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Sinusitis Overview

If you have nasal congestion, facial pressure, cough and thick nasal discharge, you may have rhinosinusitis, commonly referred to as sinusitis.

Your sinuses are hollow cavities within your cheekbones, around your eyes and behind your nose. They contain mucus, which helps to warm, moisten and filter the air you breathe. When something blocks the mucus from draining normally, an infection can occur.

Acute Sinusitis
Acute sinusitis refers to sinusitis symptoms lasting less than four weeks. Most cases begin as a common cold. Symptoms often go away within a week to 10 days; but in some people, a bacterial infection develops.

Chronic Sinusitis
Chronic sinusitis, also referred to as chronic rhinosinusitis, is often diagnosed when symptoms have gone on for more than 12 weeks, despite medical treatment.

People with allergic rhinitis or asthma are more likely to suffer from chronic sinusitis. This is because the airways are more likely to become inflamed when allergic rhinitis or asthma are present. Sinusitis may also be caused by an infection, a fungus, deviated nasal septum, nasal polyps or in rare cases an immune system deficiency.

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Sinusitis Symptoms & Diagnosis 

Sinusitis symptoms, whether acute or chronic, frequently develop after a cold or during times of severe or ongoing allergic rhinitis symptoms. The most obvious sign of sinusitis is a painful pressure in the cheeks and forehead. Other symptoms include:

•    Thick yellow-green nasal discharge
•    Postnasal drip, often with a bad taste
•    Cough
•    Congestion
•    Toothache
In cases of acute sinusitis, a fever may develop.

Allergy testing can identify what allergic triggers might be behind your chronic or reoccurring sinus infections.

In chronic or severe cases, your doctor may also examine your nasal passages using a technique called rhinoscopy or nasal endoscopy. In this procedure, a thin, flexible instrument is inserted up the nostril to view the sinus passages and look for blockages.

Your doctor may order a MRI or CT scan to look for abnormalities in the sinuses – narrow drainage passages, polyps or a deviated septum.

Make an appointment with your doctor right away if you have: a fever, pain or swelling in the face or eye, redness on the cheek or around the eye, severe headaches, confusion or a stiff neck. 

Sinusitis Treatment & Management

The treatment of sinusitis depends on the cause, severity and duration of symptoms.

Acute Sinusitis
Up to 70 % of people with acute sinusitis recover without any prescribed medications. If the cause is a bacterial infection, treatment with an antibiotic can shorten the duration of acute sinusitis and can also reduce the severity of symptoms. Other options for treatment include:

  • Decongestants or nasal sprays might help relieve your symptoms and promote drainage of the infection.

  • Many people find relief by using a sinus saline recipe.

  • Get plenty of rest, and keep your body hydrated by drinking several glasses of water a day.

  • Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) may be beneficial. Do NOT give aspirin to children under the age of 18.

  • In addition to medications, some people with sinusitis find relief by breathing hot, moist air, using hot packs or washing the nasal cavities with a saline rinse.

Chronic Sinusitis

Chronic sinusitis is typically not caused by a bacterial infection, so treating the condition with antibiotics usually doesn’t help. Avoid activities and places that may aggravate your symptoms—especially if your symptoms relate to an allergy.

Intranasal corticosteroid sprays may be appropriate for recurrent sinusitis, but only under the care of your doctor. If the diagnosis involves a fungus, your doctor may prescribe an antifungal medication.

If an allergist / immunologist has diagnosed allergies, treating these allergies by avoiding triggers or with medications or allergy shots can help prevent recurrences of sinusitis. Environmental control measures such as avoiding allergens are very important for people with rhinitis triggered by indoor allergens such as dust mites, molds or animal dander. This treatment strategy can prevent the need for surgery or prevent recurrence of disease after surgery.

When treatments or medications fail, endoscopic sinus surgery may be an option.

Surgery should always be viewed as a last resort in children. Before you agree to have sinus surgery performed on your child, consider getting a second opinion from an allergist / immunologist who treats pediatric sinusitis.

Sinus surgery is not a quick fix. Most patients who undergo sinus surgery will still need medical treatment to prevent the return of chronic sinusitis.

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