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Sinusitis

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What are the symptoms of sinusitis?

Sinusitis is an allergic or infectious processes involving the paranasal sinuses. Sinusitis is characterized by pain over the involved sinus, facial tenderness and nasal drainage. Patients with allergic sinusitis or rhinitis may be distinguished from infectious or bacterial sinusitis by intensity of their symptoms, an association of the symptoms with specific agents or environment, and clear or white nasal discharge. Patients with bacterial sinusitis often have intense facial pain or tenderness, and purulent rhinorrhea (green or yellow nasal discharge).

How is sinusitis diagnosed?

A history of the patient's illness and a physical examination are performed by a physician. The physician seeks clues as to the duration and symptoms of the present illness. The physical examination must include inspection of the nose. Such inspection is best performed with fiberoptic endoscopes which have been designed for sinus and nasal surgery. The physician inspects the nose to look for evidence of bacterial infection, polyps, tumors and structural abnormalities of the sinuses or nose which predispose the patient to sinusitis. In patients with a history of multiple sinus infections refractive to repeated courses of antibiotics, x-rays may be indicated. However, radiographic imaging is often reserved for those patients who are difficult to diagnose and/or require surgical treatment.

How is sinusitis treated?

Allergic sinusitis is initially treated by oral antihistamines and nasal steroid sprays. In those individuals refractive to such therapy, allergic evaluation is indicated. Such evaluation will include a careful questioning of the patient to detect possible allergens (such as flower pollens). If indicated, skin testing or special blood tests (RAST) are performed to identify the allergen. Failure to identify an allergen does not mean the patients lacks allergies, rather testing is limited to common allergens. Many individuals are allergic agents which are not covered by such testing. When the allergen can be identified, immunotherapy (allergy shots) is recommended.

Bacterial sinusitis requires antibiotic treatment. Initial episodes of bacterial sinusitis are treated with 10 to 14 days of a broad spectrum oral antibiotic. If the infections reoccurs multiple times, does not respond to the initial antibiotic treatment or symptoms are worsening, the patient should be re-evaluated and placed on a three week course of antibiotics specific for the range of bacteria causing acute and/or chronic sinusitis. Serious infection can spread to the adjacent eyes or brain.

Who will benefit from sinus surgery?

Given the frequency of sinusitis, relatively few individuals require surgical treatment.

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