Sinuses are a grouping of interconnected air pockets within the bones of your skull, but experts aren’t really sure what their true purpose is. Some speculate they are there to provide a cushion, protecting your face in the event of a fall or injury. Others think they’re designed to warm and humidify the air you breathe before it makes its way into your lungs, says Dr. Tanya Laidlaw, director of translational research in the Division of Allergy and Clinical Immunology at Harvard-affiliated Brigham and Women’s Hospital.
Most people probably don’t give their sinuses much thought — that is, until there’s a problem.
What are the causes of sniffles and congestion?
Sinus problems are fairly common, especially those caused by allergies, which affect some 40% of American adults, says Dr. Laidlaw, who is also an associate professor of medicine at Harvard Medical School.
Most often, sinus-related troubles manifest as stuffiness, congestion, or a reduced sense of smell. They typically fall into three main categories, she says.
It may be an acute form of sinusitis
This inflammation of the sinus tissues is more commonly referred to as a sinus infection. It is most often caused by a virus and less often from a bacterial source.
It may be allergy-related congestion
Environmental allergies affect some 50 million Americans and may cause nasal congestion and other symptoms, according to the Asthma and Allergy Foundation of America. You may experience symptoms year-round, or just in certain seasons. Common triggers are tree or grass pollens, mold, or indoor dust mites during the winter months.
Recurrent sinus infections
Some people experience chronic sinus infections, which may be due to a problem with the immune system that keeps it from fighting off infections, says Dr. Laidlaw.
Determining what is causing sinus pain
Determining what’s causing your discomfort can be something of a challenge. In some cases, “sinus” symptoms are really caused by something else entirely.
People often come into the doctor’s office when they experience a stabbing pain in the center of the face, says Dr. Laidlaw. They often assume the pain is sinus-related, but while it can be triggered by a sinus problem, it’s often not.
“Some of the most severe kinds of sinus disorders don’t cause pain at all. Among patients who seek out a rhinologist for sinus pain, a CT scan will show that 50% do not have sinus disease, and their pain is more likely due to a migraine headache,” she says.
One hint that you may be suffering from a migraine and not a sinus-related problem is that pain will lessen if you press on the part of your head that hurts the most. Sinus-related pain will typically increase with that type of pressure, says Dr. Laidlaw.
It can also be difficult to determine if your congestion and symptoms are due to an infection or allergies. But there are some clues that can help you tell the difference.
It might be allergies if
you also have an itchy nose
you have symptoms that affect your eyes, such as a burning sensation, itching, redness, or watery discharge
your symptoms occur at the same time each year.
If your symptoms are accompanied by a fever, however, it’s likely a sinus infection. Allergies rarely cause a fever, says Dr. Laidlaw.
How to treat allergy sinus problems
If allergies are at the root of your problem, you can often treat the problem at home.
To control symptoms, start with an over-the-counter antihistamine. It’s best to choose a non-drowsy antihistamine, such as fexofenadine (Allegra), cetirizine (Zyrtec), or loratadine (Claritin). Diphenhydramine (Benadryl) isn’t advised during the day because it can cause drowsiness that may affect your driving, says Dr. Laidlaw. Take the antihistamine as needed when you are experiencing symptoms, following the directions on the box. You can also add a nasal steroid spray. These sprays, such as fluticasone propionate (Flonase), triamcinolone acetonide (Nasacort), and budesonide (Rhinocort), can be purchased over the counter. They are not a quick fix, but rather something you use over a period of time to get relief.
If your allergies are triggered by pollen, reduce your exposure. In addition, it can be helpful to cleanse your sinuses of allergy-inducing irritants by regularly doing nasal irrigation. To avoid introducing harmful bacteria or other organisms to your sinuses, use distilled water, or boil tap water for one to three minutes (be sure to let it cool first).
If these strategies don’t help, see your doctor or a specialist who can prescribe a stronger allergy medication or get you started on allergy shots, which can be very effective.
“Allergy shots are the closest thing we have to a cure,” says Dr. Laidlaw. They may be even more effective if they are started at a younger age.
How to treat sinus infection
Most sinus infections are caused by viruses and will clear up on their own. But if you have a sinus infection that hasn’t gone away after two weeks, it could indicate a bacterial infection that your doctor might want to treat with antibiotics.
“It’s difficult even for doctors to tell if your sinus infection is viral or bacterial,” says Dr. Laidlaw. “So generally, we don’t recommend antibiotics at all for at least 14 days.”
It’s better to avoid antibiotics unless you really need them. Overusing antibiotics can make your sinus problems worse by impairing your immune system. Antibiotics can harm the balance of microorganisms living in your gut, in your nose, and on your skin, which play an important role in immunity. You are more likely to get sick if those populations are disrupted, says Dr. Laidlaw.
“We know that when young children use antibiotics too frequently it affects their long-term immune function,” she says.
Using antibiotics more than once a year is considered frequent use.
How to find help for recurring sinus problems
For some people, sinus infections are chronic. You should see your doctor if you experience repeated sinus infections that last for two or three weeks each time.
The same is true if you have a sinus infection accompanied by pneumonia, says Dr. Laidlaw. If your doctor determines that you are having chronic sinus infections, she or he can help you manage your condition using such strategies as prescribing preventive antibiotics to ward off infection or providing you with an antibody treatment to bolster your immune response, she says.
