Understand Sinus Problems: Causes, Symptoms, and Solutions

There are several sinus cavities in your head: Behind your cheekbones, behind your eyes, in your frontal (forehead) area, and farther back in the midportion of your head. They keep air warm and secrete mucus that carries out and removes tiny particles and germs that you breathe in. When you have inflammation of your sinuses, it is called sinusitis. The following will help you give you a better understanding of sinus problems: causes, symptoms, and solutions

The Sinuses

Meet Jim

This is Jim. He is my patient today.

"Ya know, I started to get this sinus infection yesterday. I woke up with green mucus. No fever. I know what it is—I get sinus infections all the time, and ALL I NEED IS A Z-PACK." I called my own doc, but he wouldn't give me a prescription. I don't know why because he used to."

Jim is a great guy, but doesn't have a great understanding of how things have changed in medicine today.

Let's look at everything Jim is saying here:

1. According to Oxford Academic, 90-98% of sinus infections begin as viral infections (1). Jim wants an antibiotic (the infamous Z-Pack), but antibiotics do not kill off viruses; they kill off bacteria, so it's most likely not going to work. They are NOT given for an infection that just might be bacterial because indiscriminate use can lead to resistance. Worst-case scenario: When you, your mom, your dad, or your kids get older, when they get sick, the antibiotics will not work for your illness because you have a bunch of resistant "germs" roaming around in your body and likely in your household, and maybe in your community, multiplying. So, people will end up in the hospital quite ill. The Z-Pack is an excellent example: It is a much-loved, very effective drug that is well-tolerated and easy to take. It has been given out indiscriminately for just about every upper respiratory illness (viruses included) (2). Now, there is A LOT of resistance to it. This is probably one of the reasons why our friend Jim (above) gets these things "all the time." The antibiotic is not working to kill off ALL of the bacteria. Some die, but the resistant ones survive and multiply. Maybe something other than a Z-Pack will work...but maybe not. By the way, I know we are all tired of hearing about it, but it's not unusual for our old friend (and virus) COVID to appear masquerading as a nasty sinus infection!

There is a great need to develop new antibiotics because of growing resistance. However, only a few new antibiotics are in the pipeline. They cost a great deal to produce and are generally less profitable for drug companies to develop (3). When they do develop newer ones, they may end up costing us a fortune because they will be like gold—hard to get and expensive. 

This is why Jim's doctor did not give him an antibiotic; an antibiotic would not work on a viral (or allergy-related) sinus problem. It will likely not work on Jim's early sinus. Maybe Todd thinks an antibiotic has worked in the past, but his immune system would likely have taken 5-7 days to get rid of the thing anyway. Maybe he thinks the antibiotic worked. A person feels the antibiotic worked when, in fact, it was their own body that took care of it! This is what our immune systems are for!

2. Another concern for Jim and the Z-Pack: Many antibiotics have side effects, from "mild" diarrhea and yeast infections (antibiotics kill harmful bacteria AND good bacteria) to severe anaphylaxis. In many cases (but certainly NOT ALL), the chance of becoming ill from the antibiotic may be greater than the side effects from the illness you are being treated for! We don't want Todd to get diarrhea when he is on his business trip.

This is why Jim's doctor did not give him an antibiotic: He had a sinus problem for only one day, and it was likely viral—an antibiotic probably would not work. He may also get resistance and undesirable side effects from the antibiotic.

So, when should a person take an antibiotic? Because of the above issues, many researchers do not recommend using an antibiotic unless a person has had sinus symptoms for about seven to ten days. By that time, the sinus problem had either developed into a bacterial issue or, as with many viruses, had run its course and gone away, given the proper over-the-counter treatment. Getting through the 7-10 days successfully and with the least discomfort can be facilitated by using various approaches like taking over-the-counter medicines, using various alternative remedies and treatments, and avoiding certain things. When used correctly, these will often help a person get better and will ward off worsening symptoms. While there are exceptions (risk factors), this is the general rule.

