Sinusitis Diagnosis and Treatment
By Doctor Eric Christensen, M.D.
More than 37 million Americans suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade, possibly due to increased pollution, urban sprawl, and increased resistance to antibiotics.
With the recent release of tree and grass pollens in the region, many area residents will suffer from nasal and sinus irritation. Symptoms of sinusitis can mimic those of colds and allergies, so it takes an educated patient to tell the difference. Acute bacterial infection might be present when nasal symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection or nasal allergies.
Sinusitis is an inflammation of the membrane lining the paranasal sinuses. Symptoms include facial pain and pressure, nasal obstruction, nasal discharge, diminished sense of smell, and cough. Additionally, sufferers of this disorder could incur fever, bad breath, fatigue, and dental pain. Acute sinusitis is a short-term condition that responds well to antibiotics and decongestants. Recurrent acute sinusitis is characterized by at least four recurrences of acute sinusitis annually, and chronic sinusitis is characterized by symptoms lasting 12 weeks or more.
Risk factors for the development of acute or chronic sinusitis include seasonal or perennial (year-round) allergies, environmental pollutants, a deviated nasal septum, nasal polyps, dysfunction of the nasal cilia that sweep mucous to the throat, or immune deficiency.
Acute sinusitis is generally treated with ten to 14 days of oral antibiotics. With treatment, the symptoms typically disappear, and antibiotics are no longer required for that episode. Nasal steroids, nasal saline irrigations, and oral and topical decongestants also may be prescribed to alleviate the symptoms.
In patients whose symptoms fail to resolve within 12 weeks of onset, chronic sinusitis is the underlying condition. When a patient with chronic sinus symptoms consults me for evaluation, I perform nasal endoscopy in the office using topical anesthesia. The procedure is essentially painless and takes only a few minutes. Nasal endoscopy is quite helpful, as it can allow me to diagnose anatomic risk factors that contribute to chronic sinusitis (nasal septal deviation, polyps, swollen membranes, etc.). The other advantage of nasal endoscopy is that a culture of infected drainage can be obtained, allowing me to choose the exact antibiotic to help eradicate the existing infection. I will typically treat chronic sinusitis patients with a 3 to 4 week course of culture-directed antibiotics. Oral steroids are also used on occasion.
In those patients whose symptoms persist despite an extended course of culture-directed antibiotics, a CT scan is obtained. A CT scan can help delineate the exact extent of the infection, and further diagnose contributing anatomic abnormalities.
A small percentage of chronic sinusitis patients become candidates for sinus surgery. Sinus surgery is an outpatient procedure performed under general anesthesia, with a few days of down-time to recover. The goal of sinus surgery is to correct anatomic abnormalities (i.e., deviated septum), remove polyps (if present), and open and drain the sinuses plagued with chronic infection. With surgery, approximately 85-90% or patients achieve a dramatic improvement in their sinus symptoms.
If you or a family member are suffering from acute or chronic sinus symptoms, feel free to contact me or one of our ENT physicians at Midwest Medical Specialists at 816-454-0666.
