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Topic of the Month: December 2005: Diagnosis, treatment and prevention of sinusitis
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In this Topic of the Month, you will learn:
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Sinusitis is one of the most diagnosed diseases in the United States. It affects approximately 16% of the adult population and is responsible for nearly $5.8 billion in health care costs annually.
| What are sinuses? |
The sinuses are located in the front of the face in the forehead (frontal sinuses), between the eyes (ethmoid and sphenoid sinuses) and in the cheekbones (maxillary sinuses). The sinus anatomy is illustrated below.
[click on thumbnail for large view]
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Sinusitis occurs when there is an inflammation of one or more of the paranasal sinuses, the hollow cavities within the cheek bones found around the eyes and behind the nose. The primary function of the sinuses is to warm, moisten and filter the air in the nasal cavity.
Sinusitis is very common in the winter and can last for months or years if inadequately treated. It can affect the nose, eyes, or middle ear. Symptoms of sinusitis include some or all of the following:
- Thick yellow-green nasal discharge
- Bad-tasting post-nasal drip
- Cough
- Head congestion and an accompanying headache
- Feeling of facial swelling
- Toothache
- Constant tiredness
- Occasional fever
Sinusitis can be divided into acute, subacute, chronic and recurrent. The classifications are based on length of symptoms, or the specific sinus involved, or both. The classification is as follows:
- Acute sinusitis: symptoms for less than 4 weeks consisting of some or all of the following: persistent symptoms of an upper respiratory tract infection, purulent rhinorrhea, postnasal drainage, anosmia, nasal congestion, facial pain, headache, fever, cough, and purulent discharge.
- Subacute sinusitis: symptoms from 4-8 weeks.
- Chronic sinusitis: symptoms for eight weeks or longer of varying severity consisting of the same symptoms as seen in acute sinusitis. In chronic sinusitis there should be abnormal findings on CT or MRI. Some patients with chronic sinusitis might present with vague or insidious symptoms.
- Recurrent sinusitis: three or more episodes of acute sinusitis per year. Patients with recurrent sinusitis might be infected by different organisms at different times.
Causes
Although colds are the most common cause of acute sinusitis, it is more likely that people with other allergic diseases such as allergies or asthma, will develop sinusitis. Allergies can trigger inflammation of the sinuses and nasal mucous linings. This inflammation prevents the sinus cavities from clearing out bacteria, and increases your chances of developing sinusitis. The incidence of sinusitis in asthma patients ranges from 40%-75% as well.
If you test positive for allergic disease, your allergist/immunologist should be able to suggest the appropriate treatments to control your symptoms, and thus reducing the risk of developing an infection. People with sinus problems should avoid environmental irritants such as tobacco smoke and strong chemical odors, which may increase symptoms.
Another cause of sinusitis is structural problems in the nose - such as narrow drainage passages, tumors or polyps, or a deviated nasal septum (the bone and cartilage between the left and right sides of the nose) - may be another cause of sinusitis. Surgery is sometimes needed to correct these problems, but only after all other medical treatments have failed.
Diagnosis
Allergist/immunologists diagnose sinusitis based on a combination of clinical history, physical examination, imaging studies, and/or laboratory tests. An allergist/immunologist will be able to help you manage your sinusitis, and will determine if an allergic disease is contributing to your condition. He/she will also determine what triggers your symptoms, as well as other triggers that may be causing sinus obstruction, and recommendations on how to treat that infection. An allergist/immunologist can also determine if a visit with an ENT/Otolaryngologist is needed for consideration of surgery for the sinusitis.
Treatment
Sinusitis generally requires a combination of therapies. Allergist/immunologists should withhold from prescribing antibiotics for 10-14 days, unless severe symptoms develop such as fever, facial pain or tenderness, or swelling around the eye. An allergist/immunologist may also prescribe a medication to reduce blockage or to control allergies to help keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a cortisone nasal spray. Antihistamines, cromolyn and topical steroid nasal sprays help control allergic inflammation. Other treatments that can be helpful to control and reduce symptoms of sinusitis include, breathing in hot, moist air, applying hot packs, and washing the nasal cavities with salt water.
Prevention
If you have predisposing conditions that lead to excess mucus and inflammation of the nose, such as allergic disease, structural problems or are in a profession that leads to greater risk for developing these conditions, you are more likely to develop sinusitis and should contact an allergist/immunologist for prevention methods.
Any of kind of predisposing factors makes it important to have a long-term management plan to help control allergic diseases and to keep the nasal inflammation well controlled with medications between sinusitis episodes, and consideration of surgical repair of structural abnormalities, if present and all other medical treatments have failed.
Allergist/immunologists are specialists trained in evaluating for all possible conditions related to sinusitis. These physicians use a management strategy to not only treat current infections, but to also provide management that lowers the risk for future sinus infections. Allergist/immunologists can also help to determine when surgery is indicated as part of the overall management. If you have questions about any of these treatments, be sure to ask your allergist/immunologist for more information.
Additional Resources
 Diseases 101: Rhinitis and Sinusitis
Sinusitis Tips Brochure
Spanish Sinusitis Tips Brochure
Physician Referral Directory
The AAAAI Rhinosinusitis Committee Education Pages
This topic was reviewed on 12/1/2005 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor.
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