Lori Lemonnier, MD
How common is sinusitis?
In the United States, more than 30 million people are diagnosed with sinusitis each year. Moreover, chronic sinusitis effects approximately 15% of the U.S. population and is one of the most common chronic illnesses in America.
What causes sinusitis?
The central event in sinusitis is blockage of the sinus openings, or ostia as a result of inflammation. Causes of sinonasal inflammation include:
Unable to circulate air and eliminate the secretions that are produced, obstructed sinuses become an ideal environment for bacterial infection.
Many different types of bacteria can infect the sinuses. The bacteria most often identified in acute sinusitis are:
How is sinusitis diagnosed?
The diagnosis of sinusitis is made based on the subjective symptoms that a patient experiences combined with objective findings identified on examination or testing.
Your otolaryngologist will ask questions to determine exactly what symptoms you are experiencing and for how long.
Diagnostic symptoms include:
How i sinusitis treated?
Much like the common cold, acute viral sinusitis resolves without treatment. Because viruses do not respond to antibiotic therapy, viral sinusitis is primarily managed with supportive care such as nasal saline rinses, rest and hydration. Medications, such as decongestants, mucolytics and pain relievers, may be offered by your physician to help decrease the severity of your symptoms.
The mainstay of treatment for acute bacterial sinusitis is an appropriate antibiotic, although some physicians and patients may prefer watchful waiting, as most acute bacterial infections will resolve without antibiotics. Your physician will base the choice of antibiotics on many factors, including:
Because of the vast number of underlying, often multiple, causes, the treatment of chronic sinusitis becomes more complicated. In general, however, chronic sinusitis requires more prolonged durations of medical therapy. Antibiotics, when required, are often based on the results of sinus cultures and are prescribed for 3-4 weeks time. A culture is a test that uses a sample of a patient’s mucous to determine which bacteria are present.
Who treats sinusitis?
Pediatricians, family practitioners, internists, allergists and pulmonologists are all involved in the treatment of patients with sinusitis. However, patients suffering from symptoms of recurrent acute or chronic sinusitis are often referred to an otolaryngologist. Otolaryngologists, or ENT physicians, are specialists providing both medical and surgical treatment of disorders or the ears, nose and throat.
Some otolaryngologists choose to further subspecialize in rhinology; the management of diseases of the nose and sinuses. Patients with severe or complicated disease and those who have undergone prior surgery are often referred to a rhinologist for evaluation and treatment.
When is surgery needed?
Sinus surgery is reserved for patients with chronic sinusitis who have persistent symptoms despite medical therapy.
It must be remembered that sinusitis is an inflammatory process that needs to be treated aggressively with medication before considering surgery. Even after successful sinus surgery, most patients with chronic sinusitis will continue to require medication to control the underlying cause(s) of inflammation and prevent the return of symptoms.
For patients who fail to improve with appropriate medical treatment, sinus surgery is an excellent option. Today, sinus surgery is typically performed through the nose, endoscopically, with the use of a nasal endoscope to visualize the nasal cavity and sinuses, thus avoiding the need for incisions through the skin. The primary goal of endoscopic sinus surgery is to restore normal function to the blocked sinuses. During the procedure, the surgeon locates and enlarges the small natural drainage passageways of the sinuses.
Very rarely patients with acute bacterial sinusitis will develop a complication when the infection spreads to adjacent structures such as the eye or the brain. Such complications are considered medical emergencies, requiring immediate treatment. Typically, surgery is also required in these patients in order to drain the collection of infection and enlarge the ostia of the responsible sinuses.
Clinical practice guideline: Adult sinusitis. Richard M. Rosenfeld, et al. Otolaryngology -- Head and Neck Surgery 2007 137: S1
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