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Chronic & Acute Sinusitis

Sinusitis (say: "sine-you-site-iss") is the name for a condition in which the lining of your sinuses becomes inflamed. Inflammation of the paranasal sinuses may be acute, subacute, chronic, allergic, or hyperplastic.

Acute sinusitis usually results from the common cold and lingers in subacute form in only about 10% of patients. Chronic sinusitis follows persistent bacterial infection; allergic sinusitis accompanies allergic rhinitis; hyperplastic sinusitis is a combination of purulent acute sinusitis and allergic sinusitis or rhinitis. The prognosis is good for all types.

Causes

Sinusitis can be caused by fungal, viral, or bacterial infections, as well as allergies. It can also occur as a result of a tooth infection, or from frequent air travel or deep diving, both of which cause changes in atmospheric pressure; from nasal polyps, which interfere with proper drainage; and from nasal defects. All of these causes irritate the mucous membranes in the sinus cavities, causing inflammation, poor drainage, and infection.

Signs and symptoms

Features vary with sinusitis type.

Acute sinusitis

The primary symptom of acute sinusitis is nasal congestion, followed by a gradual buildup of pressure in the affected sinus. For 24 to 48 hours after onset, nasal discharge may be present and later may become purulent. Associated symptoms include malaise, sore throat, headache, low-grade fever (temperature of 99° to 99.5° F [37.2° to 37.5°]), malodorous breath, painless morning periorbital swelling, and a sense of facial fullness.

Characteristic pain depends on the affected sinus: maxillary sinusitis causes pain over the cheeks and upper teeth; ethmoid sinusitis, pain over the eyes; frontal sinusitis, pain over the eyebrows; and sphenoid sinusitis (rare), pain behind the eyes.

Subacute sinusitis

Purulent nasal drainage that continues for longer than 3 weeks after an acute infection subsides suggests subacute sinusitis. Other clinical features of the subacute form include a stuffy nose, vague facial discomfort, fatigue, and a nonproductive cough.

Other types

The effects of chronic sinusitis are similar to those of acute sinusitis, but the chronic form causes continuous mucopurulent discharge.

The effects of allergic sinusitis are the same as those of allergic rhinitis. In both conditions, the prominent symptoms are sneezing, frontal headache, watery nasal discharge, and a stuffy, burning, itchy nose.

In hyperplastic sinusitis, bacterial growth on the diseased tissue causes pronounced tissue edema. Thickening of the mucosal lining, as well as the development of mucosal polyps, combine to produce chronic stuffiness of the nose in addition to headaches

Diagnosis

Although a stuffy nose can occur in other conditions, like the common cold, many people confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold. A doctor can diagnose sinusitis by medical history, physical examination, X-rays, and if necessary, MRIs or CT scans (magnetic resonance imaging and computed tomography).

Treatment

Effective treatment depends on the type of sinusitis.

Acute sinusitis

In acute sinusitis, local decongestants usually are tried before systemic decongestants; steam inhalation may also be helpful. Local application of heat may help to relieve pain and congestion.

Antibiotics are necessary to combat purulent or persistent infection. (The patient should be aware that allergic reactions to penicillin can occur.) Amoxicillin, ampicillin, and amoxicillin-clavu­lanate potassium are usually the antibiotics of choice; question the patient about any known allergy to penicillin. Sinusitis is a deep-seated infection, so antibiotics should be given for 2 to 3 weeks.

Subacute sinusitis

In subacute sinusitis, antibiotics and decongestants may be helpful.

Other types

Treatment of allergic sinusitis must include treatment of allergic rhinitis­administration of antihistamines, identification of allergens by skin testing, and desensitization by immunotherapy. Severe allergic symptoms may require treatment with corticosteroids and epinephrine.

In chronic sinusitis and hyperplastic sinusitis, antihistamines, antibiotics, and a steroid nasal spray may relieve pain and congestion. If irrigation fails to relieve symptoms, one or more sinuses may require surgery.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flu's and colds:

• Get an influenza vaccine each year.
• Wash your hands frequently, particularly after shaking hands with others.
• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
• Reduce stress.

Additional tips for preventing sinusitis:

• Avoid smoke and pollutants.
• Use a humidifier to increase moisture in your nose and sinuses.
• Drink plenty of fluids to increase moisture within your body.
• Take decongestants during an upper respiratory infection.
• Treat allergies promptly and appropriately.