Ask the Doctor: What is Sinusitis?

11/15/2019

by Timothy J. Schneider, M.D., FACS (This article originally appeared in Well Keys Magazine)

Strictly speaking, sinusitis is an inflammatory condition of the sinuses. Not all sinusitis is a bacterial sinus infection. And certainly not everything that appears to be sinusitis, is sinusitis. People suffer from "sinus headaches" which may or may not be related to their sinuses. People also may suffer from allergies, nasal obstruction from polyps and/or deviated septum, and even the common cold. But how do we know the difference?

These conditions are not mutually exclusive. Different conditions can lead to inflammatory disease of the sinuses. Frequent colds, secondary infections (bacterial infections following a cold), and environmental exposures both with and without allergy, can contribute to building inflammation of the sinuses. Inflammation of the sinuses or "sinusitis" in medical terminology is more accurately referred to as rhinosinusitis because it affects both the nose and the air-filled cavities of the face known as the paranasal sinuses. Sinusitis is further classified as acute (2 - 4 weeks), subacute (8 - 12 weeks), or chronic rhinosinusitis (> 12 weeks), based on the duration of symptoms.

Diagnosis is based on the presence and absence of various symptoms and physical findings including using nasal endoscopy. When the diagnosis is uncertain, symptoms are progressing to more complicated disease, or surgical planning is needed, a CT scan is obtained. A CT scan may be necessary to help differentiate facial pain syndromes such as migraine, TMJ, dental problems, trigeminal neuralgia (chronic facial pain), temporal arteritis, and other diagnoses from sinusitis.

Treatment of sinusitis, an inflammatory disease, is centered on anti-inflammatory drugs and measures. Treatment often involves managing underlying inflammatory diseases like allergy with avoidance, antihistamines and immunotherapy as well as applying topical anti-inflammatory intranasal steroids such as Flonase, Nasacort, or Rhinocort. Unfortunately, anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen and aspirin, which help treat pain, do not treat the underlying sinus inflammation; only steroids by mouth or by nose are of proven anti-inflammatory benefit.

But what about antibiotics and surgery? While these are critically important for treating some cases of sinusitis, they are not the mainstay treatment. In acute bacterial sinusitis, with symptoms persistent for more than two weeks, often following a cold, antibiotics are completely appropriate; but prolonged illnesses aren't of proven benefit and may, in fact, delay proper care or result in serious side effects. Surgery is important in the treatment of recurrent sinusitis (4 or more times a year) and chronic sinusitis but may not cure sinusitis entirely. Surgery does, however, improve or relieve symptoms int he vast majority of long-term sinus sufferers by making medical treatment such as nasal steroids more effective.

Everybody is different in their exposures, immune systems, anatomy, underlying disease processes, and even their previous treatments. Proper diagnosis and treatment of sinusitis is unique to each patient.

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