About Sinusitis

Learn what sinusitis is and its contributing factors, as well as, potential signs, symptoms, and how sinusitis is diagnosed.

Doctor Examining Patient’s Sinuses

What is Sinusitis?

Physicians routinely use the term rhinosinusitis ('rhino' = nose; sinus = air-filled cavity behind the upper facial bones) or simply 'sinusitis' to refer to an inflammation of the paranasal sinuses. Sinusitis may involve both the mucous membranes of the nasal cavity and the 4 sinus pairs - frontal, ethmoid, maxillary and sphenoid paranasal sinuses. The mucous secretions found in the nasal passages of a sinusitis sufferer are directly related to the ongoing pathologic changes in both the surrounding bone and tissue.

Sinusitis is the most common chronic condition diagnosed in the United States affecting an estimated 14% of the population. The direct medical costs of sinusitis amount to billions of dollars annually. Indirectly, the costs of treating sinusitis are greatly magnified by the staggering amount of lost hours of productivity at work and school. Current methods of cost analysis indicate that sinusitis usurps nearly 1% or the entire Gross National Product.

Contributing Factors

Contributing Causal Factors

  • Congenital conditions such as cystic fibrosis, syndromic disorders
  • Allergic conditions
  • Immune system conditions
  • Anatomic abnormalities
  • Systemic diseases
  • Malfunctioning neurosystem
  • Growths in the form of benign or malignant tumors

Contributing Environmental Factors

  • Viral, bacterial or fungal infections
  • Trauma to the area
  • Chemical agents
  • Medications
  • Surgical procedures

Signs & Symptoms

Each one of the four pairs of sinuses has an opening for mucous drainage. When this natural mucous drainage process is obstructed, chronic sinus inflammation will occur. We know sinusitis best by any of the recognizable symptoms it produces, either singly or in complex combinations. The major and minor symptoms or factors of sinusitis include:

Diagnosis

The diagnosis of Sinusitis is made after review of patient's medical history and completion of a full clinical examination. Radiologic evaluation is usually reserved for patients who need medical treatment or present with complications of sinusitis (mucocele). CT scan is the accepted form of radiologic evaluation. Scans with axial, coronal and reconstructed sagittal views are the most useful.

Clinical examination includes anterior rhinoscopy and nasal endoscopy. This can be carried out effectively under topical or local anesthesia. Rigid nasal endoscopy affords optimum viewing of the sinuses in different angles with the various angled Hopkins telescopes. An image-guided guided culture can be effectively and carefully performed without excessive contamination from the nasal cavity; this improves the isolation of the bacteria and in some situations the fungal organisms.

Recurrent acute Sinusitis is defined by symptoms and physical findings consistent with symptoms and findings worsening after 5 days or persisting as long as 10 days. However or more and may last up to 4 weeks. Furthermore, as many as 4 episodes occur in 1 year absent without current antibiotic therapy. The diagnostic criteria for recurrent acute Sinusitis for acute Sinusitis.

The standard radiologic examination for imaging sinusitis is a CT scan. This is performed in both coronal and axial views and occasionally in sagittal reconstruction. CT scanning has replaced conventional radiographic studies, as the details with CT scan evaluations are superior and more precise. The CT scan optimally reveals the relationship of the sinuses to the orbit and the brain. This is an invaluable piece of information in any patient with rhinosinusitis which is severe enough to produce complications.

The MRI examination is based on the water and protein signals of the mucosa. It will not delineate the difference between bacterial and viral infections. However, it is useful in evaluation of fungal sinusitis and in patients with fluid collections in the orbit or the brain area.

The radiologic studies are usually performed to evaluate the extent of the disease in patients having acute Sinusitis with complications. Once the clinical diagnosis is made, the medical treatment should be pursued as soon as possible.

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