Sinusitis

Sinusitis or sinus infection is an inflammation of the sinus cavities. The sinuses are hollow spaces in the bones around the nose that connect to the nose through small channels. When these channels are open, the sinuses can stay healthy. Sinusitis happens when a virus, bacteria or fungi causes the sinus cavity to become inflamed and fill with fluid leading to an infection.

Sinusitis can affect all age groups and often occurs after a cold, allergic rhinitis, nasal polyps or a deviated septum. Symptoms of sinusitis include fever, weakness, fatigue, cough, congestion and mucus in the back of the throat.

Sinusitis can become chronic and it’s important to have it diagnosed and treated. Untreated sinusitis will lead to pain and discomfort and is not usually a cause for concern; however, it can lead to meningitis, brain abscess or bone infection in very rare cases. If you or someone you care for is experiencing symptoms of sinusitis, contact us at (503) 257-3204 to schedule an appointment.

Common causes of Sinusitis:

  • Viral “cold”
  • Bacterial infection
  • Allergy induced mucosal inflammation
  • Fungal infection
  • Poor air quality – smoking, pollution

Sinus symptoms overlap with several problems such as colds, allergy, migraine, dental problems and TMJ dysfunction. This makes accurate diagnosis challenging and diagnostic criteria have been developed.

Conventional Criteria for the Diagnosis of Sinusitis

Based on the Presence of at Least 2 Major or 1 Major and ≥2 Minor Symptoms

  • Major Symptoms
    • Purulent anterior nasal discharge
    • Purulent or discolored posterior nasal discharge
    • Nasal congestion or obstruction
    • Facial congestion or fullness
    • Facial pain or pressure
    • Hyposmia or anosmia (decreased smell)
    • Fever (for acute sinusitis only)
  • Minor Symptoms
    • Headache
    • Ear pain, pressure, or fullness
    • Halitosis
    • Dental pain
    • Cough
    • Fever (for subacute or chronic sinusitis)
    • Fatigue

Acute Sinusitis: Overview

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Chronic Sinusitis: Overview

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Modified from Meltzer, E. O. and D. L. Hamilos (2011). “Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines.” Mayo Clinic proceedings. Mayo Clinic 86(5): 427-443.

  1. Onset with persistent symptoms or signs compatible with acute rhinosinusitis, lasting for 10 days without any evidence of clinical improvement.
  2. Onset with severe symptoms or signs of high fever and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days at the beginning of illness, or
  3. Onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection (URI) that lasted 5–6 days and were initially improving (‘‘double sickening’’).

2007 RSTF diagnostic criteria for Chronic Rhinosinusitis

RSTF = Task Force on Rhinosinusitis.

Twelve or more weeks of 2 or more of the following symptoms

  1. Mucopurulent drainage (anterior, posterior) or both
  2. Nasal obstruction (blockage)
  3. Facial pain-pressure-fullness
  4. Decreased sense of smell

AND

  1. Purulent mucus or edema in the middle meatus
  2. Polyps in the nasal cavity, and/or
  3. Inflammation of the paranasal sinuses on imaging

Sinusitis Evaluation:

  • Complete history and physical examination to obtain accurate diagnosis
  • Diagnostic testing if indicated:
    • Nasal endoscopy
    • Sinus CT Scan
    • Culture of sinus drainage

Sinusitis Treatment Options We Provide:

  • Conservative Treatment
    • Most sinus infections will resolve without antibiotics
  • Antibiotics
  • Allergy treatment if indicated
  • Endoscopic sinus surgery
    • Generally indicated for intolerable sinusitis symptoms despite maximal medical therapy.
  • Balloon Sinuplasty: In Office or in Operating Room

Chronic Sinusitis: Treatment Overview

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Sinus Surgery: Overview

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Balloon Sinuplasty: Overview

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If you have sinusitis problems, please call 503-257-3204 or request a visit online with us.

References:

American Academy of Otolaryngology−Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357, 1-703-836-4444. 2010 AAO-HNS/AAO-HNSF

Rosenfeld, R. M., D. Andes, et al. (2007). “Clinical practice guideline: adult sinusitis.” Otolaryngology–head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 137(3 Suppl): S1-31.

Hsueh, W. D., D. B. Conley, et al. (2013). “Identifying clinical symptoms for improving the symptomatic diagnosis of chronic rhinosinusitis.” International Forum of Allergy & Rhinology 3(4): 307-314.