Sinusitis

Sinusitis is an inflammation of the nasal sinuses, which are hollow cavities within the cheek bones found around and behind the nose. The inflammation is usually caused by inadequate draining due to allergy, infection or obstruction. Common symptoms include thick yellowish/green nasal discharge, headache, congestion, fatigue, fever, and feelings of facial fullness.

Causes of Sinusitis

There are two types of sinusitis. The first is acute sinusitis, which is caused by bacterial infection in most cases, and usually occurs as a late complication of a common cold. When this happens, nasal congestion produces swelling in the sinus cavity, obstructing drainage and causing mucus to stagnate, providing a perfect breeding ground for an infection.

Although colds are the most common cause of acute sinusitis, those with allergies may also be predisposed to the development of sinusitis. Allergy can cause chronic inflammation of the sinus and nasal mucous linings. If you test positive for allergies, we can prescribe appropriate medications to control them, thereby reducing the risk of developing infection.

The second type is chronic sinusitis, which may be caused by   bacterial infection, but more often is a chronic inflammatory disorder similar to bronchial asthma. Again allergies and immune problems are possible causes of chronic sinusitis. Structural problems in the nasal cavity may also be a factor.  Narrow drainage passages within the nose or nasal obstruction from tumors, polyps or a deviated nasal septum are examples of structural problems.  Although medications can often prevent chronic or recurring sinusitis, surgery is sometimes needed to remove the nasal obstruction. Many patients with persistent sinusitis have more than one of these factors that predispose them to infection, so addressing only one factor may not be sufficient.

Diagnosis

Even if symptoms are localized to the sinuses, infection is not always present. To make a correct diagnosis, we will take a detailed history and conduct a physical examination. Tests may also be needed. These tests can include allergy skin testing, immune studies or CT scans (which make precise images of the sinus cavities).

Treatment

Sinus infections generally require a combination of medications. In addition to an appropriate antibiotic when the sinusitis can be shown to be related to bacterial infection, a medicine may be prescribed to keep the sinus drainage passages open by reducing obstruction and controlling allergy. This drainage-opening medicine may be a decongestant, mucus-thinning medicine or a cortisone-like nasal spray. Antihistamines and topical steroids (sprayed into the nose) help control allergy and inflammation. Long-term treatment for controlling and reducing allergic sensitivity can be effective in preventing the development of sinusitis in people with allergies. This treatment may include immunotherapy, anti-inflammatory medications, decongestants, and environmental control measures. A variety of non-medicine mechanical treatments can be of value. These include steam inhalations, increasing the intake of fluids, hot packs and the use of an over-the-counter sterile salt water spray. In some cases of obstructed sinus passages, a referral to an otorhinolaryngologist (ENT) may be suggested.

Date: 1/21/2005

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