Diagnosis and Treatment of Sinusitis
Definition and Classification
- The American Academy of Allergy, Asthma, and Immunology defines sinusitis as the inflammation of one or more paranasal sinuses, with infection being the most common cause 2
- Sinusitis is classified based on duration into: acute sinusitis (symptoms for less than 4 weeks) 3, subacute sinusitis (symptoms for 4 to 8 weeks) 4, chronic sinusitis (symptoms for 8 weeks or more) 4, and recurrent sinusitis (3 or more episodes of acute sinusitis per year) 4
Diagnosis
- The diagnosis of acute sinusitis is primarily clinical, based on persistent symptoms of upper respiratory infection beyond 10-14 days 8, 7
- The American Academy of Allergy, Asthma, and Immunology recommends that computed tomography (CT) scans without contrast are the imaging technique of choice when symptoms are vague 7 or when the disease persists despite optimal medical treatment 10
- Nasal endoscopy can be useful for directly visualizing anomalies of the septum, turbinates, mucosa, and nasopharynx 8
Treatment
- The American Academy of Allergy, Asthma, and Immunology recommends amoxicillin as the first-line antibiotic for children and adults 1, 5
- The use of intranasal corticosteroids can be useful in patients with acute and chronic sinusitis 3, 9
- Short-term use of oral corticosteroids may be considered when the patient does not respond to initial treatment 5, has nasal polyps 5, or shows marked mucosal edema 3
Special Considerations
- For patients with chronic sinusitis, consideration should be given to a non-infectious form of sinusitis (chronic hyperplastic eosinophilic rhinosinusitis) 4
- A course of systemic corticosteroids may be necessary 6
- Evaluation should include coronal sinus CT scans 6
- In cases of chronic sinusitis resistant to medical treatment, consideration should be given to consultation with an otolaryngologist for possible surgical intervention 6