Sinusitis
What is Sinusitis?
Sinusitis, also called rhinosinusitis, is defined as inflammation, swollen irritated tissue, of the nasal and sinus cavity linings. Both areas are typically involved in sinusitis because the sinus linings can be described as an extension of the nasal lining, a “deeper” area of the upper respiratory tract. Rhinitis occurs commonly without sinusitis but it is uncommon for sinusitis to occur without rhinitis. The Board Certified Allergist is an expert in upper and lower respiratory tract allergy, evaluation and treatment. This includes patients with rhinosinusitis whether allergy is the primary or contributing cause or not.
The sinus cavities are primarily found within the cheek bones, around the eyes and behind the nose. The main function of these sinuses is to moisten and filter the air as an extension of the nasal cavity’s function. There is also a role in voice quality.
Inflammation of the nasal and sinus linings may be caused by allergy to inhalants such as pollens, mold spores, pet dander and house dust components, infections, tobacco smoke or other airborne irritants. Symptoms of sinusitis include mucus drainage, head congestion, fullness, pressure or headaches over the sinus cavities, cough, toothache and occasionally fever. However, also runny nose, mucus drainage, and irritated throat associated with nasal and sinus area headaches can be a common presentation of allergic rhinitis. Many people with “sinus” headaches actually have migraine or other types of headaches; therefore not all headaches localized to the sinuses are due to sinusitis.
Types of Sinusitis
There are two types of sinusitis, acute and chronic. Acute sinusitis is short in duration, typically days to a couple of weeks with symptoms completely resolving. The most common cause of acute sinusitis is a viral infection (e.g. common cold). A bacterial infection is suspected when symptoms persist beyond 10-14 days. Since most acute sinusitis episodes are not related to bacteria, antibiotics are usually not required. Symptomatic treatment may include decongestants, nasal saline irrigation or warm moist inhalation or a mild cough suppressant. If mucus is thick and colored, mucus thinning agents may be administered. If despite these therapies symptoms do not improve, an antibiotic may be considered.
Chronic sinusitis occurs when symptoms are on and off or continual for months and is potentially more serious. A more aggressive diagnostic and therapeutic approach is essential to improve the condition or if symptoms worsen or complications occur. These include progressively worse sinus disease or infection spreading to adjacent tissues and other areas of the respiratory tract. While chronic sinusitis may be related to bacterial infections, non-infectious causes of chronic sinusitis are common.
What is Hyperplastic Sinusitis?
Hyperplastic sinusitis involves inflamed sinus linings and may be seen in association with several conditions including asthma or nasal polyp disease. Individuals with frequent sinus infections may need to be evaluated for other conditions including allergic rhinitis, a structural abnormality such as an obstructing nasal septal deviation, or in some cases immunodeficiency. In addition, various environmental exposures may need to be evaluated. Also, regular or frequent use of decongestant nasal sprays, available without a prescription, can cause rhinosinusitis. The Board Certified Allergist can evaluate all of these areas. Evaluation may include allergy testing, sinus imaging (e.g. CT scan), immune function tests, analysis of nasal secretions or lining, and a flexible fiberoptic scope to more directly visualize the upper respiratory tract. Information from various tests are useful to develop an appropriate treatment plan c. A referral to an Otorhinolaryngologist, also known as Ear, Nose and Throat Surgeon may be needed if the condition cannot be controlled medically and an evaluation for surgical intervention is indicated.
Beware of frequent antibiotic use every time possible sinus symptoms arise as antibiotic resistance and allergy to antibiotics occur. Also, frequent use of oral and/or injected cortisone or steroids can create major permanent medical problems.
Lastly, “sinus headaches” may actually be a nasal related headache, migraine or another type. The Board Certified Allergist is skilled in evaluation and differentiation in these areas and can skillfully develop a more focused treatment plan.
The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.
An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.
A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.