OVERVIEW

What are the sinuses or paranasal sinuses?

The sinuses, also called paranasal sinuses, are air-filled cavities around the nasal cavity. There are four pairs in total, named the maxillary sinus, ethmoid sinus, frontal sinus, and sphenoid sinus, symmetrically located on both sides. Each has a passage (sinus ostium) connecting to the nasal cavity. Normally, dust, bacteria, and other foreign particles in the nose are expelled backward to the nasopharynx along with secretions.

To visualize this, the nasal cavity is like a living room, while the sinuses are small rooms connected to it. The "cleaners" in these rooms collect waste daily and transport it out through the back door of the living room.

What is sinusitis?

Sinusitis is an inflammatory disease of the sinus mucosa caused by various factors such as trauma, bacterial infection, or the spread of inflammation from nearby organs^[1].

Sinusitis can be classified as acute or chronic. Acute sinusitis manifests as sudden nasal congestion, runny nose, reduced sense of smell, headache, and fever. Chronic sinusitis presents as recurrent nasal congestion, runny nose, vision loss or blindness, reduced sense of smell, or foul nasal odor.

Asymptomatic sinusitis may not require treatment, while symptomatic cases need intervention, including antibiotics, nasal irrigation, or surgery. Most cases are curable, though some may take longer to treat.

Is sinusitis common?

Yes, it is relatively common. The overall prevalence of chronic sinusitis is 8%, meaning 8 out of 100 people have the condition^[2].

What is the difference between sinusitis and rhinitis?

The affected areas differ. Sinusitis involves inflammation in the "small rooms," while rhinitis affects the "living room." Clinically, sinusitis often coexists with rhinitis, and rhinitis can also lead to sinusitis. Their symptoms overlap, including nasal congestion and runny nose, but they can be distinguished by the location of inflammation.

Which department should I visit for sinusitis?

Otolaryngology (ENT).

SYMPTOMS

How is sinusitis classified?

Based on the duration of the condition, it can be divided into:

• Acute sinusitis: Sudden onset of headache, nasal congestion, and purulent discharge, lasting less than 12 weeks.
• Chronic sinusitis: Symptoms persist for more than 12 weeks^[1].

What are the symptoms and manifestations of sinusitis?

• Acute sinusitis:

  • Systemic manifestations: Lethargy, loss of appetite, general discomfort. Children may also experience coughing and diarrhea.
  • Local manifestations:
    Nasal obstruction: Thick secretions cause nasal congestion.
    Purulent discharge: Thick nasal mucus, sometimes with traces of blood or foul odor.
    Local pain and headache: Severe headache accompanied by nasal pain.

• Chronic sinusitis:

  • Systemic manifestations: Fatigue, memory decline, and difficulty concentrating.
  • Local manifestations:
    Headache: Dull pain in the head.
    Purulent discharge: Thick, sticky nasal mucus.
    Nasal obstruction: Blockage due to secretions.
    Reduced sense of smell: Temporary olfactory impairment.
    Vision problems: Blurred vision, and in severe cases, blindness.

What complications can sinusitis cause?

Orbital osteitis: Bacteria and pus from infected sinuses may spread to the orbit, causing orbital osteitis. Symptoms include eyelid swelling and mild tenderness^[1].

Why does sinusitis cause headaches?

Accumulation of purulent secretions and swelling of the nasal mucosa compress nerve endings, leading to headaches.

• Frontal sinusitis: Pain in the forehead or brow, worsening from morning to noon and easing in the afternoon.
• Ethmoid sinusitis: Pain around the nasal bridge and inner eyes.
• Maxillary sinusitis: Pain in the cheeks or around the eyes, possibly with toothache. Lying on the unaffected side may relieve pain.
• Sphenoid sinusitis: Deep pain, such as behind the eyes or at the back of the head.

Can sinusitis become malignant?

There is no evidence that sinusitis can turn malignant, but chronic inflammation may theoretically increase the risk due to long-term mucosal irritation.

What adverse effects can sinusitis cause?

• Discomfort from nasal congestion and discharge, affecting work, study, and social life.
• Chronic inflammation may impact the respiratory and digestive systems, causing cough, phlegm, or nausea.
• Severe inflammation may spread to nearby areas, leading to oral, ocular, or ear infections. Snoring and hypoxia from nasal congestion may contribute to cardiovascular issues or memory decline.
• In children, chronic mouth breathing and hypoxia may impair cognitive and facial development.

