New research finds that treatment from an allergist significantly improves asthma care
The Diagnosis and Management of Sinusitis: A Practice Parameter Update, which is featured in the December 2005 Journal of Allergy & Clinical Immunology (JACI), was developed by the Joint Task Force on Practice Parameters for Allergy & Immunology, a joint coalition of the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allergy, Asthma & Immunology's (ACAAI), and the Joint Council of Allergy, Asthma and Immunology (JCAAI). Click here to view the new practice parameter.
The findings from the parameter should be used as a ready reference for any physician who evaluates and treats patients with suspected sinusitis.
The following questions and answers are designed to help patients with sinusitis and healthcare professionals understand the recommendations in the new practice parameter.
What is sinusitis?
Sinusitis is an inflammation of the nasal sinuses, which are hollow cavities in the cheek bones found around and behind the nose. The inflammation is usually caused by inadequate draining due to allergy, infection or obstruction. Sinusitis is one of the most commonly diagnosed diseases in the United States, affecting an estimated 16% of the adult population annually.
What are symptoms of sinusitis?
Common symptoms include thick yellowish/green nasal discharge, headache, feelings of facial fullness, congestion, fatigue, and fever.
What are the different types of sinusitis?
- Acute sinusitis: symptoms last for less than 4 weeks consisting of some or all of the following: persistent symptoms of an upper respiratory tract infection, runny nose, postnasal drainage, loss of smell, nasal congestion, facial pain, headache, fever, cough, and pus discharge.
- Subacute sinusitis: symptoms last from four to eight weeks.
- Chronic sinusitis: symptoms for eight weeks or longer of varying severity consisting of the same symptoms as seen in acute sinusitis. In chronic sinusitis, abnormal findings on CT or MRI would be found. Some patients with chronic sinusitis might present with vague or dangerous symptoms.
- Recurrent sinusitis: three or more episodes of acute sinusitis per year. Patients with recurrent sinusitis might be infected by different organisms at different times.
What is allergic rhinitis?
Allergic rhinitis is an allergic inflammation that leads to nasal congestion and swelling of the mucous membrane, which can obstruct or impede normal sinus drainage. Obstructed sinuses partially fill with secretions, leading to impaired nose hair function and impaction of mucus. Allergic rhinitis, is one of the most common chronic diseases, accounting for approximately 2.5% of all physician visits.
How is allergic rhinitis linked to sinusitis?
Allergic rhinitis commonly precedes the development of recurrent or chronic sinusitis. The nasal obstruction and inflammation associated with allergic rhinitis interrupts normal clearing of mucus from the nasal passage toward the throat and leads to retention of mucus within the sinus cavities.
When should an allergist/immunologist be consulted?
Consultation with a specialist should be sought when:
- There is a need to clarify the allergic or immunologic basis for sinusitis.
- Sinusitis does not respond to the usual antibiotic treatment.
- Sinusitis is recurrent.
- Sinusitis significantly affects performance and quality of life.
- Other conditions develop such as an ear infection, bronchial asthma, and recurrent pneumonia.
How can an allergist/immunologist help?
Allergist/immunologists have unique expertise in the evaluation and medical management of sinus disorders. Working with an allergist/immunologist, the best qualified medical professional trained to manage the prevention, diagnosis and treatment of sinusitis and other allergic diseases, will demonstrate improved outcomes and quality of life for people suffering from allergic disease.
To find an allergist/immunologist in your area, visit the AAAAI's Find an Allergist/Immunologist directory.
What happens when I visit an allergist/immunologist?
When visiting an allergist/immunologist the following assessment should be taken:
- Review of medical history for diagnosis of sinusitis and underlying risk factors.
- General examination includes an evaluation for signs of upper airway and sinus inflammation. Typical signs include tenderness overlying the sinuses and dark circles beneath the eyes.
- Nasal examination in patients with acute sinusitis.
- Lung examination.
What are the treatment options?
Antibiotics:
Amoxicillin often is the drug of choice for children and adults. It is generally effective, inexpensive, and well tolerated.
A reasonable approach would be for a patient to start on amoxicillin for 3 to 5 days and determine whether the signs and symptoms are improving. If the symptoms are improving, continue this treatment until the patient is well for 7 days (generally a 10- to 14-day course). If after 3 to 5 days the patient has not shown improvement, switch to a different antibiotic.
Corticosteroids:
The use of nasal corticosteroids might be helpful in patients with acute and chronic sinusitis. Although the effectiveness has not yet been proved, the short-term use of oral corticosteroids as an adjunct in treating patients with acute sinusitis is reasonable when the patient fails to respond to initial treatment.
Saline solutions:
Saline nasal sprays might be a useful for liquefying secretions and decreasing the risk of crusting in the sinus cavities.
Decongestants:
Topical decongestants and oral decongestants reduce mucosal blood flow and might enhance drainage of secretions from the sinus.
The use of topical decongestants beyond 3 to 5 days might increase congestion.
How can I prevent sinusitis?
You can reduce your risk of sinusitis by working with your doctor to get your symptoms under control. These suggestions also may help:
- Avoid relevant allergens.
- Avoid cigarette smoke.
- Avoid activity during the day, such as early morning or heavy traffic times, when air pollution is higher.
- Limit your intake of alcohol that can cause your sinus membranes to swell.
How can I lessen my symptoms of chronic sinusitis?
Steps that may help you lessen the symptoms of chronic sinusitis are:
- Spray a saline solution in your nose several times a day.
- Adequate rest.
- Avoid bending over with your head down. This can increase the pain.
- Sleep with the head of the bed elevated.
- Apply warm facial packs.
- Use a humidifier or take a steamy shower.
- Stay hydrated by drinking lots of fluids.
Patients should contact their doctor if symptoms worsen (especially with headache or high fever) or if symptoms have not improved within 3 to 5 days of treatment.
Additional Resources
 A/I Practice Guidelines
Patient Gallery - Rhinitis & Sinusitis
Tips to Remember: Sinusitis
Easy Reader Sheet: Sinusitis
The ADVOCATE Patient Newsletter: Winter 2004 - Sinusitis: When should you see an allergist/immunologist
The Allergy Report: Sinusitis
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