When a sinus infection hits, it hits with force. You can get this type of infection, or sinusitis, at any age –- but changes in the physiology of your nose over time can make it more likely as you get older.
Sinuses are open cavities within the bones around the nose. They produce mucus, which drains into the nose.
According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF), your nose gets longer as you age, and weakening cartilage can allow the tip to droop slightly. Even a slight sag can restrict airflow, resulting in obstruction, which can lead to geriatric rhinitis. Irritation to the lining of the sinuses –- from a virus, allergy, or sensitivity to environmental irritants -- can also impede draining of the sinuses. Symptoms of rhinitis include a need to clear the throat of mucus, a feeling of pressure behind the nose and the cheeks, and a diminished sense of taste and smell. Most sinus infections begin as rhinitis.
An estimated 14% of Americans over the age of 65 report they have chronic or long-term sinusitis, as reported by the AAO-HNSF.
Bacterial or Viral?
Though sinus infections rank fifth among maladies for which physicians write antibiotic prescriptions, guidelines issued in 2012 warn that as many as 98% of sinus infections are actually caused by viruses, and therefore not affected by antibiotics. Compiled by the Infectious Diseases Society of America (IDSA), the 11-member panel represents organizations like the US Centers for Disease Control, American College of Physicians and others. The guidelines offer symptom characteristics to help doctors distinguish between viral and bacterial sinus infections.
Most likely bacterial:
- Symptoms like nasal discharge, fever, and facial pain lasting for more than 10 days
- More severe symptoms, including fever of 102F or 39C and above, for more than 3 or 4 days
- Symptoms that get worse, with new fever or pain, after the normal 5-6 day course of a cold
Treatment: Antibiotics are appropriate for the treatment of a bacterial infection.
Most likely viral:
- Sinus pain and pressure without fever, and without other symptoms outlined above.
Treatment: The IDSA guidelines recommend avoiding decongestants and antihistamines, which can dry out nasal passages and make symptoms worse. They also suggest painkillers like acetaminophen for sinus pain, and non-drug therapies like nasal irrigation to moisten and disinfect inflamed sinuses.
Many global and national health agencies, including the World Health Organization, warn against using antibiotics in the absence of a bacterial infection because of the risk of developing resistant bacteria, or superbugs.
Anthony W. Chow et al. "IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults." Clin Infect Dis. (2012) doi: 10.1093/cid/cir1043. http://cid.oxfordjournals.org/content/early/2012/03/20/cid.cir1043.full
Antimicrobial Resistance. World Health Organization Public Information Sheet. Accessed March 21, 2012. http://www.who.int/mediacentre/factsheets/fs194/en/
Sinusitis. National Institutes of Health Medline. Public Information Sheet. http://www.nlm.nih.gov/medlineplus/sinusitis.html#cat23
Sinusitis: Special Considerations for Aging Parents. Public Fact Sheet. American Academy of Otolaryngology. http://www.entnet.org/HealthInformation/agingSinusitisPatients.cfm