Acute sinusitis causes pain and tenderness in various locations on the face Table 01 Figure 02. Sinus pain tends to worsen when a person bends over or lies down. The tissue lying over the sinuses may also become tender and swollen. The pain can be felt above the eyebrow, or in the cheek and upper teeth, depending on which sinuses are affected. Pain can also occur between the eyes and behind the eye sockets, as well as along the upper sides of the nose. Some patients may experience pain in the upper half of the face, and their eyes may water and be sensitive to light. Others may experience swelling of the lower eyelids, especially upon waking in the morning.
Figure 02. Areas of Pain and Pressure in Sinusitis
Nasal and post-nasal discharge, headache, malaise, bad breath, muffled hearing, and fever can also appear with sinusitis. The pressure caused by sinus blockage can lead to headache and muffled hearing. Bacterial proliferation in the sinuses can also lead to bad breath, and can trigger an immune reaction, leading to fever.
Chronic sinusitis by definition lasts longer than three months. Symptoms are similar to those of acute sinusitis, but patients with chronic sinusitis generally experience sinus pressure rather than sinus pain. The symptoms of chronic sinusitis include nasal congestion and discharge (often of thick green mucus), postnasal drainage, and sinus pressure, all of which tend to be worse in the morning. Headache and low fever may also be present. A fever higher than 101.5° F (38.6°C) is rare in chronic sinusitis.
Table 1. Symptoms of Sinusitis
Acute sinusitis Chronic sinusitis Pain/pressure in sinus area that is worse upon waking and stooping overTenderness and swelling in skin lying over the sinusesNasal/postnasal discharge containing pusCold symptoms lasting from 7 to 10 days Sinus pressure that is worse in the morningNasal/postnasal discharge that is worse in the morningFatigueMalaiseSymptoms of acute sinus inflammation lasting three months or longer
Medical-related risk factors for sinusitis include allergies and asthma, placement of tubes into the stomach or trachea via the nose for feeding or breathing assistance, and diseases that produce mucus abnormalities, such as cystic fibrosis. Asthma and allergies can increase a person’s risk for sinusitis because they can cause inflammation of the tissue lining the nasal passages, which can interfere with normal sinus drainage. Cystic fibrosis causes a person to produce abnormally thick mucus, which also inhibits sinus function by making normal drainage difficult. Tubes placed in the nose can irritate the tissue lining the nasal passages, and also provide a route through which bacteria can enter and colonize the sinuses.
People who smoke cigarettes are more likely to develop sinusitis. Over time, smoking damages the cilia, the hairlike cells of the sinuses that help to sweep away mucus and foreign objects that enter the respiratory system. When the cilia are damaged, bateria enter the sinuses more easily, thus increasing the likelihood that people who smoke will develop sinusitis.
You are more likely to get sinusitis if you experience rapid changes of atmospheric pressure (barotrauma). Activities such as deep-sea diving, airplane travel, or jumping into the water feet-first and not holding your nose can force fluid into the sinuses and create a bacterial breeding ground within. If your immune system or muco-ciliary blanket is unable to rid your sinuses of the bacteria, you will be more likely to develop sinusitis.
Dental infections can spread to the sinuses, leading to sinusitis. Good dental hygiene (brushing, flossing, and using an antibacterial mouthwash) can help prevent dental infection, and thus help prevent certain types of sinusitis.
Physical obstructions of the sinuses caused by growths in the nasal cavity or a deviation of the nasal septum can predispose a person to sinusitis.
Chemical irritation can increase the likelihood that a person will develop sinusitis. Cocaine abuse, or exposure to any chemical that can irritate the tissue of the nasal passages, can lead to sinusitis.
People with weakened immune systems experience more frequent and more severe sinusitis that is difficult to treat. Conditions that impair immune-system function include HIV infection, diabetes (especially when blood sugar levels are poorly controlled), and leukemia. Leukemia patients and others undergoing bone marrow transplants are particularly vulnerable to sinusitis.
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