Acute Bacterial Rhinosinusitis

What is acute bacterial rhinosinusitis?

Acute bacterial (bak-TE-re-al) rhinosinusitis (RI-no-si-nu-SI-tis), or ABRS, is an inflammation (swelling) of the lining of the nasal passages and sinuses. Sinuses are hollow spaces inside the skull, located behind the bones in your forehead, cheeks, and eyes.

They are lined by mucous membranes that are clean and sterile (germ-free). Sinuses have cilia (small hairs) that help drain mucus into the nose through small openings called ostia. Bacteria (germs) infecting the lining of the nasal passages and sinuses usually cause the inflammation of ABRS. ABRS usually happens after having a common cold or allergy, and lasts not more than four weeks.

What causes acute bacterial rhinosinusitis?

ABRS is commonly caused by the same bacteria causing pneumonia or infection of the ear or brain. The sinus infection usually occurs when the mucus cannot drain properly. This may happen when the ostia is blocked or when the cilia are not working properly. The following conditions may put you at higher risk for developing ABRS:

Dental (tooth) infection and procedures.

Diseases in the nose, such as nasal polyps, septal deviation (crooked nose), and tumors.

Respiratory conditions, such as a cold, asthma, allergic rhinitis, or cystic fibrosis.

Smoking, swimming, or trauma, such as head injuries or foreign objects in the nose.

Using a breathing support, such as ventilators or nasal tubes.

Using medicines that are applied directly in the nose.

Weak immune system (body defense system).

What are the signs and symptoms of acute bacterial rhinosinusitis?

You may have any of the following signs and symptoms:

Major symptoms:

Decreased or no sense of smell.

Facial pressure or pain, which is usually one-sided. This may occur especially when bending or leaning forward.

Nasal congestion or obstruction.

Nasal discharge, which may be thick and yellow or green-colored. There may also be pus inside the nose.

Minor symptoms:

Bad breath.

Cough.

Earache or pressure.

Fatigue (tiredness) or not feeling well.

Fever.

Headache.

Toothache, particularly in the upper jaw.

How is acute bacterial rhinosinusitis diagnosed?

ABRS is diagnosed based on symptoms present and how long you have them. ABRS is usually considered when symptoms have not improved after 10 days or have gotten worse after 5 to 7 days. You must have at least two major symptoms or one major with two minor symptoms to consider ABRS. Your caregiver will check inside your nose using a nasal speculum. A nasal speculum is an instrument used to open the nostrils to better see the inside of the nose. You may also have any of the following tests:

Computed tomography scan:

This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your sinuses. Dye may be given before the pictures are taken. The dye may help sinus disease, abnormality, or other problems show up better in the pictures. Tell your caregiver if you are allergic to iodine or shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye.

Culture:

This is a test that may help caregivers learn which type of germ is causing your disease. A sample taken from the nose using an endoscope is cultured. A needle may also be inserted directly into your sinuses to get fluid and tissue samples. A catheter (thin rubber tube) may also be placed into the sinus.

Endoscopy:

This test uses a scope to see the inside of your nose. A scope is usually made of a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may look into the part of your nose where the sinuses drain. Samples may be taken from the inside of your nose and sent to a lab for tests.

Magnetic resonance imaging:

This test is called an MRI. During the MRI, pictures are taken of your sinuses. An MRI may also be used to look at your nose, face, and skull. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.

Ultrasound:

This is a test that uses sound waves to look inside your nose and sinus area. Pictures are shown on a TV-like screen. Your caregiver may do an ultrasound to better see your sinuses, and to look for pus.

X-rays:

You may need to have x-rays of your nose, face, and sinuses taken. This will help your caregiver know if you have any problems with any of these. You may need more than one x-ray.

How is acute bacterial rhinosinusitis treated?

You may need antibiotic medicines to fight the bacteria causing the infection. You must take this medicine as advised by your caregiver, even after you start to feel better. Other medicines may also be given to help relieve your symptoms. These may include medicines for fever, pain, and clogged nose. A humidifier may be used to moisten the air and help you breathe easier. The moist air makes it easier to cough up your sputum (mucus from the lungs).

Where can I find more information?

Having an acute bacterial rhinosinusitis may be hard and affect your quality of life. Contact the following for more information:

American Academy of Family Physicians
PO Box 11210
Shawnee Mission, KS 66207-1210
913-906-6000
1-800-274-2237
http://www.aafp.org