Sinusitis
Evaluation and management of acute and chronic sinus inflammation.
Overview
Sinusitis is inflammation of the paranasal sinuses, which can be acute (lasting less than 4 weeks) or chronic (lasting more than 12 weeks). It often overlaps with allergic rhinitis.
types
acute
Usually caused by viral infections, but can be bacterial. Symptoms include facial pain, nasal congestion, and discolored nasal discharge.
chronic
Persistent inflammation lasting 12+ weeks, often associated with allergies, nasal polyps, or structural abnormalities.
symptoms
- Facial pain or pressure
- Nasal congestion
- Discolored nasal discharge (yellow or green)
- Reduced sense of smell
- Cough (especially at night)
- Fatigue
- Fever (more common in acute)
red Flags
- Severe headache or facial pain
- High fever (>101.5°F)
- Vision changes or eye swelling
- Neck stiffness
- Altered mental status
- Symptoms lasting >10 days without improvement
evaluation
history
Detailed symptom history, duration, and triggers
physical
Nasal endoscopy, assessment of facial tenderness
imaging
CT scan of sinuses (for chronic or recurrent cases)
allergy
Consider allergy testing if allergic triggers are suspected
treatment
acute
- Nasal saline irrigation
- Nasal corticosteroids
- Decongestants (short-term use)
- Pain relievers
- Antibiotics only if bacterial infection is confirmed
chronic
- Long-term nasal corticosteroids
- Nasal saline irrigation
- Treatment of underlying allergies
- Consideration of surgery for structural issues or polyps
allergy Overlap
Many patients with chronic sinusitis also have allergic rhinitis. Treating allergies can significantly improve sinusitis symptoms.
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