A. More than 37 million Americans suffer from at least one episode of acute
sinusitis each year. The prevalence of sinusitis has soared in the last decade
due to increased pollution, urban sprawl, and increased resistance to
antibiotics.
Q. What is sinusitis?
A. Sinusitis is an inflammation of the membrane lining of any sinus,
especially one of the paranasal sinuses. Acute sinusitis is a short-term
condition that responds well to antibiotics and decongestants; chronic sinusitis
is characterized by at least four recurrences of acute sinusitis. Either
medication or surgery is a possible treatment.
Q. What are the signs and symptoms of acute sinusitis?
A. For acute sinusitis, symptoms include facial pain/pressure, nasal
obstruction, nasal discharge, diminished sense of smell, and cough not due to
asthma (in children). Additionally, sufferers of this disorder could incur
fever, bad breath, fatigue, dental pain, and cough (in adults).
Acute sinusitis can last four weeks or more. This condition may be present
when the patient has two or more symptoms and/or the presence of thick, green or
yellow nasal discharge. Acute bacterial infection might be present when symptoms
worsen after five days, persist after ten days, or the severity of symptoms is
out of proportion to those normally associated with a viral infection.
Q. How is acute sinusitis treated?
A. Acute sinusitis is generally treated with 10 to 14 days of antibiotic
care. With treatment, the symptoms disappear and antibiotics are no longer
required for that episode. Oral and topical decongestants also may be prescribed
to alleviate the symptoms.
Q. What are the signs and symptoms of chronic sinusitis?
A. Victims of chronic sinusitis may have the following symptoms for 12 weeks
or more: facial pain/pressure, facial congestion/fullness, nasal
obstruction/blockage, thick nasal discharge/discolored post-nasal drainage, pus
in the nasal cavity, and at times, fever. They may also have headache, bad
breath, and fatigue.
Q. What measures can be taken at home to relieve sinus pain?
A. Warm moist air may alleviate sinus congestion. A vaporizer or steam from a
pan of boiled water (removed from the heat) are both recommended (humidifiers
should have a clear filter to preclude spraying bacteria or fungal spores into
the air). Warm compresses are useful in relieving pain in the nose and sinuses.
Saline nose drops are safe for use at home.
Q. How effective are non-prescription nose drops or sprays?
A. Use of nonprescription drops or sprays might help control symptoms.
However, non-prescription drops should not be used beyond their label
recommendation.
Q. How does a physician determine the best treatment for acute or
chronic sinusitis?
A. To obtain the best treatment option, the physician needs to properly
assess the patient's history and symptoms and then progress through a structured
physical examination.
Q. What should one expect during the physical examination for
sinusitis?
A. At a specialist's office, the patient will receive a thorough ear, nose,
and throat examination. During that physical examination, the physician will
explore the facial features where swelling and erythema (redness of the skin)
over the cheekbone exists. Facial swelling and redness are generally worse in
the morning; as the patient remains upright, the symptoms gradually improve. The
physician may feel and press the sinuses for tenderness. Additionally, the
physician may tap the teeth to help identify an inflamed paranasal sinus.
Q. What other diagnostic procedures might be taken?
A. Other diagnostic tests may include a study of a mucus culture, endoscopy,
x-rays, allergy testing, or CT scan of the sinuses.
Q. What is nasal endoscopy?
A. An endoscope is a special fiberoptic instrument for the examination of the
interior of a canal or hollow viscus. It allows a visual examination of the nose
and sinus drainage areas.
Q. Why does a physician specialist carry out nasal endoscopy?
A Nasal endoscopy offers the physician specialist a reliable, visual view of
all the accessible areas of the sinus drainage pathways. First, the patient's
nasal cavity is anesthetized; a rigid or flexible endoscope is then placed in a
position to view the structure of the nasal cavity. The procedure is utilized to
observe signs of obstruction as well as detect nasal polyps hidden from routine
nasal examination. During the endoscopic examination, the physician specialist
also looks for pus as well as polyp formation and structural abnormalities that
will cause the patient to suffer from recurrent sinusitis.
Q. What course of treatment will the physician recommend?
A. To reduce congestion, the physician may prescribe nasal sprays, nose
drops, or oral decongestants. Antibiotics will be prescribed for any bacterial
infection found in the sinuses (antibiotics are not effective against a viral
infection). Antihistamines may be recommended for the treatment of allergies.
Antifungal medicine will be the treatment for any fungal infection.
Q. Will any changes in lifestyle be suggested during
treatment?
A. Smoking is never condoned, but if one has the habit, it is important to
refrain during treatment for sinus problems. A special diet is not required, but
drinking extra fluids helps to thin mucus.
Q. When is sinus surgery necessary?
A. Mucus is developed by the body to act as a lubricant. In the sinus
cavities, the lubricant is moved across mucus membrane linings toward the
opening of each sinus by millions of cilia (a mobile extension of a cell).
Inflammation from an allergy causes membrane swelling and the sinus opening to
narrow, thereby blocking mucus movement. If antibiotics are not effective, sinus
surgery can correct the problem.
Q. What does the surgical procedure entail?
A. The basic endoscopic surgical procedure is performed under local or
general anesthesia. The patient returns to normal activities within four days;
full recovery takes about four weeks.
Q. What does sinus surgery accomplish?
A. The surgery should enlarge the natural opening to the sinuses, leaving as
many cilia in place as possible. Otolaryngologist-head and neck surgeons have
found endoscopic surgery to be highly effective in restoring normal functioning
to the sinuses. The procedure removes areas of obstruction, resulting in the
normal flow of mucus.
Q. What are the consequences of not treating infected sinuses?
A. Not seeking treatment for sinusitis will result in unnecessary pain and
discomfort. In rare circumstances, meningitis or brain abscess and infection of
the bone or bone marrow can occur.
Q. Where should sinus pain sufferers seek treatment?
A. If you suffer from severe sinus pain, you should seek treatment from a
physician who can treat your condition with medical and/or surgical remedies.
This information (with the exception of photos) may be freely used.
Attribution to the American Academy of Otolaryngology-Head and Neck Surgery is
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