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Allergy & Asthma Advocate: Winter 2003
Sinusitis: More than just an infection
Sinusitis usually happens when mucus cannot drain normally from the sinuses. The sinuses are like empty walnut shells in your face: behind your forehead, cheeks, and nose. The sinuses have very small openings through which mucus can drain. Therefore, if the openings get blocked for any reason, the mucus cannot drain and your sinuses may feel full and painful. Causes of sinus blockage include allergies, upper respiratory infections (colds), and a structural abnormality such as polyps. It is important not just to diagnose sinusitis when it happens but also to consider if there is an underlying cause, since this may cause the sinusitis to come back. Finding the cause Symptoms may include, for example, a swollen and painful sensation over the forehead, cheeks, and eyes; toothache over the upper teeth; nasal congestion with yellow and green mucus; foul tasting post-nasal drip; bad breath; sore throat; and cough. There may also be general symptoms of feeling unwell, such as fatigue and, sometimes, low-grade fever. Another clue about possible sinusitis is a poor or absent sense of smell. The treatment of sinusitis involves, first of all, determining if the sinusitis is acute or chronic. Acute sinusitis has been present for less than four weeks, while chronic sinusitis has been present for more than four weeks. This distinction is important because the treatment may differ for sinusitis of different durations. In the case of acute sinusitis, an antibiotic course of 10 to 14 days (to kill the bacteria) along with decongestants (to reduce the volume of mucus, which contributes to the discomfort) may be all that is required. In the case of chronic sinusitis, an antibiotic course of 21 days or longer may be needed, along with nasal corticosteroid sprays (to reduce swelling), decongestants, mucus thinners (to help mucus to drain normally), nasal saline (to clean the nasal passages and to help to loosen up the mucus), oral corticosteroids (to reduce swelling), and sometimes surgery. Another reason why it is important to differentiate between acute and chronic sinusitis is the bacterial organisms may be different, which would require different antibiotic medications. Chronic sinusitis may also be caused by fungal infection, which would also require different treatment. An important aspect of sinusitis treat-ment, especially in the case of chronic sinusitis or recurrent acute sinusitis, is prevention. If you have conditions that lead to excess mucus and inflammation of the nose, such as allergic rhinitis (nasal allergies such as hay fever), or are in a profession that leads to lot of viral upper respiratory infections (colds), such as teaching in a grade school, you are more likely to develop sinusitis. In addition, if there are structural abnormalities of the nose or sinuses, such as polyps, you are more likely to develop sinusitis. Most people with chronic sinusitis or recurrent sinusitis have predisposing factors of some kind, so it is important to have a long-term treatment plan. This plan may include controlling for allergies, keeping the nasal inflammation well controlled with medications between sinusitis episodes, and consideration of surgical repair of structural abnormalities, if present. Allergist/immunologists are experts in the evaluation and treatment of sinusitis and, well qualified to help people with this condition. |
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© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
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Sinusitis, which is defined as inflammation of the sinus cavities under the
face, is a common and difficult problem. In my practice, for example, I see
patients every day who are suffering from sinusitis. Furthermore, it has been
estimated that 31 million Americans develop sinusitis every year.