JOSEPH R. ANTICAGLIA, MD
Medical Advisory Board
Sinusitis is the symptomatic inflammation of the linings of the paranasal sinuses. Part B asks five more questions about sinusitis.
6. WHAT ARE THE OTHER FORMS OF SINUSITIS?
“As soon as I get off the antibiotics, the infection comes back.”
‘Recurrent’ Sinusitis
Recurrent sinusitis is acute sinusitis that repeats itself four or more times within a twelve month period. The sinusitis completely clears up with antibiotic treatment, but within weeks or months it returns and another course of antibiotics is necessary to treat the recurrent problem.
‘Chronic’ sinusitis
“This infection won’t go away.”
Chronic sinusitis is a sinusitis that lasts for three or more months in spite of medical treatment. It’s usually associated with a prolonged “inflammation” rather than an infection. Chronic inflammation can result in permanent changes in the mucosa and walls of the sinuses making it a chronic problem. Different things cause chronic sinusitis — from anatomical abnormalities to fungus infections.
7. HOW IS SINUSITIS DIAGNOSED?
If you are complaining of nasal congestion, pain over the sinuses and colored nasal discharge for several days, then you ought to be treated with antibiotics for bacterial sinusitis without the need for image studies.
At times, diagnostic tests for rhino-sinusitis are needed to assist in making the diagnosis. These tests include CT of the sinuses (Computerized Tomography), laboratory tests, culture and sensitivity, nasal endoscopy (i.e. examining the nose in the office with a special instrument) and testing for allergies and the immune system.
8. HOW IS UNCOMPLICATED ACUTE SINUSITIS TREATED?
It’s important to distinguish acute viral from acute bacterial sinusitis. If you’ve been sick for less than ten days and are not getting worse, you probably have acute viral sinusitis and antibiotics or topical steroids would not be of help in these cases. Clinicians may suggest nasal saline irrigation, decongestants and analgesics for symptomatic relief of viral sinusitis.
If you have been sick for ten days or more with symptoms described under diagnosis and show no evidence of improvement or are getting worse, you likely have bacterial sinusitis. Antibiotics are helpful in these cases in addition to the above treatments for viral sinusitis. (1)
9. HOW IS CHRONIC RHINOSINUSITIS (CRS) TREATED?
CRS is treated differently compared to acute bacterial sinusitis. One of the objectives is to treat the inflammation of chronic sinusitis with saline nasal washes, topical steroids and analgesics. One reserves antibiotics to treat an infectious flare-up in the CRS patient.
One needs to be alert to other chronic conditions that could change the treatment in patients with (CRS). Some of these conditions that need treatment are asthma, allergies, nasal polyps and difficulties with the body’s ability to fight infection (immune deficiencies).
10. WHAT ARE THE COMPLICATIONS OF SINUSITIS?
Sinusitis has the potential to infect structures surrounding the sinuses. The complications of sinusitis are uncommon, but can have serious consequences. It has become more worrisome in the age of “superbugs” — where antibiotics that once were effective in treating sinusitis are no longer useful.
Sinusitis has been known to spread to the brain causing meningitis and brain abscess. It can spread to the eye causing problems with vision, infect the eye tissue and form a pus pocket in the eye socket. It can decrease the sense of smell permanently. It can form a “mucocele” — a cystic mass (it’s like a balloon filled with snot) caused by blockage of the sinus openings.
SUMMARY
A great number of antibiotics are prescribed for adults with sinusitis. (1) The accurate diagnosis of sinusitis and the judicious use of antibiotics not only benefits patients, it lowers the cost of health care and minimizes the appearance of superbugs.
Recurrent and chronic sinusitis can adversely affect the quality of one’s life. An understanding of the different aspects of sinusitis is critical to the management and wellbeing of patients.
(1) Rosenthal, Richard M.; Clinical Practice Update (Adult Sinusitis); April, 2015
(2) Clinicians refer to this intersection as the “osteomeatal complex”.