Introduction
People often use terms like “sinusitis,” “rhinosinusitis,” and “sinus infection” to talk about problems with the nose and sinuses. But diagnosing sinusitis can be more complicated than it seems. Doctors look at various factors, like your symptoms, how long they’ve been going on, and the results of imaging studies and tests, to make an accurate diagnosis.
Symptoms
Sinusitis happens when the inside of the nose and sinuses get inflamed. The sinuses are air spaces in your cheeks, forehead, and between your eyes (See Sinus Anatomy). Some symptoms are very common with sinusitis. Other symptoms occur less frequently. Sometimes, people confuse symptoms of sinusitis with those of a common cold or allergies. Your doctor, called an Otolaryngologist (ENT physician), can help figure out the right diagnosis and treatment.
Common Symptoms of Sinusitis
- Nasal congestion or stuffy/blocked nose
- Thick and discolored drainage
- Decreased sense of smell or taste
- Facial pressure, discomfort, or fullness
Less Common Symptoms
- Headache
- Fatigue
- Bad breath
- Fever
- Upper tooth pain
- Cough
- Ear pressure
Because these symptoms can be similar to other conditions, the timing, combination of symptoms, and other tests can help find the correct diagnosis.
Time Course
- Less than 10 Days: Usually caused by a viral infection or upper respiratory infection (URI), like the common cold. Some symptoms commonly occur with viral URI but are less likely to occur with bacterial sinus infections. These include fatigue, sore throat, and muscle aches. Antibiotics don’t help; rest, fluids, and over-the-counter remedies are recommended.
- More than 10 Days: It might be a bacterial sinus infection, especially if symptoms worsen after about 5 days following a cold or during allergy season. Antibiotics can speed up recovery.
- More than 3 Months: It could be chronic sinusitis; infection is NOT typically the cause of the inflammation. Symptoms of chronic sinusitis may be worse some times than others, but they are always present. Tests like nasal endoscopy or CT scans help confirm the diagnosis.
Tests Used to Diagnose Sinusitis
Nasal Endoscopy: A simple office procedure where a doctor looks inside your nose with a small scope. Typically, a spray will be applied to your nose to make the procedure more comfortable. The spray usually contains a decongestant and a topical anesthetic medication. The decongestant helps to shrink the nasal lining to allow the scope to pass more easily. The anesthetic numbs your nasal lining. It helps identify inflammation, infection, and take cultures if needed.
Radiologic Studies
- X-ray: Not commonly used.
- CT Scan: This is now the study of choice. Shows detailed images of sinuses. Used when the diagnosis is unclear or for chronic cases. Because many conditions can mimic sinusitis, a CT scan that shows no sinusitis is still valuable. A “negative” or “clear” sinus CT scan allows doctors to consider other causes of your symptoms. Finally, if more serious complications of sinusitis are suspected, a CT or MRI scan may be obtained. Rare complications include the spread of infection to the eyes or brain.
Limitations of Tests
Tests like CT scans are just pictures at one point in time. A CT should only be obtained if (1) the results will change your treatment, (2) sinus surgery is being considered, or (3) if the sinusitis is causing a complication. In addition, a CT scan cannot distinguish between a viral URI and bacterial sinusitis. For this reason, early infections are typically based on symptoms and time course rather than imaging studies. CT scans also expose you to a small amount of radiation.
Other Conditions That May Seem Like Sinusitis
- Common Cold: Symptoms can be similar, but treatment is different (see above).
- Environmental Allergies: Symptoms may fluctuate based on seasons or changes in the environment and may include sneezing, clear nasal drainage, and an itchy nose or throat. Allergies often have triggers like pollen, grasses, or cats/dogs.
- Headaches: Sinus headaches are rare; facial pain/pressure or headache that occurs without nasal congestion or discolored drainage is rarely caused by sinusitis. Other problems like tension headaches, migraines, temporomandibular joint (TMJ or jaw joint) problems, and dental issues are much more common.
- Acid Reflux: Acid reflux occurs when stomach acid comes up to irritate the back of the throat. Though it can sometimes cause throat symptoms similar to sinusitis, it usually leads to thick phlegm in the throat, post-nasal drainage, chronic throat clearing, and voice changes.
Serious Concerns Related to Sinus Infections
In rare cases, sinus infections can lead to severe complications (See Complications Of Sinusitis). Seek immediate medical attention if you experience severe headache, stiff neck, confusion, high fever (>101°F), vision changes, or eye swelling.
Treatment
Treatment options include nasal sprays and irrigations (rinses), antibiotics, steroids, and sometimes surgery. Your doctor will consider your symptoms, how long you’ve had sinusitis, other medical issues, and test results to determine the course of best treatment.
Summary
While we’ve covered common symptoms and tests for sinusitis, every patient is different. Sinus infections don’t always follow a typical pattern, so it’s crucial to talk to your doctor about your specific concerns.