What Causes Sinus Pressure?

What is Sinus Pressure?

The paranasal sinuses are hollow, air-filled, mucous membrane-lined spaces in the skull. They serve to make the head lighter as opposed to having a skull of solid bone. The mucous membrane lining produces mucus that helps in the cleaning and moistening of the nasal cavity. Each sinus has an opening into the nasal cavity that makes it possible for the mucus to drain into the nose and for air to enter the sinus cavity.

There are conditions that cause excessive production of mucus that is thicker than usual. This causes an obstruction or blockage of the ostia or the openings of the sinuses. When the openings are blocked, a vacuum is created in the sinus space causing the mucous lining to pull away from the underlying structures (bone), causing pain and pressure. Another mechanism is the filling of the sinus space with mucus which cannot be drained away due to the blocked opening.

What are the Symptoms of Sinus Pressure?

Sinus pressure can be felt as tightness and pain behind the eyes and in the ears. It may be felt as a mild throbbing or sometimes as a relentless pounding in the head and face. A painful, sloshing sensation is also felt as if there is fluid inside the skull. In some cases, the pressure is perceived as a toothache. The pain is exacerbated by bending or lying down.

Other symptoms accompanying sinus pressure are tenderness over the frontal and maxillary sinuses, earache, cough, purulent nasal discharge, wheezing, tearing, sneezing, and post-nasal drip. In complicated cases, fever and loss of sight can accompany sinus pressure. This indicates an extension of the infection into the orbit or eye sockets.

What Causes Sinus Pressure?

The most common culprit for sinus pressure is sinusitis or inflammation of the sinuses. The causes of sinusitis may be infection, allergies, or autoimmune diseases. Infections could be caused by viral agents or could be of bacterial etiology. The most common bacterial pathogens involved are: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Fungal infection can also cause sinusitis. Fungal infections are mostly seen in diabetics and immune-compromised patients such as those with HIV and AIDS and those taking immunosuppressive drugs and steroids.

Other causes of sinus pressure are obstructions caused by an anatomical abnormality. This includes a deviated nasal septum, small sinus opening and nasal polyps.

Any substance that can irritate the lining of the sinuses can cause sinusitis. Of these, the most notorious are smoke, pollen and dust. Fumes from chemicals, perfumes and disinfectants have also been implicated.

How to Diagnose Sinus Pressure/Sinusitis?

Diagnosis of sinusitis depends on whether the symptoms are acute or chronic. Acute sinusitis can be viral or bacterial. Mostly, viral sinusitis lasts less than ten days and bacterial sinusitis more than ten days. Diagnosis is made by the presence of characteristic symptoms.

Sinusitis lasting more than eight weeks will warrant a CT scan and nasal endoscopy. CT scan alone is not sufficient to diagnose chronic sinusitis. A tissue sample for histology and cultures may be obtained.

How is Sinus Pressure Treated?

Sinus pressure can be relieved by thinning the mucus and facilitating its drainage. Drinking lots of fluids can help. Agents that will relieve nasal congestion such as antihistamines and decongestants are also used. These agents may come in tablets or as nasal sprays and nasal irrigations. A neti pot to irrigate the nasal sinuses could also be employed. Agents that will bring down inflammation could also be of help. A simple home remedy to relieve congestion and facilitate drainage is steam inhalation.

Some of these agents, though, must be used with caution and prudence. Prolonged use and abrupt discontinuance can cause a rebound sinusitis that will be harder to relieve.

Definitive treatment of sinus pressure is aimed at treating the underlying cause of sinusitis. Viral infections usually are self-limiting and needs only supportive therapy such as those mentioned above. Bacterial sinusitis will benefit from antibiotics. Most pathogens respond to a course of amoxicillin and to amoxicillin plus clavulanic acid for beta-lactam resistant organisms. For patients allergic to penicillin, fluoroquinolones, macrolides and tetracycline could be used. For patients who have had cultures done, a sensitivity testing could be performed to determine the specific antibiotic needed.

Sinus surgery may be considered as a last resort for patients who have exhausted supportive and medical therapeutic regimens. A consultation with an otolaryngologist will elucidate some options for managing sinusitis. Maxillary antral washout involves making a hole in the sinus and flushing with saline to clear out the mucus.

Functional endoscopic sinus surgery (FESS) removes anatomical and pathological obstructions to facilitate drainage of the sinuses. This involves using an endoscope, a very thin fiber-optic cable with a small camera and light source at one end. This is used to visualize enclosed spaces such as the sinuses without making large openings and disrupting a lot of tissues, thereby minimizing post-operative complications.

Balloon sinuplasty uses inflatable balloons to unclog the narrow passages and openings of the sinuses. This mode of treatment is still being studied but shows great promise. Caldwell-Luc radical antrostomy involves making an incision in the upper gum, opening the antrum and removing entire diseased maxillary sinus mucosa. This is reserved for persistent disease even after FESS.