Chronic Sinusitus

When Sinus Problems Won’t Go Away
Normal CT Scan

Normal CT Scan

Affecting 35 million patients per year, sinusitis is one of the most common illnesses diagnosed by primary care physicians, accounting for 16 million office visits per year.  Sinusitis is characterized by inflammation of the lining of the nose and paranasal sinuses.  Common symptoms include nasal congestion, facial pain and pressure, changes in sense of smell, dental pain, purulent nasal drainage, and fever.  Symptoms lasting less than a week or improving within a week are usually viral in nature.  Antibiotics are frequently prescribed for symptoms lasting more than a week.  The majority of acute sinusitis cases will respond to a single course of antibiotics.  Chronic sinusitis is defined as symptoms lasting longer than three months.  For patients with chronic sinusitis, longer courses of antibiotics are prescribed, frequently with 3-4 weeks of a broad spectrum penicillin based antibiotic (Augmentin) or fluoroquinolone (Levaquin) if penicillin allergic.  A CT scan of the sinuses is obtained for symptoms that persist despite treatment with multiple courses of antibiotics.  The CT scan is reviewed for evidence of obstructed sinuses and for anatomical issues that may predispose to sinus obstruction, such as a deviated nasal septum.

Chronic sinusitis with deviated nasal septum

Chronic sinusitis with deviated nasal septum

Endoscopic sinus surgery is frequently recommended for patients with evidence of chronic sinusitis despite antibiotic therapy, or for patients who have recurrent episodes requiring several courses of antibiotics a year.  Performed using endoscopes, the purpose of sinus surgery is to open the natural openings of the sinuses to allow for better drainage.  Select patients may be candidates for a new in-office procedure to treat recurrent episodes of sinusitis known as balloon sinuplasty.  Performed under light sedation and under local anesthesia, in office balloon sinuplasty avoids the discomfort of a general anesthetic and has been shown to be effective in treating recurrent sinusitis.  Because allergic rhinitis is often the cause of chronic sinusitis, allergy testing and treatment is frequently recommended as part of an overall “nasal health” protocol.

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