Sinusitis Workup And Treatment- Allergy/Immunology

Doctors: Allergist, Immunologist

What is sinusitis?

Sinusitis is characterized by nasal congestion, facial pressure, cough and thick nasal discharge. Sinusitis can be acute or chronic. Acute sinusitis refers to sinusitis symptoms for less than four weeks. Acute sinusitis begins as a common cold and symptoms usually go away within a week to 10 days. Chronic sinusitis is generally diagnosed when symptoms have been there for more than 12 weeks, in spite of medical treatment.

How to diagnose sinusitis?

A regular examination of ears and nose can help to see the swelling, congestion, and infection. To diagnose any fungal or bacterial infection, a swab from inside the sinuses is taken and sent to laboratory for analysis. If allergies are causing sinusitis, patient may be recommended to undergo allergy testing (skin prick test, intradermal skin test, or patch test).

Nasal endoscopy, a simple and quick procedure, is helpful for precise evaluation of sinuses. During this procedure, a spray is used to numb the nose and a thin flexible device called an endoscope is inserted inside the nose. This endoscope has a tiny lens at one end, which provides a detailed look at the sinuses.

In cases with serious inflammation, a CT scan or MRI scan is recommended. These tests will help to identify any abnormalities in the sinuses such as narrow drainage passages, polyps or a deviated septum.

Treatment:

Treatment plan varies depending on the severity of sinusitis.

• Acute Sinusitis: Patients with acute sinusitis may not require any medications. Antibiotics are prescribed if bacterial infection is causing acute sinusitis. Other treatment options include decongestants or nasal sprays. Pain relievers such as aspirin, acetaminophen or ibuprofen may be also helpful. Patient is asked to drink lot of water. Some patients may find relief after washing the nasal cavities with a saline rinse.
• Chronic Sinusitis: It is not caused due to bacterial infection. Hence, antibiotics are not recommended. Intranasal corticosteroid sprays may be prescribed. If patient has fungal infection, an anti-fungal medicine would be prescribed. If allergies are responsible for chronic sinusitis, antihistamines, allergy shots may be prescribed. Patient would be asked to avoid all possible allergens. In severe cases, sinus surgery might be recommended.

References:

• https://www.aaaai.org/conditions-and-treatments/allergies/sinusitis
• https://www.webmd.com/allergies/sinusitus-test#2

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