Acute and Chronic Sinusitis

Inflammation of Air Sinuses in the Facial Bones

Feb 14, 2009 Anthony Lee

How does a physician evaluate and treat sinusitis?

Sinusitis is a common ailment that occurs in millions of individuals. It is defined as the inflammation of the paranasal sinuses, the cavities within the maxillary, ethmoidal, sphenoidal, and frontal bones that are connected to the nasal cavity. Sinusitis may be acute or chronic depending on whether the condition lasts for shorter than or longer than three months, respectively.

Etiology and Pathophysiology

Sinusitis has various infectious causes, including bacterias (e.g., Steptococcus pneumoniae), viruses, and, rarely, fungi (e.g., Candida species). Additionally, sinusitis can have noninfectious causes, such as allergic rhinitis, nasal polyps, other abnormalities of nasal structures, smoking, and air pollution. Regardless of the cause, the pathophysiology of sinusitis is generally similar.

Normally, the paranasal sinuses secrete mucus that is cleared into the nasal cavity. In sinusitis, there is obstruction of nasal mucus flow, causing mucus accumulation in the sinuses. This can lead to increased sinus pressure and the growth of bacterial pathogens, both of which can cause the clinical manifestations of sinusitis.

Symptoms and Signs

Individuals with sinusitis complain of various symptoms, including but not limited to the following:

Runny nose (rhinorrhea)
Stuffy nose (nasal congestion)
Diminished or absent sense of smell (hyposmia or anosmia, respectively)
Sneezing
Postnasal drip
Facial pressure
Headache
Fever
Sore throat
Cough
Ear discomfort

When a physician examines the patient's face and nasal cavity, additional signs may be noted:

Nasal secretions
Swollen mucous membranes
Redness in the throat (pharyngeal erythema)
Tenderness over frontal or maxillary sinuses
Facial redness (facial erythema)

Diagnosis and Treatment

The diagnosis of sinusitis is based primarily on a patient history and physical exam. In some cases, a physician may order computed tomography (CT) or magnetic resonance imaging (MRI) of the sinuses to visualize certain abnormalities, such as a nasal tumor. Other tests may be done to rule out associated conditions that may predispose the patient to sinusitis, such as HIV infection.

Treatment of sinusitis entails several components. At the most basic level, one can control risk factors through various methods, such as reduction of air pollutants and maintaining adequate hygiene. In addition, treatment involves the use of nasal decongestants (e.g., Visine or Flonase) and saline nasal sprays to mitigate symptoms and the use of antibiotics (e.g., amoxicillin or Bactrim) to control infection. For sinusitis that cannot be treated only by medical means, surgical procedures may be necessary to correct the problem.

Final Words

Sinusitis is a common ailment and is usually not associated with significant morbidity or mortality. As with any medical topic, the preceding information is for educational purposes only.

References

The copyright of the article Acute and Chronic Sinusitis in General Medicine is owned by Anthony Lee. Permission to republish Acute and Chronic Sinusitis in print or online must be granted by the author in writing.

Sinuses