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Headache Headache Basics

Sinusitis: Acute or Chronic?


Medical Reviewer:

Marc Sicklick, MD, FAAAAI, FACAAI

Medically Reviewed On: December 22, 2010

You know it's not the flu because no one else is sick, and you know it's not a cold because you had that last week. So what's causing that killer headache and the feeling that your nose is locked in a vise? A quick trip to the doctor's office may confirm that you have sinusitis, a common inflammation of the sinuses that affects 30 million to 40 million Americans every year.

What is Sinusitis?
If you've never given your sinuses much thought, a bout of sinusitis can make you think about nothing else. Sinusitis is used to describe any condition where the sinuses become inflamed. Sinuses are the four pairs of air-filled pockets located around the nose and eyes. They are designed to strengthen your skull, filter the air that comes through your nose, add resonance to your voice and help remove mucus from the body. If they become blocked, mucus can't drain properly and air pressure can build up in the sinuses, resulting in the familiar headache and congestion.

Although "sinusitis" and "sinus infection" are often used interchangeably, an infection is only one of many possible causes. The sinuses can also become inflamed by allergens or other environmental irritants, or if you have structural abnormalities in your nose that interfere with sinus functioning.

Your doctor might suspect sinusitis if you show up complaining of a headache, especially one that gets worse when you lower your head, tenderness around the eyes and nose, and thick greenish-yellow nasal discharge. However, not all cases of sinusitis are created equal. One of the major distinctions that physicians use when diagnosing sinusitis is whether it's an acute or a chronic problem.

Acute Sinusitis
An acute infection is one that crops up seemingly out of nowhere. You could be breathing free and easy one day and then struck with an unbearable sinus headache the next.

In most cases, acute sinusitis occurs after a particularly nasty cold. The cold virus causes the mucous membranes in your sinuses to swell and become less effective at draining mucus. The mucus and other material sitting around in your sinuses becomes perfect food for bacteria, leading to a bacterial infection in the sinuses.

Although a bacterial infection following the cold is the most common cause of acute sinusitis, it can also be caused by allergies or viral and fungal infections.

If you have symptoms of sinusitis, your doctor will probably examine you and use a long swab to take samples from your nasal passages and sinuses. These samples can then be analyzed for signs of bacterial or fungal infection. Nasal swabbing doesn't usually hurt, but it can be uncomfortable, especially if you have structural abnormalities like a deviated septum.

Acute sinusitis is usually easy to treat. In some cases, it clears up on its own, but anti-inflammatory painkillers such as ibuprofen and aspirin can help alleviate most symptoms. Your physician might also prescribe antibiotics or allergy medication, depending on the cause of your sinusitis. Washing the sinuses out with saline solution (using a saline nasal spray, a sinus cleansing kit or neti-pot) can also help to alleviate the symptoms of acute sinusitis.

Chronic Sinusitis
If you have sinus headaches and congestion that never seem to go away, or that go away and come back repeatedly, you could be experiencing chronic sinusitis. You have sinus passages that are constantly inflamed, and this causes chronic headaches, difficulty breathing and postnasal drip into the throat.

Unfortunately, in many cases the cause of chronic sinusitis is unknown. Allergies may be a factor, in addition to tiny nasal polyps that can aggravate the sinuses and cause chronic sinusitis.

Chronic sinusitis can be tough to treat because it can be difficult to figure out what's causing it. Acute flare-ups can usually be treated with painkillers, although this won't fix the underlying problem. Your physician might suggest that you wash your sinuses out regularly with saline solution to remove some of the mucus and keep your sinuses from drying out. In extreme circumstances, surgery to remove polyps or enlarge the sinus passages may be recommended.

Whichever type of sinusitis you have, do your best to treat it. A nasty little sinus infection can quickly turn into a more severe one that can spread throughout your body. So, if you find yourself complaining of a sinus headache and congestion for more than a couple of days, visit your doctor to discuss treatment options.

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