What is Sinusitis?

Q&A with James A. Hadley, MD, FACS –

A: Sinusitis is defined as an inflammation (swelling) of the membranes of the paranasal sinuses.  The inflammation may be induced from a common upper respiratory viral episode (the most common reason) or possibly allergic episode.  They are not commonly due to a bacterial cause.  Most commonly, these episodes are limited in duration for 5-7 days, but sometimes (<2%) are complicated by secondary bacterial infection if symptoms persist more than 10 days.

Q: What are the signs and symptoms of acute sinusitis?
A: Acute sinusitis manifests itself with symptoms of predominant nasal blockage or nasal congestion, symptoms of difficulty with breathing through one or both sides of the nose, pressure in the face and forehead and may be associated with increased thickness of nasal drainage and discharge.  Typically, patients feel malaise, nasal congestion, difficulty breathing through the nose, especially at night secondary to the inflammation, and patients may also have low-grade fever.  The color of nasal drainage may not always suggest that the patient has an infection.

Q: How is acute sinusitis treated?
A: Acute inflammation of the nose and paranasal sinuses should be initially treated with topical decongestants to relieve the symptoms of congestion, oral decongestants such as pseudoephedrine, anti-inflammatory agents such as ibuprofen, analgesics such as acetaminophen and aspirin, and if the patient has a history of allergies, antihistamines can also be utilized.  Some of the antihistamines also contain a decongestant.  Symptomatic relief can also be achieved with inhalation of topical saline or the use of steam tent.  Use of a nasal irrigation method with saline such as a Netti-Pot can also alleviate some of the thickened nasal secretions to improve breathing.  Because the manifestations of acute sinusitis are usually secondary to a virus, antibiotics are usually not effective nor are they recommended although many patients believe that they require antibiotics to improve their symptoms.  Antibiotics are not to be prescribed for routine symptoms in the early stages of acute sinusitis, but only after symptoms are present for more than 7 days.

Q: What are the signs and symptoms of chronic sinusitis?
A: Chronic inflammatory rhinosinusitis is defined as persistent symptoms of inflammation that lasts more than 12 weeks.  Patients usually complain of persisting symptoms of nasal blockage, congestion, decreased sense of smell, thick discolored nasal drainage and discharge either from front of nose or back of nose along with facial pressure, but usually are not accompanied with fever or muscle aches. The patient has symptoms of persisting nasal blockage unrelieved with the over-the-counter medications mentioned previously as well as courses of antibiotic therapies.  Many patients have confusion over the difference between postnasal drainage and discharge from chronic rhinosinusitis versus other causes of that process including acid reflux disorder.

Q: How is chronic sinusitis treated?
A: Chronic rhinosinusitis (inflammation of both the nose and paranasal sinuses) may be treated with topical nasal anti-inflammatory sprays such as nasal steroids, short courses of oral anti-inflammatory regions such as prednisone or methylprednisolone, appropriate allergy evaluation and management, oral antibiotics when patients have symptoms of discolored nasal drainage and discharge.  Antibiotics are most commonly prescribed in these circumstances but should be limited to the appropriate standard recommendations for the most common bacteria: Streptococcus, Haemophilus influenza, and Moraxella catarrhalis.  Chronic rhinosinusitis can smolder, but may also give rise to acute exacerbations for which antibiotics may be prescribed to reduce symptoms.  Topical nasal steroids are helpful to reduce the inflammation and relieve some of the allergic manifestations.

Q: What measures can be taken at home to relieve sinus pain?
A: Sinus discomfort is common with either acute and/or chronic manifestations of persistent inflammation of the nose and sinuses.  This discomfort can be alleviated with appropriate use of anti-inflammatory agents such as ibuprofen/naproxen sodium by mouth or the use of topical anti-inflammatory agent such as nasal steroids prescribed by a physician.  Decongestant therapies can also help alleviate some of this problem.

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