Sinusitis

Sinusitis
Other names	Sinus infection, rhinosinusitis
An illustration showing the difference between healthy sinuses and diseased sinuses
Specialty	Otorhinolaryngology
Symptoms	nasal discharge, nasal blockage, facial pain, reduction or loss of smell, fever[1][2]
Causes	Infection (bacterial, fungal, viral), allergies, air pollution, structural problems in the nose[3]
Risk factors	Asthma, cystic fibrosis, poor immune function[1]
Diagnostic method	Usually based on symptoms
Differential diagnosis	common cold, rhinitis, upper respiratory infection, temporomandibular joint disorder, tension headache, vascular headache, dental infection
Prevention	handwashing, vaccinations, avoiding smoking[3]
Treatment	Pain medications, nasal steroids, nasal irrigation, antibiotic[1][4]
Frequency	10–30% each year (developed world)[1][5]

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include production of thick nasal mucus, nasal congestion, facial congestion, facial pain, facial pressure, loss of smell, or fever.^[6][7]

Sinusitis is a condition that affects both children and adults. It is caused by a combination of environmental and a person's individual health factors.^[8] It can occur in individuals with allergies, exposure to environmental irritants, structural abnormalities of the nasal cavity and sinuses and poor immune function.^[9] Most cases are caused by a viral infection.^[3] Recurrent episodes are more likely in persons with asthma, cystic fibrosis, and immunodeficiency.^[10]

The diagnosis of sinusitis is based on the symptoms and their duration along with signs of disease identified by endoscopic and/or radiologic criteria.^[11] Sinusitis is classified into acute sinusitis and chronic sinusitis. In acute sinusitis, symptoms last for less than 4 weeks. In chronic sinusitis symptoms must be present for at least 12 weeks.^[12] In the initial evaluation of sinusitis an Otolaryngologist, also known as an ear, nose and throat (ENT) doctor, may confirm sinusitis using nasal endoscopy.^[11] Diagnostic imaging is not usually needed in acute stage unless complications are suspected.^[13] In chronic cases, confirmatory testing is recommended by use of computed tomography.^[13]

Prevention of sinusitis focuses on regular hand washing, staying up-to date on vaccinations, and avoiding smoking.^[14] Pain killers such as naproxen, nasal steroids, and nasal irrigation may be used to help with symptoms.^[15][16] Recommended initial treatment for acute sinusitis is watchful waiting.^[15] If symptoms do not improve in 7–10 days or worsen, then an antibiotic may be implemented or changed.^[15] In those in whom antibiotics are indicated, either amoxicillin or amoxicillin/clavulanate is recommended first line, with amoxicillin/clavulanate being superior to amoxicillin alone but with more side effects.^[17][15] Surgery may be recommended in those with chronic disease who have failed medical management.^[18]

Sinusitis is a common condition.^[19] It affects between about 10 and 30 percent of people each year in the United States and Europe.^[19][5] The management of sinusitis in the United States results in more than US$11 billion in costs.^[19]