What is Sinusitis?

Sinusitis is inflammation of the air-containing cavities that surround the nose and the eyes. When the sinuses become blocked or swollen shut, mucous becomes trapped under pressure, resulting in facial pain and nasal stuffiness. If the mucous is infected with bacteria, the pain swelling and blockage can become worse, resulting in a vicious cycle of obstruction, infected mucous and sinus swelling.

When it is just a cold?

Most Americans experience 3-5 viral upper respiratory infections per year – the common cold. Typically we experience sneezing, watery drainage and mild feverishness. These symptoms evolve over several days into a thicker, discolored mucous, and maybe even a cough. Most colds are self-limited and can be treated with over-the-counter, symptom-specific remedies. If the cold hits you like you’ve been run over by a truck, see your family doctor immediately – you may have influenza. If your cold lingers more than ten days, or continues to get worse after the seventh day, you probably have sinusitis. Again, see your physician.

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Acute Bacterial Sinusitis

Acute bacterial sinusitis (also called rhinosinusitis) is defined as a bacterial infection causing inflammation of the sinuses. Because primary care physicians are not routinely equipped to culture the contents of the sinuses, acute bacterial rhinosinusitis is diagnosed when upper respiratory symptoms last longer than ten days or get worse after seven days AND are associated with sinus pain or pressure, nasal stuffiness or nasal drainage that is cloudy or discolored.

Chronic Sinusitis

Chronic sinusitis is defined as sinus inflammation lasting longer than three months. Symptoms are sometimes milder, predominated by nasal congestion and drainage but less commonly pain and fever. Other patients may have recurrent bouts of acute sinusitis, but are sick so frequently that they have not been symptom-free for more than four weeks at a time in the past year.

ENT Consultation

During your ear, nose and throat consultation, we will perform a complete ENT examination, as well as a video endoscopic examination of your nose. We will show you any abnormalities, including large turbinates, nasal septal deformities, polyps or sinus drainage.

Medical Management

Acute bacterial sinusitis is usually treated with antibiotics that cover the most common organisms – Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. These bacteria are often resistant to amoxicillin and azithromycin, the most common first line agents for acute sinusitis. Broader spectrum choices include amoxicillin-clavulanate (Augmentin), cephalosporins, and the quinolones. Sometimes we are able to culture the bacteria endoscopically. This is quite helpful for treating resistant bacteria and refractory cases of sinusitis.

Steroids are especially helpful in treating chronic sinusitis, but they are also proven to hasten the recovery from acute sinusitis. The side effects of oral steroids can be avoided by using topical nasal steroid sprays.

>> Fact Sheet: Antibiotics and Sinusitis

Endoscopic Sinus Surgery

Functional Endoscopic Sinus Surgery (FESS or ESS) was developed in the 1980’s with the introduction of high quality optical lenses that can be inserted into the nose. Rather than blindly scraping out the membranes of the sinuses, surgeons were now able to identify and carefully enlarge the natural openings into each sinus. Further development of equipment and techniques allows surgeons to perform a variety of procedures within and around the sinuses, including drainage of clogged tear ducts, decompression of the orbit for Graves disease, and removal of tumors from the pituitary gland and other skull base locations.

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Balloon Sinuplasty

Balloon Sinuplasty™ was the first endoscopic, catheter-based system to dilate the sinus openings in patients suffering from sinusitis. It is especially useful in patients with obstruction of the frontal and sphenoid sinuses, but can also be used for maxillary sinus disease. Typically performed in the operating room with fluoroscopic (X-ray) guidance, a small flexible wire is gently inserted into the natural opening of the sinus, and the balloon is passed over the wire, inflated and removed.

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Research Subjects Needed

Richmond ENT is a designated research site for two national clinical trials evaluating outcomes following balloon dilation of the sinuses. One of these studies, restricted to patients with isolated maxillary sinus disease, will pay for the cost of your surgery. Call now to see if you may qualify. >> Read more