What is the best, most accurate web page for information on nasal and sinus disease and surgery?

This web page is written and edited by the American Rhinologic Society (ARS), the society of physicians whose practice is specialized in the treatment of the nose and sinuses.  Drs. Dubin and Reh are past members of the Board of Directors of the ARS and were course directors of their annual Summer Sinus Symposium, the best physician sinus course in the world, from 2016-2022.

What are the sinuses?

Your sinuses are air filled compartments in your face. They have a lining that makes mucus that flows out of small holes into your nose. Typically, one has four sets of sinuses on each side, although some people do not. It is normal for them to be different on one side or the other. They are connected to your nose, and drain into it but are separate from it anatomically. Unless you have had surgery, things that you spray into your nose do not reach your sinuses, but only get into your nose. The mucus can flow out of the sinuses into your nose, but (in general) sprays do not get from your nose into your sinuses.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Why do we have sinuses?

Good question! There is no known function of the sinuses although there are several theories. One theory is that they make the skull lighter. Another is that they function as an “airbag” for your brain.

On the other hand, the nose has several known functions. It serves as a source of humidification and warming for the air you breathe. It also has a role in fighting infection.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

How many sinuses do I have?

Typically each person has four sinuses on each side of their face. The maxillary sinus is located below your eye, in your cheek. The sphenoid sinus is located in the middle of your head, behind your eyes and the ethmoid sinuses are located between your eyes. The frontal sinus is located in your forehead. Some people only have one frontal sinus or none at all. This is a normal variant and is nothing to worry about. You are born without frontal sinuses and they develop (to a varying degree) after birth. If you do not have one, it simply did not develop. Any or all of the sinuses can be affected by sinusitis.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

What is sinusitis?

Sinusitis is inflammation of your sinuses. It is separate from rhinitis, which is inflammation of your nose. Most often, these two occur together, which is termed rhinosinusitis.

The symptoms of sinusitis can be similar to that of the common cold, but last longer than the 7-10 days of viral infections. Symptoms include difficulty breathing through the nose, increased mucus that you blow out the front of your nose or runs down the back of the throat, pain or pressure in your face, decreased sense of smell, fatigue, fever, or cough. The mucous does not have to colored, but often is.

Sinusitis can occur in numerous forms. Acute sinusitis is what most people typically describe as a “sinus infection” that occurs after a cold. It lasts longer than the 7-10 days of the typical cold, but lasts less than a month. Many will resolve without prescription medications, but some require antibiotics and other therapy. The symptoms of acute sinusitis resolve completely but may return (recurrent acute sinusitis)

By definition, chronic rhinosinusitis occurs when some number of the above symptoms last longer than 12 weeks. Diagnosis also includes clear evidence of sinus inflammation as documented by looking in your nose with an endoscope (camera) and/or a CT (cat) scan. The symptoms of chronic sinusitis are typically similar to acute sinusitis, therefore, the hallmark of chronic rhinosinusitis is a failure of medical therapy and how long the symptoms last. This medical therapy typically consists of oral antibiotics, nasal steroids and saline washes. It may also include oral steroids.

Sub-acute sinusitis is disease that lasts longer than one month, but less than three months. It is during this interval that maximizing and tailoring medical therapy makes the distinction between sub-optimally treated acute sinusitis and chronic sinusitis.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

What causes sinus disease?

There are a number of factors that cause and/or contribute to sinus disease that we know about and many others that we do not. There are some aspects of peoples nasal anatomy that have been shown to increase the likelihood of infections (i.e. septal deviations or crooked nasal septum). Certainly allergy or viral infections (i.e. the common cold) can contribute to sinusitis in that they lead to swelling of the nasal and sinus lining. Allergy and viruses, however, are not the primary cause. It is often many different things added up together than lead to the condition.

There are many people, however, whose cause of their sinus problems is unknown. This is particularly the case in people who have nasal polyps. In these individuals inflammation or swelling is the primary problem and it is not a true infection. Where this inflammation comes from is unknown. Some patients have this issue for decades whereas some develop it later in life. It is similar to the inflammation that occurs in asthma, and many patients have both.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

What are nasal polyps?

Nasal polyps (grape like swelling that occur in the nose and sinuses) are your noses reaction to significant inflammation. They are an indication of significant inflammation and are rarely the primary cause of your sinus condition. More commonly, the polyps result from the inflammation that has combined from the lack of adequate sinus drainage due to anatomy, allergy and the bacterial infection that cannot resolve due to the swelling. There are some people that even when the anatomy has been corrected and allergy is under control, their nose will still form polyps. These peoples noses have a baseline level of inflammation that is high enough to form polyps even without the addition of other factors.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

What are the medications used to treat sinusitis?

