Acute Sinusitis

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What is acute sinusitis?

Sinusitis means inflammation of the lining or “mucosa” of the nose and sinus cavities. This is usually due to an infection. The sinuses are air-filled spaces located in the forehead, cheeks, between the eyes, and behind the eyes. These air-filled cavities communicate with the nose, and therefore the outside world, through small 1-2 mm openings. If these openings are obstructed, fluid accumulates in the sinuses, and becomes infected with bacteria. This is acute sinusitis.

What are the symptoms?

Sinusitis is often difficult to differentiate from a common cold. In fact, sinusitis often follows a regular cold, which persists and progresses to a sinus infection. The symptoms are very similar and can include congestion, blocked nose and decreased sense of smell, clear or colored drainage from the nose or to the back of the throat, pressure-type discomfort in the face or forehead in the area of the sinuses, discomfort in the upper teeth or pain with chewing, and occasionally fever.

How is the diagnosis of acute sinusitis made?

Doctors make the diagnosis of sinusitis by asking about symptoms and performing an examination, which includes looking in the nose and throat. Tests, such as x-rays are not usually necessary unless there are special circumstances, such as the presence of other medical conditions, which increase the risk of infections, or patients who are hospitalized for another condition. Because the symptoms of a common cold are so similar to those of acute sinusitis, the diagnosis may not be evident until sufficient time (usually > 7-10 days) has passed to make the diagnosis of a cold less likely.

What is the treatment for acute sinusitis?

The majority of people suffering from acute sinusitis improve without antibiotics. Therefore, the treatment of acute sinusitis initially consists of decongestants in oral or spray forms, and analgesics for the discomfort – acetamenophen, aspirin, ibuprofen. The goal is to alleviate discomfort and decongest the sinus openings to open the sinuses and allow them to drain and rid themselves of any accumulated infected material.

Should this initial treatment be unsuccessful, antibiotics may become necessary. In addition, depending on the stage when one consults with a physician, antibiotics may be prescribed as an initial treatment. Many antibiotics are adequate for the treatment of acute sinusitis. Some antibiotics target a short list of bacteria (narrow spectrum) while others target a wider range (broad spectrum). Often, the narrow spectrum antibiotics are the best choice in the treatment of acute sinusitis as most episodes of sinusitis are caused by one of three bacteria. The use of broad spectrum antibiotics as an initial treatment may not be warranted as they are more costly and confer a higher risk of causing the bacteria to become more resistant to antibiotics, both for the current episode and in the future. The use of these antibiotics may become necessary, however, should treatment with narrow-spectrum antibiotics fail to resolve the infection. In addition, in certain situations, the use of broad-spectrum antibiotics may be indicated as an initial treatment.