Sinusitis refers to any inflammatory condition affecting the lining of the sinuses. This is the result of exposure to viruses, fungi (molds) or bacteria. Most commonly, patients present to a sinus specialist (Rhinologist) when bacterial infections are present.

The Sinus and Allergy Health Partnership was a joint task force that met in 1996 to redefine terminology related to sinus disease and offer evidence based recommendations for treatment. The task force included members from the American Rhinologic Society, the American Academy of Otolaryngology – Head and Neck Surgery and the American Academy of Otolaryngic Allergy. The task force met again in January of 2000. The term “rhinosinusitis” has been proposed to replace the term sinusitis. Rhinitis typically comes before sinusitis and to have sinusitis without rhinitis is unusual.

1. Acute Rhinosinusitis: bacterial infection of the nose and sinuses that is usually preceded by a cold and requires antibiotic treatment to cure. This infection lasts for less than 4 weeks.
2. Subacute Rhinosinusitis: infection that lasts for more than 4 weeks, but less than 12 weeks.
3. Chronic Rhinosinusitis: infection present for greater than 12 weeks.
4. Recurrent Acute Rhinosinusitis: more than 4 acute sinus infections in a 12 month period. Patients are healthy in between infections.

Sinusitis refers to any inflammatory condition affecting the lining of the sinuses. This is the result of exposure to viruses, fungi (molds) or bacteria. Most commonly, patients present to a sinus specialist (Rhinologist) when bacterial infections are present.

The Sinus and Allergy Health Partnership was a joint task force that met in 1996 to redefine terminology related to sinus disease and offer evidence based recommendations for treatment. The task force included members from the American Rhinologic Society, the American Academy of Otolaryngology – Head and Neck Surgery and the American Academy of Otolaryngic Allergy. The task force met again in January of 2000. The term “rhinosinusitis” has been proposed to replace the term sinusitis. Rhinitis typically comes before sinusitis and to have sinusitis without rhinitis is unusual.

It is estimated that in excess of 37 million Americans suffer from chronic sinusitis. This number maybe significantly higher as many patients go untreated because their condition has been dismissed as allergies or a viral illness.

The Sinus and Allergy Health Partnership was a joint task force that met in 1996 to redefine terminology related to sinus disease and offer evidence based recommendations for treatment. The task force included members from the American Rhinologic Society, the American Academy of Otolaryngology – Head and Neck Surgery and the American Academy of Otolaryngic Allergy. The task force met again in January of 2000. The term “rhinosinusitis” has been proposed to replace the term sinusitis. Rhinitis typically comes before sinusitis and to have sinusitis without rhinitis is unusual.

There are multiple causes of sinusitis, however, the most important factor is blockage of the sinus passageways. Mucous produced by the sinuses collects and bacteria infect the pooled secretions. Factors that contribute to sinusitis include viral infections, allergies, cystic fibrosis, immunodeficiency, asthma, anatomic obstructions, previous sinus surgery with scar tissue and facial trauma.

Sinusitis often mimics other inflammatory conditions of the nose, especially colds and allergies. A combination of signs, symptoms and duration of illness are used to narrow the diagnosis.

The most common symptoms are nasal drainage, nasal congestion, cough as a result of postnasal drip, headache/facial pain, decreased sense of smell, low grade fever and ear discomfort. Nasal drainage is typically discolored in an acute sinus infections.

Acute sinus infections present with symptoms that last at least 10 or more days. Allergy symptoms can vary in regards to length of illness and the common cold usually resolves within 10 days.

In addition to a thorough history and physical examination, x-rays and nasal endoscopy are 2 additional techniques that aid in the diagnosis of sinusitis.

Plain x-rays of the sinuses used to serve as the main radiologic tool to assess sinus health, however, since the advent of CAT scans, few experts support the use of plain x-rays. CAT scans are the gold standard to diagnose chronic sinusitis. CAT scans are reserved for patients who have failed medical therapy.

Nasal endoscopy involves passing either a thin rigid or flexible optical device into the nose to visualize the quality of the mucous lining and the sinus openings. Infected mucous can be sampled for cultures. Nasal endoscopy is also reserved for patients who have failed initial medical therapy. Nasal endoscopy requires specialized equipment and expertise.

The main therapy for the treatment of acute bacterial rhinosinusitis is an appropriate antibiotic. Antibiotic choices are made by your treating physician based upon several factors. In patients who have had multiple infections and have already been treated with multiple antibiotics, sinus cultures are required. Sinus cultures may be obtained in the office with advanced nasal endoscopy techniques.

Other treatments that will often be prescribed include steroids, either systemic or topical, decongestants, mucous thinning agents and nasal saline irrigations.

Over the counter decongestants should be used according to their label recommendations. Nasal sprays containing oxymetazoline or neosynephrine, such as Afrin, should be not used more than three consecutive days.

A variety of practitioners will treat acute sinus infections because it is a very common condition. These include primary care physicians, internists, pediatricians, allergists, pulmonologists and physician extenders. When patients do not improve with several courses of antibiotics they require a referral to an otolaryngologist (E.N.T. doctor).

Some otolaryngologists have chosen to specialize in treating diseases of the nose and paranasal sinuses. These doctors are referred to as rhinologists and the majority have completed one year post-residency fellowships with leaders in the field. Less than 100 fellowship trained rhinologists practice in the U.S. and they are most qualified to treat complicated, chronic sinus disease.

Not seeking treatment results in unnecessary discomfort related to the chronic infections. More severe complications can occur, including meningitis, brain abscess, eye problems and infected bone.

For acute, uncomplicated sinus infections treatment is usually 7 to 14 days. A generic or first choice antibiotic will be selected by your physician. If the sinus infection does not resolve after the first course of antibiotics, a second stronger antibiotic will be prescribed.

If the sinus infection has been present for several weeks, treatment is extended. Patients with chronic sinusitis and an acute exacerbation will be treated for at least 3 weeks and can be up to 12 weeks.

Antibiotic resistance refers to certain bacteria being immune to the antibiotic that your doctor prescribed. Antibiotic resistance has made treating some chronic sinus infections very difficult. It is important to finish all of your medicine your doctor has prescribed.

Sinus surgery is recommended by your physician when chronic sinusitis does not resolve with maximal medical treatment. Maximal medical treatment involves treating patients with long-term antibiotics.

Sinus surgery has evolved over the last 100 years. Prior to the early-80’s, nearly all sinus surgeries were performed either as an open approach with incisions on the face or through the nose with direct visualization. These procedures were painful, bloody and results varied. Functional Endoscopic Sinus Surgery (FESS) was introduced in mid-80’s and has become the treatment of choice for chronic sinus disease. The goal of FESS is to enlarge the natural opening to the sinuses and restoring normal function. This is accomplished in a minimally invasive manner with very little tissue damage and bleeding. Additional improvements in the technique have been made with the introduction of precise tissue shavers, computer image-guided surgery, specialized frontal sinus instruments and the newest technique of balloon sinuplasty.