Sinusitis

Introduction

Sinus disease is a very important health condition impacting 15% of the US population at one time or another. Sinusitis is defined as an inflammation of the sinuses, which are air-filled cavities within the face. Because the nasal cavities are also inflamed, sinusitis may also be called rhinosinusitis. An infection often starts because of inadequate drainage from multiple causes including infections, a narrow opening, allergies, a weak immune system, or some combination of all of the above. Sinusitis is becoming more prevalent. There is also an association between chronic sinusitis, and asthma.

Types of sinusitis

Sinusitis can be divided into acute and chronic sinusitis. Acute sinusitis resolves completely within 12 weeks, whereas chronic sinusitis is associated with incomplete resolution after 12 weeks. Acute sinusitis is often triggered initially by a viral respiratory infection, with persistent symptoms beyond 10 days, suggesting a secondary bacterial infection. Chronic sinusitis can be divided into 2 subtypes based on the presence or absence of nasal polyps: Chronic rhinosinusitis without nasal polyps (CRSsNP), and chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal polyps are pale gray gelatinous like structures that are associated with extreme nasal congestion, and often the complete loss of the ability to smell. The presence, or absence of nasal polyps and has significant implications in regards to treatment.

Symptoms of sinusitis

Some of the symptoms of sinusitis include postnasal drip, green nasal discharge, nasal congestion, facial tenderness (usually not severe or acute), and reduction or loss of the sense of smell. Sinusitis is more common in asthma. Treatment of sinusitis may improve the underlying asthma. Allergic and non-allergic rhinitis may also cause sinusitis. In chronic sinusitis, the symptoms may be diffuse or there may be a single symptom such as a headache, or postnasal drip.

Treatment of sinusitis

The treatment of rhinitis sinusitis encompasses both symptomatic relief, and the treatment of an underlying infection. Topical and oral decongestants can decrease congestion. Topical nasal steroid sprays, and occasionally oral steroids can provide additional symptom relief. Antibiotics are also used to address picked her growth of the sinuses and decrease the inflammation. Treatment of chronic sinusitis may include prolonged courses of antibiotics. A useful strategy may be to treat for a week beyond complete symptom resolution. Another strategy may be to use prophylactic or preventative macrolide antibiotics such as azithromycin on a chronic basis, and/or through the viral season. If nasal polyps are present, the use of corticosteroids, and possibly doxycycline, may play a crucial role. The presence of nasal polyps might indicate a condition called aspirin exacerbated respiratory disease (AERD). In the future, some of the biological medicines for asthma may be useful in cases of sinusitis with nasal polyps. If a comprehensive treatment regimen is unsuccessful, then a screening CT scan of the sinuses may be obtained. There may also be a role for referral to a sinus specialist called otolaryngologist for possible surgery. In young children, the removal of the adenoids may improve the course of sinusitis. In some cases, an immunodeficiency workup may be obtained, especially if there are other infections such as pneumonia.