Treatment options such as medications, immunotherapy, or both allergy shots are considered. Additional evaluation for comorbid conditions such as asthma, sinusitis, and gastroesophageal reflux are addressed and treated. Allergists are also trained in aspirin desensitization for treatment of patients with the aspirin triad.
Orbital extension of sinus disease is the most common complication of acute sinusitis. This complication is more common in children. Immediate management includes broad-spectrum intravenous antibiotics, a CT scan to determine the extent of disease, and possibly surgical drainage of the infection if there is no response to antibiotics.
Extension to the central nervous system can also occur. The most common intracranial complications are meningitis usually from the sphenoid sinus, which is anatomically located closest to the brain and epidural abscess usually from the frontal sinuses.
Because of the extent of sinus blockage and the strong association with polyps, surgery is usually indicated to remove the inspissated allergic mucin and polyps, followed by systemic corticosteroids to decrease the inflammatory response.
Commonly, nasal steroids are also added for topical treatment. Studies are currently being conducted to establish the role of antifungal agents or inhalant allergen immunotherapy for the treatment of AFS. URTIs of viral origin should run their course, with gradual improvement in symptoms daily until complete resolution of symptoms occurs by day 7 to 10, with supportive treatment only and no antibiotics.
When a secondary bacterial infection is suspected and antibiotics are given for acute sinusitis, the expected clinical outcome would be resolution of the infection and associated symptoms. The data on outcomes of medical management of chronic sinusitis are showing that we can control symptoms to a degree, although with a high rate of recurrence. Hamilos reported a retrospective series of patients treated medically for chronic sinusitis. Treatment included systemic steroids for 10 days, antibiotic coverage for aerobic and anaerobic organisms for 4 to 6 weeks, nasal saline irrigation, and topical steroid nasal spray.
There were symptomatic and radiographic improvements in 17 of 19 patients, but 8 of 19 had persistent ostiomeatal complex abnormalities. In addition, relapse of sinusitis has been significantly associated with nasal polyposis and a history of prior sinus surgery. Overall, we have many treatment options for the sinusitis patient: antibiotics for the bacterial infection; steroids, systemic or topical, for the inflammatory component; and surgery for the anatomic and structural abnormalities that can predispose to sinusitis.
Although these have helped with initial improvement, we still see a high rate of recurrence of sinus disease. This forces us to address the role of comorbid conditions such as allergic rhinitis , environmental irritants e.
Definition Prevalence Pathophysiology Signs and symptoms. Diagnosis Therapy References. Definition Sinusitis is inflammation of the sinuses, which are air-filled cavities in the skull. Figure 1: Click to Enlarge. Figure 2: Click to Enlarge. Box 1: Conditions that Predispose to Sinusitis Allergic rhinitis Nonallergic rhinitis Anatomic factors: Septal deviation Paradoxical middle turbinate Ethmoid bulla hypertrophy Choanal atresia Adenoid hypertrophy Hormonal conditions e.
Figure 3: Click to Enlarge. Figure 4: Click to Enlarge. References Slavin RG. The diagnosis and management of sinusitis: A practice parameter update. J Allergy Clin Immunol. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis. Rockville, Md: U. Spiegel JH. Sinusitis [entire issue]. Otolaryngol Clin North Am. Ivker R. Respiratory disease: Sinusitis, upper respiratory infection, otitis media. Clin Fam Pract. Hamilos DL. Chronic sinusitis. Winstead W. Prim Care. Dykewicz MS.
The microbiology and management of acute and chronic rhino-sinusitis. Curr Infect Dis Rep. Clin Infect Dis.
Diagnostic criteria for allergic fungal sinusitis. Clinical practice guideline: Management of sinusitis. Adult rhinosinusitis defined.
Otolaryngol Head Neck Surg. Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Executive summary. Wald ER. Sinus infection known as sinusitis is a major health problem. People who have allergies, asthma , structural blockages in the nose or sinuses, or people with weak immune systems are at greater risk.
A bad cold is often mistaken for a sinus infection. Many symptoms are the same, including headache or facial pain, runny nose and nasal congestion. Unlike a cold, a sinus infection symptoms may be caused by bacterial infections. It often requires treatment with antibiotics drugs that kill the germs causing the infection.
If you think you have a sinus infection, see your allergist for proper diagnosis. In most cases, sinus infection treatment is easy. By stopping a sinus infection early, you avoid later symptoms and complications.
Sinusitis is an inflammation of the sinuses. It is often caused by bacterial germ infection. Sometimes, viruses and fungi molds cause it. People with weak immune systems are more likely to develop bacterial or fungal sinus infection. A sinus infection lasting longer than eight weeks is considered chronic.
