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Sinusitis

Sinusitis is an swelling or inflammation of the hallow nasal passages that surround the nose, cheeks and eyes. The main function of the sinuses are to warm, moisten and filter air and to normalize the pressures in your head. They may also play a roll in vocalizing certain sounds.  When you experience sinusitis, you may feel “stuffed up” or congested, you may have a runny nose or nose bleeds, you may feel dizzy, get headaches or have a fever.  Sinusitis can also affect your eyes and ears or cause a “post-nasal drip” causing mucus to run down the back of your throat.  Post-nasal drip can lead do gastric upset (a tummy ache).  Symptoms can also include tooth aches, fatigue and facial swelling. 

Types and causes of sinusitis
Sinusitis is conventionally characterized as acute, chronic or recurrent.   Acute sinusitis usually develops as a complication of the common cold.  It is most often of infectious in origin.  Symptoms of acute sinusitis usually last no longer than a couple of months.  Chronic sinusitis is an inflammatory disorder which usually lasts longer than a month.  If three or more episodes of sinusitis are experienced in a year or less, the diagnosis of recurrent sinusitis is made.  

While colds are the most common cause of acute sinusitis, people with allergic propensities are far more likely to develop sinusitis than those who are not predisposed to allergic disease.  Allergies can trigger inflammation which prevents the sinus cavities from clearing bacteria. This increases the chances of developing acute or secondary bacterial sinusitis. If you test positive for allergies, your physician can prescribe appropriate medications to control your symptoms, thereby reducing the risk of developing an infection. People with sinus problems and allergies should avoid environmental irritants such as tobacco smoke and strong chemical odors, which may increase symptoms.

Structural problems, such as narrow nasal passages, tumors, polyps or a deviated septum can block sinus passages and prevent drainage.  This may lead to recurrent sinusitis.  Surgery may be necessary in order to correct the structural problem. In patients with recurring or chronic sinusitis there is often more than one predisposing condition. Correcting only one problem may not be sufficient to eliminate the problem. 

Sinusitis vs. Rhinitis

Rhinitis whether allergic (such as hay fever) or non-allergic (vasomotor) occurs in the nose and nasal passages, while sinusitis is an infammation of the passages beyond the nose, around the eyes, cheeks and forehead.  But rhinitis, when chronic or recurrent, can often progress to sinusitis. Since symptoms can be similar, the two conditions may be difficult to distinguish and may overlap, as in rhino-sinusitis. 

Diagnosis

Symptoms of inflammation in the sinuses can be caused by infection, allergic reaction or obstructions, determining the underlying cause can be difficult and may require a variety of tests. These may include allergen skin testing, blood testing and radiographic tests, such as X-rays or scans of the sinuses to rule out deviated septum or nasal polyps. Physicians may also perform an endoscopic examination (look up into your sinuses through your nasal passages) using a fiber optic scope and may even take a tissue sample of the lining of your nasal cavity.  New flexible fiber optic scopes are designed to allow your doctor to perform this kind of test in an easily and cause minimal discomfort. 

Treatment

Since sinus infections may have multiple contributing causes, one treatment modality may be insufficient alone.  Antibiotics may be prescribed in conjunction with antihistamines to fight infection while at the same time clearing nasal congestion.  Topical steroids may also be added when necessary to thin nasal secretions. 

Since patients with allergic disease are at increased risk for sinusitis, long-term treatment to control and reduce allergic symptoms can also be effective in preventing the development of chronic or recurrent sinusitis. This treatment may include immunotherapy (or allergy shots), anti-inflammatory medications, decongestants, and environmental controls. Low dose antibiotics may also be used in a preventative capacity when symptoms will likely be worse, such as in winter.

Non-drug therapies, including humidifiers, hot packs, nasal lavage (nasal rinsing with salt water) may also be helpful. In cases of obstruction, your allergist may refer you to an ear nose and throat surgeon to determine if surgical treatment is indicated.

You should see your allergist if you or a family member have:
• Infectious rhino-sinusitis.
• Chronic rhino-sinusitis
• Allergic fungal rhino-sinusitis.

Copyright © 2008-2010 Dr. Beth Cowan