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Patients & Consumers Online Tools Find an Allergist / Immunologist Pollen Counts Diseases 101 Drug Guide Featured Resources » AAAAI Tips Brochures Topic of the Month New Research Information Request Form Donate Now En Español Just for Kids Seniors Contact Us Search by Condition (A-Z) Request a Speaker Smoke Free Homes Referral Guidelines Other Resources En Español Just for Kids Seniors		Allergy & Asthma Advocate: Winter 2004 Sinusitis: When do you need to see an allergist? By Garrick Paul Hubbard, MD, and Michael C. Zacharisen, MD, FAAAAI Do you ever have a cold that just never seems to go away? Is it associated with nasal congestion, facial or head pressure, increased mucus production (what we all know as “snot”), cough, bad breath, a toothache or fatigue? If you have any of these, you may be suffering from sinusitis. You are not alone as nearly 14% of Americans claim to have had a previous diagnosis of sinusitis. Both children and adults can be affected, but it is less common and more difficult to diagnose in very young children. Sinusitis occurs when the air-filled spaces in the skull (or the sinuses) become inflamed and swollen regardless of the cause. This may be due to irritants such as tobacco smoke, a bacterial infection following a viral infection or “cold,” an allergy or various other causes. When it is caused by an infection it may be due to viruses, bacteria or less commonly, fungi. Because sinusitis is almost always associated with nasal congestion and inflammation, the term rhinosinusitis (“rhino” refers to the nose) has become the preferred term. Colds or viruses cause the majority of cases of rhinosinusitis. It can be very difficult to distinguish viral from bacterial causes. Bacterial causes of rhinosinusitis, unlike viral infections, generally last longer than seven to ten days and are usually associated with pain and discolored nasal drainage. Most cases of bacterial infections are resolved on their own and management should be aimed at making the symptoms tolerable as well as preventing future infections. Antibiotics are generally reserved for those patients who have more moderate or severe symptoms or for those who are more likely to suffer from complications from the infection. You are not alone as nearly 14% of Americans claim to have had a previous diagnosis of sinusitis. Rhinosinusitis is considered chronic if it lasts longer than four weeks, in which case a longer course of antibiotics may be prescribed. Because rhinosinusitis is so common, most primary care clinicians are well trained to diagnose and treat the majority of cases. However, sometimes you may need to seek a specialist for evaluation. Otolaryngologists are specialists in treating conditions affecting the ear, nose and throat, also known as ENT (ear, nose and throat) physicians. They are trained in the surgical treatment of rhinosinusitis. Surgery is rarely needed, usually only when there is a problem with the structure or anatomy of the nose, making the person more likely to have recurrent or chronic infections. The more common conditions include nasal polyps (non-cancerous growths) and septal deviation (the nose is crooked or pointing to one side). Allergists are specialists trained in evaluating for all possible conditions to rhinosinusitis. These physicians use a management strategy to not only treat current infections, but to also provide management that lowers the risk for future sinus infections. Allergists can also help to determine when surgery is indicated as part of the overall management. Here is a list of possible reasons your doctor may want you or your child to see an allergist about your rhinosinusitis: You have had more than two serious infections in a year or have chronic rhinosinusitis. You have conditions that put you at risk for rhinosinusitis, such as allergic rhinitis or “hay-fever.” You have other conditions that may be worsened by rhinosinusitis, such as asthma or COPD (emphysema or chronic bronchitis). You have had a more severe case of rhinosinusitis that did not respond to standard treatment or required intravenous antibiotics. You have a history of nasal polyps, asthma and/or reactions to aspirin. You have had recurrent or severe infections at other sites, such as the lungs (pneumonia). You or a family member is immunocompromised or immunodeficient; a state or disorder in which the body’s immune system cannot fight infections normally.   <back>
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