problem, early detection of nasal congestion and immediate, appropriate treatment can help you fight sinusitis.