Sinusitis is one of the most commonly diagnosed diseases in the United States. Rhinosinusitis is used interchangeably with the term sinusitis. Because of its importance, I will review the diagnosis and management of this disease.
The definition of acute sinusitis is symptoms less than 12 weeks of nasal discharge, congestion, fever, cough and headache. Recurrent sinusitis is at least 3 episodes a year. Chronic sinusitis is the same symptoms but longer than 12 weeks, plus there should be an abnormal CT scan or endoscopy.
I will list here the major summary statements that the executive Joint Taskforce on Practice Parameters have come up regarding sinusitis.
Suspects acute sinusitis in patients whom a URI persists beyond 10 days who is worsening.
- A CT scan is the preferred image modality.
- Perform an allergy evaluation in patients with chronic sinusitis.
- Nonallergic rhinitis can accompany chronic sinusitis.
- Evaluate patients for immune deficiency with quantitative immune globulins and specific antibody responses.
- Evaluate patients for reflux disease.
- A subgroup of patients may have allergic fungal sinusitis, those patients need to be treated differently.
- Penicillin antibiotics are the treatment of choice.
- A short course of oral steroids may be warranted and intranasal steroids may provide benefit.
- Use nasal saline irrigation as an adjunctive treatment.
- Consider antihistamines for patients with allergies.
- Neither oral nor topical decongestants are beneficial for long term treatment.
- Consider Xolair for nasal polyps.
- Consider sinuplasty for patients unresponsive to medical management.
Pediatric sinusitis is a self limited process and antibiotics usually accelerate resolution. Nasal steroids can be particularly useful in children. But irrigation, antihistamines, decongestants or mucolytics have not shown to be helpful. There is limited data in treating children with an extended course of antibiotics in chronic sinusitis, but they have shown benefit in acute sinusitis. Nasal steroids though have helped in chronic sinusitis. Surgery is much less common in children than adults and the mainstay is medical management.