Sinusitis

Symptoms

Symptoms vary, depending on the length and severity of the infection.

If the patient has two or more of the following symptoms and thick, green or yellow nasal
discharge, they may be diagnosed with acute sinusitis.

 facial pain and pressure

 blocked nose

 nasal discharge

 reduced sense of smell

 congestion

 cough

In more advanced cases, the following symptoms may also be present:

 fever

 halitosis, or foul-smelling breath

 tiredness

 toothache

 headache

Causes

Sinusitis can stem from various factors, but it always results from fluid becoming trapped in the
sinuses. This fuels the growth of germs.
  Viruses: In adults, 90 percent cases of sinusitis result from a virus

 Bacteria: In adults, 1 case in 10 is caused by bacteria

 Pollutants: Chemicals or irritants in the air can trigger a buildup of mucus

 Fungi: The sinuses either react to fungi in the air, as in allergic fungal sinusitis (AFS), or
they are invaded by fungi, as in chronic indolent sinusitis. This is rare in the U.S.

Diagnosis

A doctor will carry out a physical examination and ask the patient about their symptoms. This is
usually enough to make a diagnosis.

The doctor may visually examine the nasal cavity with a light source, or a small, handheld
device with a light attached called an otoscope, which can also be used to examine the ears.

If symptoms persist, a doctor may refer a person with sinusitis to an ear, nose, and throat
specialist (ENT) for a more in-depth examination. They may insert an endoscope into the nose,
a small, thin, flexible tube with a light and camera attached. This can provide more detailed
images.

In cases of persistent or severe sinusitis, a CT scan may be needed.

Treatment

Treatment options depend on how long the condition lasts.

Acute and subacute sinusitis

Most acute cases will resolve without treatment.

However, sinusitis can be uncomfortable, so people often use home remedies and over-the-
counter (OTC) medications to relieve symptoms.
In the following cases, the person should see a doctor:

 Symptoms persist longer than 7 to 10 days.

 There is a fever higher than 101.5° Fahrenheit, or around 38.6° Celsius.

 There is a bad headache that does not resolve with over-the-counter (OTC) drugs.

 Visual disturbances occur, or there is swelling around the eyes.

 Symptoms continue after taking antibiotics prescribed by a physician.

If the sinusitis has a bacterial cause, a doctor may prescribe antibiotics. If symptoms remain
after the course of medication is finished, the individual should return to the doctor.

Chronic sinusitis

Chronic sinusitis is not usually bacterial in nature, so antibiotics are unlikely to resolve
symptoms. A fungal infection can be treated with antifungal drugs.

Corticosteroid sprays can help in recurrent cases, but these need a prescription and medical
supervision.

In allergic sinusitis, treating allergies with shots or reducing and avoiding exposure to allergens
like animal dander or mold can lessen the occurrence of chronic sinusitis.

Surgery

Structural issues, such as a deviated septum, may need surgery. Surgery may also be advised
if there are polyps, or if the sinusitis has resisted all other treatments.

Functional endoscopic sinus surgery (FESS) is the main procedure used for treatment, but other
surgeries may be required as other parts of the nose are often affected. If a deviated septum is
causing recurrent infections, for example, a septoplasty will be used to straighten out this bone
and cartilage.
Treatment may still be required following surgery to prevent the return of sinusitis.

Surgery should always be the last resort on sinusitis in children, and obtaining a second
opinion is recommended before proceeding.

Insurers may require patients to provide in-depth evidence to ensure that the surgery isfor
sinusitis and not for cosmetic surgery, to improve the appearance of the nose.

Pathophysiology

The most common cause of acute sinusitis is an upper respiratory tract infection (URTI) of viral
origin. The viral infection can lead to inflammation of the sinuses that usually resolves without
treatment in less than 14 days. If symptoms worsen after 3 to 5 days or persist for longer than
10 days and are more severe than normally experienced with a viral infection, a secondary
bacterial infection is diagnosed. The inflammation can predispose to the development of acute
sinusitis by causing sinus ostial blockage. Although inflammation in any of the sinuses can lead
to blockade of the sinus ostia, the most commonly involved sinuses in both acute and chronic
sinusitis are the maxillary and the anterior ethmoid sinuses.7 The anterior ethmoid, frontal, and
maxillary sinuses drain into the middle meatus, creating an anatomic area known as
the ostiomeatal complex (Fig. 3).

The nasal mucosa responds to the virus by producing mucus and recruiting mediators of
inflammation, such as white blood cells, to the lining of the nose, which cause congestion and
swelling of the nasal passages. The resultant sinus cavity hypoxia and mucus retention cause
the cilia—which move mucus and debris from the nose—to function less efficiently, creating an
environment for bacterial growth.

Modalities and Medical

DIAGNOSIS

1. Sinusitis may be clinically defined as the condition manifested by an inflammatory

response involving the mucous membranes of the nasal cavity and paranasal sinuses,
fluids within these cavities, and the underlying bone.
2. The United States Food and Drug Administration (FDA) recognizes "acute rhinosinusitis"
as a condition lasting up to four weeks and "chronic rhinosinusitis" as a condition
diagnosed after three months of rhinosinusitis. "Subacute rhinosinusitis" may be taken to
refer to the time period in between.
1. See Classification (Lanza 1997) 
2. Chronic adult rhinosinusitis (Lanza 1997)
1. Major Factors
 1. Facial pain/pressure
2. Facial congestion/fullness
3. Nasal obstruction/blockage
4. Nasal discharge/purulence/discolored postnasal drainage
5. Hyposmia/anosmia
6. Purulence in nasal cavity on examination
7. Fever (acute rhinosinusitis only)
2. Minor Factors
1. Headache
2. Fever (all nonacute)
3. Halitosis
4. Fatigue
5. Dental pain
6. Cough
7. Ear pain/pressure/fullness
3. A history indicative of chronic rhinosinusitis includes two or more "major"
factors or one major and two minor factors.
4. A history of facial pain alone is not, in and of itself, highly suggestive of
chronic rhinosinusitis.
5. To be diagnosed as chronic, symptoms consistent with the diagnosis
must persist for 12 or more weeks.
3. Acute adult rhinosinusitis
1. Sudden in onset and self-limiting
2. Most acute infections are viral in origin.  Less than 2% of viral
rhinosinusitis is due to a bacterial origin.  Infections that do not improve
after 10 days or worsen after 5-7 days may be bacterial.
3. May last up to four weeks
4. A strong history indicative of acute sinusitis includes two or more major
factors from Table IIA-2 or one major and two minor factors. In the
absence of other supporting symptoms, fever or pain alone is not
indicative.
5. Acute rhinosinusitis can be differentiated from a simple upper respiratory
tract infection, in part by the longevity and/or severity of symptoms.