Sinusitis is inflammation of the sinuses. There are two basic types of sinusitis: acute sinusitis and chronic sinusitis. Acute sinusitis is a sinus infection that lasts less than four weeks. Chronic sinusitis is a sinus infection or sinus inflammation that lasts more than 12 weeks. Both have similar symptoms.

Symptoms of sinusitis include trouble breathing through the nose, nasal congestion, runny nose, postnasal drip or drainage in the throat, facial pain or pressure and trouble smelling. Based on symptoms alone, it is hard to know what the exact cause is without a comprehensive nasal evaluation including nasal endoscopy - a procedure that uses a camera to look at the inside of your nose where your sinuses drain to assess your nasal and sinus cavities to determine the underlying cause of your problems.

Acute sinusitis does not always need to be treated with antibiotics. Often, saline irrigations (similar to a Neti-pot) and some nasal sprays can provide enough relief until the infection clears. If further treatment is needed, it is common to use antibiotics and/or steroids to treat an acute infection if has lasted too long or if you began to improve but then abruptly worsened. If necessary, a culture can be taken directly from your sinuses. To make sure this is accurate, I do this during nasal endoscopy, so that I can culture the drainage as it comes out of your sinuses to make sure the results are not contaminated and to ensure that the results are accurate. Antibiotics specifically directed toward the bacteria collected can then be prescribed. A CT scan is not usually required unless a complication of acute sinusitis is suspected. If a complication of sinusitis is suspected, you may need more urgent treatment including a CT scan, IV antibiotics, and possibly endoscopic sinus surgery.

If your sinus infections keep coming back, you may have recurrent acute sinusitis. A CT scan may be helpful in order to determine whether certain factors in your sinus anatomy are predisposing you to these infections. If so, you might be a candidate for balloon sinuplasty or sinus surgery. The goal in this case is to reduce the frequency or the severity of your infections.

Chronic sinusitis can be a debilitating condition. We know that chronic sinusitis severely impacts quality of life and can result in many clinic visits and lost work days. So, having your chronic sinusitis treated can improve your quality of life.

There are a variety of types of chronic sinusitis. Chronic sinusitis can broadly be separated into two categories: chronic sinusitis without polyps and chronic sinusitis with polyps. Some types of chronic sinusitis are infectious, such as odontogenic sinusitis (sinus infections resulting from an infected tooth); however, the majority of chronic sinusitis cases are inflammatory in nature. This means that many patients with chronic sinusitis don’t actually have an infection. Instead, they have excess inflammation in the sinuses that is the result of an exaggerated response of the immune system to irritants within the sinuses.

Fungal sinusitis warrants its own mention. There are many types of fungal sinusitis. One of the more common types is a fungal ball. A fungal ball is a relatively common occurrence. The sinuses are a great place for fungi to grow. The sinuses are warm and humid, just the environment fungi are looking for. If a fungal spore sets up shop in your sinus cavity, it can proliferate into a fungal ball. Fortunately, these can usually be removed easily. Once removed, further treatment is not usually necessary. Another common type of fungal sinusitis is allergic fungal sinusitis. In this condition, your immune system is overreacting to normal fungi in the environment. This conditions results in significant inflammation and polyp development - see below for more information on nasal polyps. For more information, see my blog post on fungal sinusitis.

The good news is that chronic sinusitis can often be treated medically. Medical treatment always includes saline irrigations and nasal steroid sprays. The medical treatment of chronic sinusitis often includes either a long course of antibiotics and/or a steroid taper. Many patients have their symptoms resolve with this therapy.

Unfortunately, some patients continue to have symptoms of chronic sinusitis. If that is the case, a CT scan may be needed to evaluate the extent of sinus disease seen after medical treatment. In these cases, balloon sinuplasty or endoscopic sinus surgery is often recommended. Only certain patients truly are candidates for balloon sinuplasty, and many rhinologists think it is utilized more frequently than it should be. Most patients will benefit from endoscopic sinus surgery. If you think you might suffer from chronic sinus disease, come in for an evaluation so we can get started on improving your quality of life!