Therefore, sinusitis should be treated promptly and properly.

CAUSES

What are the causes of sinusitis?

The causes of sinusitis are complex and may result from a combination of factors, including:

• Decreased immunity: A weakened immune system makes the body more susceptible to bacterial and viral infections, which can invade the sinuses and trigger the condition.
• Pathogenic bacterial infections: For example, infections like Streptococcus pneumoniae can cause inflammatory reactions leading to mucosal edema, obstructing airflow and resulting in sinusitis.
• Adjacent organ diseases: Conditions such as tonsillitis or dental caries can spread inflammation to the sinuses, causing sinusitis.
• Trauma or foreign objects: Fractures in the sinuses due to injury or the entry of pathogens or foreign objects can lead to sinusitis.
• Genetics: Chronic sinusitis has a hereditary tendency^[2].
• Nasal diseases: Conditions like nasal polyps or a deviated nasal septum can obstruct sinus ventilation, contributing to sinusitis.

Who is more prone to sinusitis?

• Children: Due to their narrow nasal passages, underdeveloped sinuses, and weaker immune systems, children are more susceptible to sinusitis.
• People with nasal trauma: Injuries may allow bacteria or viruses to enter the sinuses, triggering the condition.
• Those with a family history of chronic sinusitis: Since chronic sinusitis has a genetic tendency, having relatives with the condition increases the risk.
• Individuals with abnormal nasal structures: Structural issues may obstruct sinus drainage, leading to sinusitis.
• People with nasal diseases: Conditions like rhinitis or nasal polyps can block sinus ventilation, making them more prone to sinusitis.

Is sinusitis contagious?

Sinusitis is not a contagious disease. However, patients, especially during acute episodes, often carry bacteria. Close contact with immunocompromised individuals may lead to infections.

Is sinusitis hereditary?

Sinusitis itself is not hereditary. However, conditions like allergic rhinitis, which can trigger sinusitis, have a genetic tendency. This is why parents and children may both develop sinusitis.

DIAGNOSIS

What is the difference between sinusitis and rhinitis?

The affected areas are different. Sinusitis is inflammation of the "rooms" (sinuses), while rhinitis is inflammation of the "living room" (nasal cavity). The treatment methods also differ.

However, clinically, sinusitis is often accompanied by rhinitis, and rhinitis can also lead to sinusitis. Their symptoms are also quite similar. Therefore, diagnosis and treatment plans should be determined by a specialist.

What tests are needed for sinusitis?

• Routine nasal examination, such as anterior rhinoscopy: To observe whether the nasal mucosa is congested or swollen.
• Nasal endoscopy: Provides a complete view of the nasal cavity and the condition of the sinus mucosa.
• Imaging tests like sinus CT: Used to check whether sinusitis has caused complications or tumors, and for preoperative localization.
• Maxillary sinus puncture and irrigation: By puncturing, it can determine whether there is pus in the sinuses. If present, further analysis can identify the type of bacteria to select appropriate antibiotics for treatment.

Doctors may perform multiple tests based on the condition.

TREATMENT

How to treat sinusitis?

Acute sinusitis is primarily treated with medication^[3].

Chronic sinusitis should focus on eliminating the root cause, and surgical treatment may be necessary for cases with large polyps^[3].

• Endoscopic sinus surgery: Removes polyps or other lesions in the sinuses to restore ventilation^[2].
• Nasal irrigation therapy: Suitable for all types of sinusitis patients. Rinsing with saline solution 1-2 times daily helps clear nasal secretions and restore ventilation^[2].

Which types of sinusitis require treatment?

Symptomatic sinusitis requires treatment.

Asymptomatic cases, such as mild sinusitis incidentally found during head CT scans, may not need treatment. Consult a doctor for specifics.

Can sinusitis be cured?

Sinusitis is treatable. However, due to complex causes, some cases may require prolonged treatment (weeks to months). Patients should follow medical and lifestyle advice for recovery.

What medications are used for acute/chronic sinusitis?

Sinusitis medications fall into two categories: systemic drugs (anti-inflammatory, promoting secretion drainage) and local treatments (nasal sprays, drops, or irrigation solutions). Antibiotics may be added for bacterial infections.