An infection of the sinus cavity close to the brain can be life threatening, if not treated. In rare cases, it can spread to the brain. Normal sinuses are lined with a thin layer of mucus that traps dust, germs and other particles in the air. Tiny hair-like projections in the sinuses sweep the mucus and whatever is trapped in it towards openings that lead to the back of the throat. From there, it slides down to the stomach. This continual process is a normal body function. A sinus infection stops the normal flow of mucus from the sinuses to the back of the throat.
The swelling traps mucus in the sinuses. Some people have bodily defects that contribute to sinus infection. The most common of these defects are:. Sinus infection sinusitis is often confused with rhinitis , a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies. Allergies can play an important role in chronic long-lasting or seasonal rhinitis episodes.
Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens.
Molds, dust mites and pet dander can cause symptoms year-round. Asthma also has been linked to chronic sinus infections. Appropriate treatment of sinus infection often improves asthma symptoms. Before, I was always thinking about my breathing. Now I can go on my rides with confidence, knowing my condition is under control. Diagnosis depends on symptoms and requires an examination of the throat, nose and sinuses. Your allergist will look for:. If your sinus infection lasts longer than eight weeks, or if standard antibiotic treatment is not working, a sinus CT scan may help your allergist diagnose the problem.
Your allergist may examine your nose or sinus openings. The exam uses a long, thin, flexible tube with a tiny camera and a light at one end that is inserted through the nose. It is not painful. Your allergist may give you a light anesthetic nasal spray to make you more comfortable.
Mucus cultures: If your sinus infection is chronic or has not improved after several rounds of antibiotics, a mucus culture may help to determine what is causing the infection. Most mucus samples are taken from the nose. However, it is sometimes necessary to get mucus or pus directly from the sinuses.
Knowing what kind of bacteria is causing the infection can lead to more effective antibiotic therapy. A fungus could also cause your sinus infection. Confirming the presence of fungus is important.
Fungal sinus infection needs to be treated with antifungal agents, rather than antibiotics. Bacterial sinusitis may be treated with anti-inflammatory medications, and antibiotics as needed. Most cases of bacterial sinusitis resolve within two weeks, and have no further symptoms. Viral sinusitis is the most common type of sinusitis. It is usually caused by the same viruses that cause the common cold, and typically lasts for between seven and ten days.
Bacterial sinusitis can be grouped into the following subtypes based on the duration of symptoms: [2] [4] [5]. Symptoms of bacterial sinusitis include: [1] [2] [4] [6].
Good to know: Bacterial sinusitis can follow a cold or the flu, and often the symptoms occur just when it seems as if the initial infection is clearing up. In this situation it is common to start to feel better, and then to feel worse as the subsequent bacterial sinusitis develops.
If you are concerned that you or a loved one may have bacterial sinusitis, you can do a free symptom assessment using the Ada app at any time.
In children, the symptoms of sinusitis may differ from those in adults. Children may experience: [4] [6]. Good to know: Bacterial sinusitis can affect children of any age, even though the paranasal sinuses are not visible on X-ray before the age of about nine.
The condition is caused by bacteria that live in the nose, throat and, sometimes, the mouth. Types of bacteria which commonly cause bacterial sinusitis include: [1] [2] [5]. As detailed above, bacterial sinusitis often follows a cold or flu infection. The diagnosis is based on the symptoms and physical examination. In severe cases or cases that do not respond to treatment, a nasal endoscopy may be done to aid diagnosis and treatment.
An endoscope is a small, flexible tool equipped with a camera, which allows the doctor a detailed view of the inside of the nose and sinuses. A nasal decongestant will be administered, and the nose will be numbed by an anesthetic spray.
If the endoscopic exam is not helpful or if the doctor wants to carry out further examination, a ct scan may be ordered. A CT scan can be helpful in assessing the sinuses and confirming the diagnosis in complicated cases. Most cases of bacterial sinusitis will get better without antibiotics, usually within 14 days. Antibiotics are usually only prescribed for people who have severe or ongoing symptoms, or whose infection may be complicated by various other medical factors. Viral sinusitis does not respond to antibiotic treatment.
Although most cases of bacterial sinusitis clear up without the help of a doctor, affected people should seek medical assistance if: [2]. In many cases, home remedies may be sufficient. Some people find breathing humid air or steam, such as in a warm shower, helps to relieve symptoms.
Also, holding a warm pad over the painful area helps to relieve discomfort. Nasal irrigation with saline solution is helpful in reducing congestion in the nose. It is also very important to stay well-hydrated, so affected people should be sure to drink enough fluids.
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