Sinusitis, Sinus Disease
Sinusitis and Sinus Disease Treatment
The paranasal sinuses are cavities within the skull which develop as outgrowths from the nose. They participate in the cleaning, warming, and moisturizing of inspired air by producing mucus. For the sinuses to remain healthy, this mucus must drain into the nose (and air must enter the sinuses). If this clearing process (called mucociliary clearance) does not occur then bacteria can propagate within the sinus cavities and invade the lining membranes. This condition is called bacterial rhinosinusitis.
Mechanical blockage to the mucus flow can occur with the common cold, nasal allergies, irritative reactions, and deviation of the nasal septum, nasal/sinus polyps, or tumors. Non-mechanical causes of reduced mucus clearance include abnormalities in the mucus itself such as cystic fibrosis and inadequate number or function of the hair-like fibers (called cilia), which "sweep" the mucus from the sinuses.
The symptoms of bacterial sinusitis include discolored post-nasal discharge, localized facial pain, nasal obstruction, decreased sense of smell and taste, fever, fatigue, halitosis, headache, cough, and pain involving the upper teeth. These symptoms can be confused with those of the "common cold" (URIs) making an accurate diagnosis difficult. Various combinations of symptoms can exist but it is safest to seek medical attention for pain localized to one area of the face, persistently discolored nasal or post-nasal discharge, "cold symptoms" associated with fevers of 101F or greater, or for symptoms lasting for more than 1 week.
Conservative treatment for the "simple cold" include: humidification, saline irrigations, over-the-counter mucus-thinning agents (combined with decongestants if there is no medical contraindication for their use), and topical nasal decongestant sprays for 3-5 days. As previously stated, "cold symptoms" lasting more than 1 week require medical attention, as do patients with localized facial pain, persistently discolored nasal or post -nasal secretions, or those with high fevers. Antibiotics prescribed by your doctor usually relieve sinus symptoms quickly, cure the acute infection, and avoid complications or chronic infection.
If one suffers from recurring bouts of acute sinusitis or if chronic symptoms exist, an ENT consultation is advisable. The office evaluation will consist of a detailed history including the nature and duration of symptoms, response to treatment, results of any prior testing, presence of prior sinonasal trauma or surgery, and pertinent general medical issues. The head and neck physical examination will include fiber optic visualization of the nasal recesses, "sinus outflow channels", and nasopharynx. This examination often identifies obstructions which are the cause of the recurrent or chronic symptoms and helps to direct the physician towards further diagnostic requirements (e.g. sinus CT scans, allergy tests, etc). Integration of history, physicals, and additional tests allows accurate diagnosis. This in turn leads to an effective treatment plan that may include medications, environmental management, allergy treatment, and/or surgery.