What is sinusitis?

Sinusitis (infection of the sinuses) is very common.  Some studies suggest that 15-20% of the population are affected by chronic sinusitis at some time in their lives.  There are 4 paranasal sinuses.  These are the maxillary, ethmoid, sphenoid, and frontal sinuses.  Only the ethmoid and maxillary sinuses are present at birth.  The sphenoid sinus develops sometime after age 2 years and the frontal sinuses begin to develop by age 6 years.

What are the symptoms of sinusitis and how do we diagnose it?

Clear or thick nasal drainage and cough are the major symptoms of sinusitis.  Other symptoms include fever, headache, facial pain, earache, nasal congestion, tooth pain, inability to smell, sore throat, foul breath, irritability, eye swelling, cough and worsening of asthma.  The most common factors that predispose an individual to sinusitis are viral upper respiratory tract infections (“colds”, allergic rhinitis, nasal polyps, anatomical abnormalities, and defects of the immune system).

Complications that may arise from sinusitis include worsening of asthma, ear infection, and rarely extension of the infection to the bones of the head and the brain.  Occasionally, an x-ray or CT scan of the sinuses must be obtained to thoroughly examine the anatomy of the sinuses.

How do we treat sinusitis?

Treatment is aimed at killing the bacteria found in the sinuses with antibiotic, promoting adequate drainage of the sinuses and eliminating the inflammation and swelling found in the sinuses.  For patients who suffer from recurrent sinusitis, measure directed at the prevention of recurrent attacks are the most important principles in the management of sinus disease.

Kill the bacteria: Amoxillcin or a similar antibiotic is the drug of choice for sinusitis.   However, if there is not a response to treatment within a few days or if there is evidence of recurrent or chronic disease, other antibiotics may need to be used.  Antibiotic therapy is continued for 14 days and may need to be extended to 30-45 days on some episodes.

Drainage of the sinuses: as with any infection, the bacteria and pus must have an opening to drain.  Oral decongestant help shrink swollen tissue and thus can assist with drainage.  Topical decongestants also help shrink swollen nasal tissue, however, they cannot be used form more than three days as a dependence quickly develops with continued use.  Topic nasal steroids will help reduce the inflammation and swelling present in sinusitis and thus will also assist in drainage.  Their ability to decrease inflammation is not seen until several days after starting these agents.  Irrigation of the most can remove secretions and liquefy mucus.  Irrigation can be performed with steam, hot showers, vaporizers, a saline sprays.  Sometimes surgery may be required to correct an anatomical abnormality that may be responsible for inadequate drainage.  Most sinus surgeries can be performed using a limited endoscopic approach with a very high success rate.

– Prevention: preventive measure include treatment of allergic rhinitis with nasal steroids, avoidance of allergens and viruses, and if indicated, immunotherapy.

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