Sinusitis

Sinusitis is a term that covers both acute and chronic inflammatory or infectious conditions that result from allergies or nonallergic sources, such as bacteria and viruses.

Allergic sinusitis is an inflammatory reaction to things like pollen, dust, smoke and animal dander. Allergic sinusitis can be acute, lasting less than four weeks, or chronic, lasting longer than 12 weeks.

Allergic rhinitis and secondary sinusitis symptoms may vary with the seasons or last all year-round and have similar symptoms to nonallergic sinusitis; however, nonallergic sinusitis doesn’t usually cause an itchy nose, eyes or throat.

Sinusitis symptoms may include:

  • Nasal congestion, sneezing, runny nose and post-nasal drip
  • Headache, pain, tenderness, swelling and pressure in the forehead, cheeks, nose and around the eyes
  • Irritability, inability to focus, fatigue
  • Sleep problems, such as insomnia
  • Reduced or altered sense of smell and taste
  • Itchy eyes, nose and throat (allergic sinusitis)
  • Persistent cough
  • Fever

A physician diagnoses allergic sinusitis by taking a detailed medical history and performing a physical examination. If appropriate, the physician may order allergy skin or blood tests to identify the allergen causing the nasal flare-up, nasal endoscopy (inserting a flexible or rigid fiber-optic telescope into the nasal passages to see abnormalities clearly) or a CT scan to help assess the nasal and sinus anatomy, extent of disease, any injury, infection or other problems.

Allergic Fungal Sinusitis
Allergic fungal sinusitis (AFS) is not a fungal infection in the sinuses per se. Fungi, such as mold, are found in the environment and, in some people, create an allergic reaction which results in thick fungal debris, sticky mucus forming a fungus ball and sinus blockage.

Patients with AFS may also have other allergies, nasal polyps and/or asthma. The patient’s sense of smell may be affected. Left untreated, like any other form of acute or chronic sinusitis, this can cause serious secondary consequences such as spread of infection to the eye (orbital cellulitis, subperiosteal abscess, orbital abscess) with visual loss or brain abscess, encephalitis and meningitis.

AFS is diagnosed through laboratory testing of secretions or tissue. Treatment includes endoscopic sinus surgery and removal of the thick fungal debris and mucus in the sinuses. Steroids may also be given but will not eradicate the fungal debris within the affected sinus(es). Immunotherapy and anti-inflammatory therapy may also be helpful. Recurrence of AFS is not uncommon.

Nonallergic Rhinitis and Sinusitis
Nonallergic rhinitis and sinusitis may be triggered by dust, smog, smoke, temperature or humidity changes, strong odors and chemicals, alcoholic beverages, spicy foods or stress. Other causes include spontaneous abnormal regulation of the natural nasal cycle (congestion/decongestion, mucus secretion/hypersecretion), viral infections, such as a cold or flu, hormonal changes, such as during pregnancy, and certain medications.

Self-Help Treatments
For mild seasonal sinusitis, avoidance of the allergen is often an effective course of action. Some other self-help and medicinal remedies are:

  • Saline nasal sprays to rinse the nasal passages
  • Inhaling steam may reduce nasal congestion
  • Decongestants, over-the-counter products
  • Corticosteroid nasal sprays (by prescription)
  • Antihistamine nasal sprays (by prescription)
  • Over-the-counter or prescription antihistamines
  • Desensitization through allergy shots (immunotherapy)
  • Over-the-counter pain relievers, such as ibuprofen and acetaminophen
  • Antibiotics for secondary bacterial infections

When self-help and medical therapy are insufficient, sinusitis may be treated with Balloon Sinuplasty™ or endoscopic sinus surgery if CT-proven sinus disease is non-responsive to an aggressive four to six weeks of antibiotic therapy. The timing of getting the CT scan is very important in relation to when the antibiotics are completed so as not to give an incorrect representation. Getting a CT scan prematurely—prior to or too soon after appropriate treatment—could falsely or misleadingly represent the extent or existence of disease.

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