Sinusitis

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include production of thick nasal mucus, nasal congestion, facial congestion, facial pain, facial pressure, loss of smell, or fever.

Sinusitis is a condition that affects both children and adults. It is caused by a combination of environmental factors and a person's health factors. It can occur in individuals with allergies, exposure to environmental irritants, structural abnormalities of the nasal cavity and sinuses and poor immune function. Most cases are caused by a viral infection. Recurrent episodes are more likely in persons with asthma, cystic fibrosis, and immunodeficiency.

The diagnosis of sinusitis is based on the symptoms and their duration along with signs of disease identified by endoscopic and/or radiologic criteria. Sinusitis is classified into acute sinusitis, subacute sinusitis, and chronic sinusitis. In acute sinusitis, symptoms last for less than four weeks, and in subacute sinusitis, they last between 4 and 12 weeks. In chronic sinusitis, symptoms must be present for at least 12 weeks. In the initial evaluation of sinusitis an otolaryngologist, also known as an ear, nose and throat (ENT) doctor, may confirm sinusitis using nasal endoscopy. Diagnostic imaging is not usually needed in the acute stage unless complications are suspected. In chronic cases, confirmatory testing is recommended by use of computed tomography.

Prevention of sinusitis focuses on regular hand washing, staying up-to-date on vaccinations, and avoiding smoking. Pain killers such as naproxen, nasal steroids, and nasal irrigation may be used to help with symptoms. Recommended initial treatment for acute sinusitis is watchful waiting. If symptoms do not improve in 7–10 days or worsen, then an antibiotic may be implemented or changed. In those in whom antibiotics are indicated, either amoxicillin or amoxicillin/clavulanate is recommended first line, with amoxicillin/clavulanate being superior to amoxicillin alone but with more side effects. Surgery may be recommended in those with chronic disease who have failed medical management.

Sinusitis is a common condition. It affects between about 10 and 30 percent of people each year in the United States and Europe. The management of sinusitis in the United States results in more than US$11 billion in costs.

Acute sinusitis can present as facial pain and tenderness that may worsen on standing up or bending over, headache, cough, bad breath, nasal congestion, ear pain, ear pressure or nasal discharge that is usually green in color, and may contain pus or blood.Dental pain can also occur. A way to distinguish between toothache and sinusitis is that sinusitis-related pain is usually worsened by tilting the head forward or performing the Valsalva maneuver.

Chronic sinusitis presents with more subtle symptoms of nasal obstruction, with less fever and pain. Symptoms include facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or yellow nasal discharge, feeling of facial fullness or tightness that may worsen when bending over, dizziness, aching teeth, and bad breath. Often, chronic sinusitis can lead to anosmia, the loss of the sense of smell.

A 2005 review suggested that most "sinus headaches" are migraines. The confusion occurs in part because migraine involves activation of the trigeminal nerves, which innervate both the sinus region and the meninges surrounding the brain. As a result, accurately determining the site from which the pain originates is difficult. People with migraines do not typically have the thick nasal discharge that is a common symptom of a sinus infection.