Sinusitis is an acute or chronic inflammation of the nasal sinuses, the hollow cavities found within the cheek bones and around and behind the eyes. The sinuses are designed to warm, moisten and filter the air in the nasal cavity and aid in vocalizing certain sounds. The inflammation is generally a result of inadequate draining due to allergy, infection or obstruction.
Symptoms of sinusitis include nasal congestion, green or gray nasal discharge, postnasal drip, pressure in the face, headache and chronic cough. Sinusitis develops in approximately 31 million Americans each year, resulting in more than 18 million physician visits and more than $5.8 billion in overall health expenditures.
There are two types of sinusitis. Acute sinusitis is usually caused by a bacterial infection and develops as a complication of the common cold. Although colds are the most common cause of acute sinusitis, those with allergies may also be predisposed to sinusitis. Allergies can trigger inflammation of the sinus and nasal mucous linings. This inflammation prevents the sinus cavity from clearing out bacteria, and increases the chances of developing secondary bacterial sinusitis.
Chronic sinusitis, which can also be caused by a bacterial infection, is more often a chronic inflammatory disorder similar to bronchial asthma. It is defined as two or more episodes of sinusitis requiring antibiotic treatment per year for two or more years. Although allergic rhinitis is the most common underlying cause of chronic sinusitis, immunologic problems can also be the root of the problem.
Structural problems in the nose such as narrow drainage passages, tumors or polyps, or a deviated septum can also cause sinusitis. Surgery is sometimes needed to correct these problems.
To diagnose sinusitis, an allergist will take a complete history and perform a physical exam. Typical signs of sinusitis include tenderness over the sinus cavities, swelling of the mucous glands, nasal secretions, postnasal drip and swelling around the eyes. An allergist may suggest allergy testing, sinus X-rays, CT scans or a sampling of the nasal secretions or lining. An endoscopy procedure may also be performed, allowing the allergist to view the area where the sinuses and middle ear drain into the nose.
If sinusitis is caused by a bacterial infection, treatment begins with an antibiotic. Medications such as decongestants, mucus-thinning medicine or cortisone nasal sprays are prescribed to reduce blockage and control allergies. Antihistamines, cromolyn and topical steroid nasal sprays also help control allergic inflammation and keep the sinus passages open. For people with allergies, long-term treatments, like immunotherapy, can be effective in preventing the development of sinusitis and reducing allergic symptoms. Patients are advised to drink eight glasses of water daily and to wash inside the nostrils with a saline solution.