• Nasal decongestants: e.g., naphazoline HCl or ephedrine derivatives, reduce mucosal swelling. Suitable for acute flare-ups or severe congestion. Avoid use beyond 7 days to prevent rebound congestion. Side effects may include anxiety or elevated blood pressure^[2].
• Nasal corticosteroids: e.g., mometasone or budesonide, reduce inflammation. Suitable for all sinusitis types. Possible side effects: nosebleeds or irritation^[2].
• Antibiotics: e.g., amoxicillin or metronidazole, control infections. Used for severe acute/chronic sinusitis or pediatric cases^[3].
• Mucolytics: e.g., acetylcysteine or ambroxol, clear mucus. May cause gastrointestinal discomfort or allergies^[2].

Are nasal sprays addictive?

Nasal sprays/drops fall into three categories:

• Decongestants: OTC options (e.g., oxymetazoline HCl) provide short-term relief but risk "rhinitis medicamentosa" if overused (>7 days).
• Corticosteroids: Prescription-based (e.g., budesonide sprays).
• Antihistamines: Prescription-based (e.g., azelastine HCl).

The latter two are safe with medical guidance. Decongestant misuse can worsen symptoms.

Do steroid nasal sprays have side effects?

All medications carry risks, but benefits outweigh concerns for localized steroid sprays. Minimal systemic absorption makes side effects rare during treatment.

Why does sinusitis persist despite medication?

• Structural abnormalities (e.g., deviated septum) may require surgery.
• Sinuses' deep, semi-closed anatomy limits drug penetration.
• Underlying conditions (e.g., allergic rhinitis) contribute to recurrence.

When is surgery needed for sinusitis?

• Structural abnormalities causing sinusitis.
• Cases unresponsive to conservative treatment.
• Nasal polyps obstructing sinus drainage.

Why pre-surgery medication?

Preoperative drugs reduce bleeding, improve surgical precision, and aid post-op mucosal healing.

How is sinusitis surgery performed?

Most surgeries use endoscopy via nostrils to correct structures and clear blockages—no external scars. Rarely, a gingival incision (hidden inside mouth) may be needed, causing temporary facial swelling/numbness.

Is sinusitis surgery minimally invasive?

Yes. Functional endoscopic sinus surgery leaves no scars but requires 1-2 days of nasal packing for hemostasis.

What are the surgical risks?

Bleeding and infection are common. Proximity to eyes/brain (separated by thin bone) necessitates expert care at certified hospitals.

Why follow-up visits post-surgery?

Scabbing and swelling may re-block sinus openings, requiring repeat debridement.

Why does sinusitis recur?

Recurrent colds or rhinitis can trigger irreversible mucosal thickening and secretion buildup. Ongoing care is essential post-recovery.

DIET & LIFESTYLE

What dietary restrictions should sinusitis patients follow?

Avoid foods that clearly trigger allergies. Otherwise, there are no specific dietary restrictions for sinusitis patients, but a balanced diet with a reasonable mix of meat and vegetables is recommended. Consume more fresh vegetables and fruits, as a healthy and balanced diet helps boost immunity.

What lifestyle precautions should sinusitis patients take?

• Strengthen physical fitness to prevent colds.

• Avoid allergens.

• Perform daily nasal irrigation if needed.

• Avoid long-term use of nasal sprays containing decongestants.

How can sinusitis patients perform nasal irrigation at home?

Nasal irrigation at home is recommended for post-sinus surgery patients and those with a history of rhinitis or sinusitis. There are two common methods:

• Purchase a nasal irrigation device (various models available—consult sales staff for usage instructions). Add warm water and a saline solution packet to the device for rinsing, or use saline alone. Suitable for adults and children willing to cooperate, it can be used at home or in school dorms, 1–2 times daily.

• Spray-type saline bottles. Pre-mixed saline solution can be sprayed into the nostrils a few times per use (single-use only). Portable and suitable for frequent daily use. The gentle spray pressure makes it ideal for children unwilling to use irrigation devices.

PREVENTION

How to Prevent and Care for Sinusitis?

• For those with weakened immunity, exercise regularly, balance work and rest, and improve physical resistance.
• For patients with a history of rhinitis or sinusitis, perform nasal irrigation daily.
• For those with abnormal nasal structures, correct nasal deformities such as a deviated septum.
• For patients with nasal diseases or inflammation in adjacent organs, actively treat the primary condition.