This list of medications that have been suggested for the treatment of sinusitis is quite long, and all you have to do is look in your local pharmacy for hundreds of over the counter treatments. For acute sinusitis (an infection that typically occurs after a cold and lasts less than four weeks), antibiotics are the main treatment. Nasal saline irrigation or spray is another treatment with little risk. Nasal decongestant sprays (pseudophedrine or oxymetazaline) can also be recommended for use for three days and may improve the stuffy nose but absolutely should not be used for any longer. There are also numerous combination products that have decongestants, antihistamines and products that thin mucus. These have no proven benefit it sinusitis.

As an infection progresses beyond four weeks, treatment may change. Antibiotics that cover more types of bacteria may be utilized for longer than the typical 10-14 days. Steroid sprays to decrease inflammation and oral steroids (i.e. Prednisone) may also be used. It is not uncommon to get CT (cat) scans to evaluate sub-acute and chronic sinusitis and a culture of nasal mucus can help to choose the appropriate antibiotic.

Allergy medications (antihistamines, nasal steroids, nasal antihistamine sprays, allergy shots) have a role in treating allergy which is one of the major causes of nasal swelling. If someone does not have allergy, these treatments are of little benefit (with the possible exception of nasal steroids).

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Is Sinusitis caused by allergy?

Allergy is often something that goes hand in hand with allergy but is rarely to true cause of sinusitis in and of itself. As most chronic sinusitis is a disease of inflammation or swelling, and additional cause of swelling (i.e. allergy or viral infections) makes the situation worse. Allergy symptoms are often misdiagnosed as sinusitis and sinusitis is misdiagnosed and treated as allergy. An allergy evaluation is critical in sinusitis management for these reasons.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Why do I need to get at CT (cat) scan for my sinusitis?

Sinusitis is typically a diagnosis that usually can be made based on how you feel. When your symptoms have not responded to medical therapy a CT scan may be ordered. The CT is the best test for sinus inflammation, and is much better than an MRI. It gives detailed information about the degree of swelling of the sinus lining and shows your nasal and sinus anatomy in detail. Additionally, if the inside of your nose looks healthy (often with a camera called an endoscope) it is reasonable to get a CT scan to ensure that your symptoms are being caused by a sinus process and not by something else. Lastly, a CT scan may be obtained for planning for surgery.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Am I a candidate for sinus surgery?

Sinus surgery can dramatically improve the symptoms of patients who are appropriate candidates. That being said, sinus surgery is not the answer for all patients with sinus disease. Only after a thoughtful analysis of your symptoms, past medical treatments, endoscopic exam and CT scan can a specialist determine if you are a candidate for surgery.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Is sinusitis hereditary?

Sinusitis in and of itself is not hereditary. That being said, it is common for allergy to be more common in family members and certainly there may be some aspects of anatomy that are hereditary.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

My sinusitis has come back even though I have had surgery. Why?

There are a number of reasons that your sinusitis may return after surgery. The most simple of these, is that sinus surgery does not prevent sinus infections, but makes them more manageable and less symptomatic. Another reason is that there are some people whose noses make polyps and these people are not cured by sinus surgery. Surgery is still the first step in managing the disease, but successfully controlling symptoms requires continuous medical management of the inflammation of the lining of the sinuses which ultimately results in polyps. The third common reason is scarring that can occur that can result in sinus drainage problems. Regardless, if your symptoms either did not improve after sinus surgery or rapidly return, it is appropriate to see someone who has advanced training in nasal and sinus disease and who has expertise in revision sinus surgery.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Do different sinuses cause pain/symptoms in different places in my head?

Sinus pressure can occur in your entire face, or can be isolated to different parts. Although it is certainly not a rule, each sinus has a “classic” place that is uncomfortable when affected by sinus inflammation (sinusitis). The frontal sinuses are in your forehead and can cause pressure in this location above your eyes. The ethmoid sinuses can cause pressure between or behind your eyes. The maxillary sinuses can cause discomfort in your cheek or in your upper teeth. The sphenoid sinus, because of its location in the middle of your head, can cause symptoms that localize to the back of your head (occiput) or the top of your head (vertex).

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Why do I have facial pain if my CT is normal?

Sinusitis and sinus inflammation can cause facial discomfort and in some cases of severe infection can cause pain. However, when a CT is normal it is VERY unlikely that the source of facial pain is the sinuses. In these situation, true headache (migraine, cluster, muscle tension) is a much more likely diagnosis. In patients where this is the case it is common to have been treated for sinus disease without improvement and a neurologic evaluation is appropriate.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

What is a deviated septum?

The nasal septum is the wall that separates your right nasal passage from your left. It is almost always deviated to one side or the other. This happens as your nose develops and as a result of trauma. A deviated septum does not necessarily need to be corrected unless it is found to be a cause of your problem.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.

Is it abnormal if I do not have frontal sinuses?

Some people only have one frontal sinus or none at all. This is a normal variant and is nothing to worry about. You are born without frontal sinuses and they develop (to a varying degree) after birth. If you do not have one, it simply did not develop.

* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice.