Sinusitis

Are you suffering from Blocked Nose? Speak to us!

Sinusitis affects about 1 in 8 adults. There is good demographic data from America showing that the diagnosis is made more than 30 million times annually. Australian figures show that in 2010 3.5 million consultations a year took place for acute sinusitis.

Professor Havas is one of the few specialists who has post-fellowship training in this field. He is the Chairman of the Department of Otolaryngology Head and Neck Surgery at Prince of Wales and Sydney Hospitals. Please give us a call or use the booking form on the right to arrange an appointment to see him. You will be in capable hands.

 

What is sinusitis?

Sinusitis is an inflammation or infection of the nose and paranasal sinuses. These cavities are contiguous and any inflammatory or infective process that affects one affects the other. So the first thing to note is that the appropriate term is: “rhinosinusitis” rather than “sinusitis”.

Clinicians should aim to distinguish acute rhinosinusitis caused by a viral upper respiratory tract infection from acute bacterial rhinosinusitis. Both of these conditions ideally should, on the basis of history and clinical examination, be differentiated from acute rhinosinusitis caused by noninfectious conditions.

 

Acute sinusitis

Clinicians should aim to distinguish acute sinusitis caused by a viral upper respiratory tract infection from acute bacterial sinusitis. Both of these conditions ideally should, on the basis of history and clinical examination, be differentiated from acute sinusitis caused by noninfectious conditions.

A clinician should diagnose acute bacterial sinusitis when symptoms or signs of acute sinusitis, that is to say purulent nasal discharge, are accompanied by: nasal obstruction, facial pain, pressure sensation or fullness in the head which persist without evidence of an improvement for at least 10 days after the onset of a viral upper respiratory tract infection. Acute bacterial sinusitis can also be diagnosed when the symptoms and signs laid out above, worsen within 10 days after an initial clinical improvement. In both of these instances it is reasonable and appropriate, particularly in the presence of mucopurulent nasal discharge, to imply that there is an infective bacterial acute sinusitis.

 

Chronic sinusitis

acute sinusitis

Chronic sinusitis is a condition characterized by the presence of nasal obstruction, facial pain, fullness in the head, nasal discharge or post nasal drip persisting for more than 12 weeks, with or without acute exacerbations. Chronic sinusitis is now defined as:

  • Chronic sinusitis without nasal polyps or,
  • Chronic sinusitis with nasal polyps.

Remember that facial pain with nasal discharge is more likely than not acute sinusitis although many patients may present with a history of self-reported/self-diagnosed sinus headache. This headache without the presence of nasal discharge is more likely to be a variant of migraine and is appropriately treated with anti-migraine therapy.

 

Transition from viral sinusitis to bacterial infection

Only 0.5% to 2% of viral sinusitis episodes are complicated by a secondary or intercurrent bacterial infection. Viral infections can promote acute bacterial rhinosinusitis by obstructing sinus drainage, promoting growth of bacterial pathogens that colonize the nose and nasopharynx, by depositing nasal bacteria into the nose/sinuses during nose blowing and by altering the immune response. Notwithstanding all of these things occurring no more than 1 in 50 cases of a viral upper respiratory tract infection, of which sinusitis symptoms predominate, go on to frank acute bacterial sinusitis.

In the first 3-4 days of a viral upper respiratory tract infection and viral sinusitis cannot really be differentiated from the onset of bacterial sinusitis therefore only patients with unusually severe presentations or extra sinus manifestations are presumed to have a bacterial illness. For the first 5-10 days it is reasonable clinical practice to assume that everyone has a viral infection of their nose and sinuses unless the symptoms are:

  • Unusually severe
  • Not responsive to simple supportive medication
  • Presence of any extra sinus complication or infection.

During this period of time the so called double worsening “effect”, whereby a patient initially improves and then symptoms return with increased severity should be assumed to have a secondary bacterial infection and treated as acute bacterial sinusitis.

 

If you are suffering from sinusitis, do not hesitate to get a referral letter to see us! As one of the most experienced nasal specialist in Australia, Professor Thomas Havas will solve your problem. Our clinics are located in Bondi Junction, Kogarah and North Sydney. Give us a call on 02 9387 7360 or use the appointment booking form, we will arrange the best location and time for you!

For more information about Sinusitis, you can get a copy of the Handbook of Otolaryngology Head and Neck Surgery 2nd edition, written by Professor Havas.