Rhinosinusitis

Rhinosinusitis

Rhinosinusitis, also called sinusitis, results from an infection and inflammation of the mucous membranes in the sinuses. Since the sinuses empty into the nasal passages, a sinus infection could spread to these areas as well. This often leads to facial swelling, pain, and breathing difficulties.

Types of Rhinosinusitis

Rhinosinusitis is classified into four classes based on the duration of the condition:

  • Acute rhinosinusitis: Symptoms persist for less than 4 weeks and are often caused by an upper respiratory tract infection.
  • Subacute rhinosinusitis: Symptoms persist for four to 12 weeks.
  • Chronic rhinosinusitis: Symptoms extend beyond 12 weeks and may be linked to factors such as allergies, a deviated septum, nasal polyps, or undiagnosed fungal infections, particularly in immunocompromised individuals.
  • Recurrent rhinosinusitis: Characterized by four or more episodes of rhinosinusitis within a year.

Signs and Symptoms

The signs and symptoms of rhinosinusitis are generally consistent irrespective of its duration or underlying cause. Common symptoms include:

  • Nasal congestion or stuffiness
  • Running nose
  • Headache
  • Itchy nose
  • Discolored or cloudy nasal discharge
  • Weariness
  • Swelling around the eyes
  • Pain and pressure in the face
  • Sore throat
  • Reduced sense of smell
  • Dry, persistent cough (particularly at night)
  • Fever

In children, rhinosinusitis often presents with a persistent cough in addition to these symptoms.

Since not all symptoms are isolated to the nose or sinuses, healthcare professionals like dentists or optometrists may sometimes be the first to recognize the signs and refer patients to an otolaryngologist (ear, nose, and throat specialist).

If untreated, chronic rhinosinusitis may result in severe complications, such as sleep apnea and the development of nasal polyps.

Causes and Risk Factors

Rhinosinusitis is a prevalent condition characterized by inflammation of the nasal passages and sinus cavities. Approximately 1 in 7 persons experience this disorder annually, especially when certain risk factors are involved, such as:

  • Smoking
  • Asthma
  • A weakened immune system
  • Dental issues
  • Swimming
  • Rapid air pressure changes (e.g., during air travel or scuba diving).

In general, the most common causes of rhinosinusitis are allergies and infections.

Diagnosis

Rhinosinusitis is normally diagnosed depending on your medical history and a physical examination. In most cases, additional testing is unnecessary.

If an infection is suspected, your healthcare provider may order a nasal or sputum culture and, sometimes, a CT scan to determine the cause and degree of the infection. These tests can assist in identifying the appropriate antibiotic for treatment.

If allergies are thought to be contributing to rhinosinusitis, your doctor may refer you to an allergist for a comprehensive evaluation. Managing your symptoms effectively will often require identifying and avoiding the allergens responsible for triggering your condition.

Treatment Options

Rhinosinusitis treatment depends on the symptoms duration and severity. Key approaches include. Antibiotics will be prescribed if the infection is bacterial. However, antibiotics are not recommended for viral infections since they are ineffective.

Most rhinosinusitis symptoms can also be addressed with over-the-counter topical steroids, decongestants (such as pseudoephedrine), nasal irrigation, and pain medications (such as acetaminophen or ibuprofen). For allergic antihistamines, Allegra, Zyrtec, or Claritin can be used to manage symptoms.

Nasal decongestants can help relieve inflammation in nasal passages and are often available over the counter, making self-medication common. However, it’s essential to avoid overusing products like Neo-Synephrine (phenylephrine hydrochloride) or Afrin (oxymetazoline), as this can cause rebound congestion and lead to dependency on nasal sprays.

If a CT scan reveals a blockage, deviated septum, or nasal polyps (small growths in the nasal lining) contributing to chronic sinusitis, sinus surgery may be recommended. This procedure aims to address the underlying cause of inflammation and improve sinus drainage, providing relief from chronic symptoms.

Conclusion

Individuals who mistake their symptoms for seasonal allergies often misdiagnose chronic sinusitis. Likewise, those experiencing migraines may incorrectly attribute their symptoms to sinusitis and self-treat ineffectively.

 

For this reason, it is essential to seek an accurate diagnosis from a skilled healthcare provider, especially if your symptoms are serious, recurrent, persistent, getting worse, or significantly impacting your quality of life. Proper evaluation generally ensures appropriate treatment and prevents unnecessary complications.

 

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