Sinusitis

Sinusitis is an inflammation of the sinuses, which are the interconnected hollow spaces in the bones around the nose. They can become blocked and infected after a cold, allergic rhinitis, nasal polyps or a deviated septum. If you would like to learn more about sinusitis, please click here to read more.

Acute Sinusitis: Overview

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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 diagnosis criteria have been developed.

Chronic Sinusitis: Overview

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Chronic Sinusitis: Treatment Overview

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Chronic Sinusitis: Overview

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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

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

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.