Rhinosinusitis: Symptoms, Diagnosis and Treatment

Rhinosinusitis is a common disorder related to inflammation of your nasal passages and sinus cavities. About 1 out of every 8 people experience rhino sinusitis every year, so you will likely experience this; particularly if you have any of the risk factors which includes: smoking, elderly, air travel or other activities that changes air pressure (like scuba diving), swimming, asthma, allergies, dental problems, or a weakened immune system.

Most cases of rhinosinusitis are caused by allergies or infection. Rhinosinusitis is divided into 4 categories depending on how long the illness lasts.

acute rhiniosinusitis — symptoms last less than 4 weeks
subacute rhinosinusitis — symptoms last between 4 and 12 weeks
chronic rhinosinusitis — symptoms last longer than 12 weeks
recurrent rhinosinusitis — frequent episodes of rhino sinusitis throughout the year (4 or more episodes per year)

Acute sinusitis often occurs after you have been sick with a cold virus or upper respiratory infection. Chronic sinusitis on the other hand is often the result of allergies or even a fungus.

Symptoms of Rhinosinusitis

Symptoms of rhinosinusitis are similar regardless of the duration or cause. Common symptoms include:

nasal drainage — including a runny nose & post-nasal drip
nasal congestion
pain, pressure, or feeling of fullness in your nose, eyes, or ears
toothaches

decreased sense of smell
headaches
halitosis (bad breath)

Because not all of the symptoms feel like they are nasal or sinus, you may occasional start at the dentist or optometrist (eye doctor) and later be referred to an otolaryngologist (doctor specializing in the ears, nose, and throat). Children will likely also have a cough, while adults usually will not experience a cough related to rhinosinusitis, unless the cough is related to one of the causing factors.

Diagnosing Rhinosinusitis

Your doctor will likely not perform any tests beyond their general assessment for rhinosinusitis. This can usually be diagnosed based on the history of your symptoms and physical exam findings. However if your doctor suspects an infection, they will likely send a culture and possibly order a CT scan to help them determine the extent of the infection and help guide their choice of antibiotics. A specimen collected from the sinus is better than a nasal swab or collection of drainage. If your doctor does not have access to the scopes needed to collect a specimen from your sinuses, they will likely then send either a nasal swab or nasal drainage specimen to the lab.

If your doctor believes that your rhinosinusitis is related to allergies, you will likely be referred to an allergist for a thorough evaluation of your allergies. In order to achieve maximal relief, you will need to avoid allergens that are causing your symptoms.

Treatment For Rhinosinusitis

Treatment for rhinosinusitis varies, and is usually based on the duration and severity of symptoms. If your doctor's evaluation suggests that the infection is bacterial, antibiotics will be prescribed. Antibiotics will not be given for infections caused by viruses, since antibiotics will have no effect whatsoever on these infections.

Many of the symptoms related to rhinosinusitis can be managed using over-the-counter pain relievers, (like acetaminophen or ibuprofen), decongestants (like pseudoephedrine), nasal irrigation, or topical steroids. Allergic rhinosinusitis is often treated with antihistamines like Claritin, Zyrtec, or Allegra.

Nasal decongestants are commonly used to help reduce inflammation in your nasal passages. Since many decongestants are now available over-the-counter it is common to self-medicate with these drugs before seeing a physician. It should be noted that if misused some nasal decongestants, such as Afrin (oxymetazoline), can lead to a condition called rebound congestion or nasal spray addiction.

Chronic sinusitis has been shown to be self diagnosed incorrectly by many individuals who mistakenly believe that they are suffering from seasonal allergies and use over-the-counter medications to treat their symptoms, (one study showed this to be true in 50% of chronic sinusitis cases). For this reason, even if you think you know what is causing your symptoms, it is always a good idea to be evaluated by a qualified health professional.

Untreated rhinosinusitis can impair your quality of life and lead to other conditions such as nasal polyps, the growth of abnormal tissue in the sinuses or sleep apnea. Rhinosinusitis — Symptoms, Diagnosis & Treatment

Sources:

Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis. UpToDate website. http://www.uptodate.com (Subscription Required). Updated November 8, 2016. Accessed July 7, 2017.

Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis. UpToDate website. http://www.uptodate.com (Subscription Required). Updated October 28, 2016. Accessed July 7, 2017.