What Is Sinusitis Symptoms And Treatments
Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa. The term rhinosinusitis is used by some specialists, because sinusitis typically also involves the nasal mucosa. The majority of these infections are viral in origin. It is important to differentiate between viral and bacterial sinusitis to aid in optimizing treatment decisions.
Bacterial sinusitis can be categorized into acute and chronic disease. Acute disease lasts less than 30 days with complete resolution of symptoms. Chronic sinusitis is defined as episodes of inflammation lasting more than 3 months with persistence of respiratory symptoms.
Acute bacterial sinusitis is most often caused by the same bacteria implicated in acute otitis media
: Streptococcus pneumoniae and Haemophilus influenzae.
These organisms are responsible for about 70% of bacterial causes of acute sinusitis in both adults and children. Chronic sinusitis can be polymicrobial, with an increased prevalence of anaerobes as well as less common pathogens including gram-negative bacilli and fungi.
- The goals of treatment of acute sinusitis are the reduction in signs and symptoms, achieving and maintaining patency of the ostia, limiting antimicrobial treatment to those who may benefit, eradication of bacterial infection with appropriate antimicrobial therapy, minimizing the duration of illness, prevention of complications, and prevention of progression from acute disease to chronic disease.
- Approximately 40% to 60% of patients with acute sinusitis will recover spontaneously (these are likely patients with viral sinusitis).
- Nasal decongestant sprays such as phenylephrine and oxymetazoline that reduce inflammation by vasoconstriction are often used in sinusitis. Use should be limited to the recommended duration of the product to prevent rebound congestion. Oral decongestants may also aid in nasal or sinus patency. To reduce mucociliary function, irrigation of the nasal cavity with saline and steam inhalation may be used to increase mucosal moisture, and mucolytics (e.g. guaifenesin) may be used to decrease the viscosity of nasal secretions. Antihistamines should not be used for acute bacterial sinusitis in view of their anticholineric effects that can dry mucosa and disturb clearance of mucosal secretions.
- Antimicrobial therapy is superior to placebo in reducing or eliminating symptoms, although the benefit is small.
- Amoxicillin is first-line treatment for acute bacterial sinusitis. It is cost effective in acute uncomplicated disease, and intial use of newer broad-spectrum agents is not justified.
- The current recommendations are 10 to 14 days, or at least 7 days, of antimicrobial therapy after signs and symptoms are under control.