The truth about mucus. Mucus is often thick, yellow, or green in the morning because it's been sitting in your sinuses all night, even if it is a viral issue. In fact, mucus can be discolored constantly and still be a viral issue! 

Back in the day, many patients were given antibiotics for anything, anytime, in the doctor's office, on the phone. That has ALL changed. Modern medicine has learned a lot since then. Although telemedicine has arrived, many doctors still do not like to prescribe antibiotics (or other medication) based on just a phone message - they want a more extensive conversation. This is prudent, wise medicine. A patient should be seen and evaluated in person or on a virtual (video) visit if they are sick enough to get an antibiotic. 

Sinus Pain

The healthcare provider needs to examine and treat each patient as an individual because there will ALWAYS be exceptions!! For example, a person with severe symptoms, especially one with significant unilateral facial pain, may be treated regardless of the duration of the illness.

COMMON CAUSES OF A SINUS INFECTION

A sinus infection often begins as a minor issue, like a cold or allergies. Then, after several days, a person may not be able to contain their symptoms, and what started as a simple cold evolves into a full-blown sinus infection. But there are other causes as well. Below are several factors that may set the stage for a sinus infection. If you can control these, you may be able to control your sinus infections:

A Cold, Flu , or Sinusitis- Bacteria love that warm, moist, dark environment, so they might multiply and cause a watery, runny nose to evolve into a bacterial sinus infection. I have had patients tell me that their friends say, "You cannot catch a sinus infection." I have also read this in the literature. But look at it this way: what happens in a family when a child goes home with a nasty, drippy nose, and a couple of days later, the parents end up with the same thing? It does not matter if it is viral or bacterial; you can catch a sinus infection because another person's respiratory droplets or mucus can spread it.

Allergies—Again, allergies create a warm, dark, and moist environment and set the stage for a sinus infection. Things like air pollutants, cigarette and cigar smoke, mold, dust, pollen, animal hair, dust mites, and chemical fumes can irritate your nose and cause inflammation, congestion, sometimes watery drainage, making you more susceptible to sinus infections. If you get sinus infections frequently or at the same time EVERY YEAR, you should consider allergies as a possible underlying issue. If you can control the allergy, you may be able to control the infections that develop. I cannot tell you how many people I have met who were mowing the lawn, developed minor sinus symptoms a day later, that evolved into a significant sinus infection several days later!

Anatomy - When mucus cannot drain adequately because of sinus structures, it can collect and fester in a person's sinus cavities. This would be a case for the Ear Nose and Throat (ENT) specialist and may require surgery - Sinus surgeries have gotten very mixed reviews from past patients who tell me anything from "it's great" to "it worked for a while then got bad again" or "it did not work at all" (rare).

Room Temperature and Humidity - Dry air and cold air tend to foster the growth of more viruses in winter, which, in turn, may cause more sinus and respiratory problems. Dryness and warmth also promote the growth of certain types of bacteria, such as pneumococcus, staphylococcus, and streptococcus. These bacteria are eliminated much faster when relative humidity is above 55%, and warm, moist humidity tends to help get rid of viruses.  When used correctly, humidifiers may offer some resolution to this problem and the spreading of "germs" around your house.

Fungus - This can cause a sinus infection. Fungus loves dark, moist places. It also loves immunocompromised people (for example, people with diabetes or people taking medicine that decreases their immunity), so it sometimes "attacks" these people. If you cannot get rid of a sinus infection or it keeps returning, talk to your healthcare provider about who can test you for it. These can also become bacterial sinus infections.

APPROACHES TO CARE OF SINUS PROBLEMS

Over the short term, treat your symptoms. Learn more about treating the symptoms by visiting the following pages:

Treating nasal congestion

How to Treat a Runny Nose

If your sinus symptoms are not responding to over-the-counter approaches, if they getting worse, or just not going away, consider seeing a healthcare provider. You may need an antibiotic.

If your problem keeps coming back or never seems to fully resolve, it might be time to see an Ear, Nose, and Throat (ENT) specialist. They can identify the underlying cause and provide solutions to help you gain control of your symptoms and minimize episodes of sinusitis.