What is it?

Sinusitis is an inflammation of the sinuses, which are air-filled cavities in the facial bones that are connected to the nose. Sinusitis can lead to blockage of the narrow passages connecting the sinuses and the nose, causing a painful buildup of pressure.

 

Sinusitis is typically the result of an infection caused by either viruses or bacteria; it can be difficult to tell which one is the cause. The vast majority of cases do not need to be treated with antibiotics, even if bacteria are the cause, because the body’s own immune system will often get rid of the infection on its own. Complications of severe bacterial sinusitis are rare, but can be dangerous if not treated appropriately.

 

Symptoms

Common symptoms of sinusitis may include:

• Congestion

• Runny nose with thick mucus

• Headache

• Facial pain

• Tooth pain

• Fever

• Loss of smell

• Bad breath

 

Sports Medicine Evaluation and Treatment

A primary care sports medicine physician will ask questions about the athlete’s symptoms, evaluate vital signs, including temperature, and examine his/her ears, nose, and throat to make a diagnosis of sinusitis. Once the diagnosis is made, a determination will be made as to whether or not antibiotics will be needed to fight the infection. Antibiotics are usually only needed if any of the following are present:

• Persistent symptoms for more than 10 days without improvement

• Rapid onset of severe symptoms (fever greater than 102 degrees Fahrenheit), lasting 3-4 days

• Worsening symptoms after initially improving over the first 5-6 days

 

Antibiotics are used in these situations to treat the infection and prevent complications from the infection. The doctor will likely also recommend over-the-counter medications to treat the symptoms of sinusitis, including decongestants, antiinflammatories, nasal saline irrigation, and/or nasal steroid sprays to reduce inflammation.

 

Injury Prevention

The best prevention strategy for sinusitis is encompassed by strategies to prevent upper respiratory infections in general, such as avoiding sick people and good hand-washing. It is a good idea to treat symptoms of congestion quickly so that they do not have the opportunity to develop into a sinus infection.

 

Return to Play

Athletes with uncomplicated sinusitis may return to play immediately but may need to ease back into their training, depending on how their illness makes them feel. Athletes with fever, resting heart rates more than 10 beats per minute greater than their baseline, or significant fatigue, should avoid exercise and competition until symptoms have resolved. A good rule of thumb is that if an athlete is having symptoms below the neck (such as chills and body aches), return to play is not recommended. If symptoms are above the neck and there is no fever, athletes may return to play as symptoms allow.

AMSSM Member Authors
Thomas A Starnes, MD and Jason L. Zaremski, MD

References
1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. Apr 2012;54(8):e72-e112.
2. Del Mar C. Acute sinusitis and sore throat in primary care. Aust Prescr. Aug 2016;39(4):116-118.
3. Iqbal Z, Tahir H. Common sports-related infections. In: Brukner P, ed. Clinical Sports Medicine. Sydney: McGraw-Hill; 2012: 1104.
4. Morcom S, Phillips N, Pastuszek A, Timperley D. Sinusitis. Aust Fam Physician. Jun 2016;45(6):374-377.