Sinusitis

Sinusitis is inflammation affecting the nose and the paranasal sinuses. It may occur as a short-lived acute illness, as recurrent episodes, or persist as chronic rhinosinusitis.

Symptoms can include nasal blockage, nasal discharge, reduced sense of smell and facial pressure or discomfort. Similar symptoms can occur with other nasal conditions, so persistent symptoms need to be considered together with the examination findings rather than relying on symptoms alone.

H2: Common symptoms of sinusitis

Common symptoms include:

• Nasal blockage or congestion

• Nasal discharge or postnasal drainage

• Reduced or altered sense of smell

• Facial pressure or discomfort

• Recurrent episodes of acute sinus infection

The pattern and duration of symptoms are important because acute sinusitis and chronic rhinosinusitis are different conditions and may require different approaches to treatment.

Acute and recurrent sinusitis

Acute sinusitis commonly develops during or following an upper respiratory infection. Many episodes improve without specialist treatment.

Some people experience repeated episodes of acute sinusitis with periods of relatively normal nasal health between infections. When episodes are frequent, assessment may help determine whether there are underlying inflammatory, anatomical or other factors contributing to the problem.

Chronic rhinosinusitis

Chronic rhinosinusitis involves persistent inflammation of the nose and sinuses. Symptoms generally continue for more than 12 weeks and are accompanied by evidence of inflammation on examination or imaging.

Chronic rhinosinusitis can occur with or without nasal polyps.

It is not simply a prolonged bacterial infection. Inflammation of the lining of the nose and sinuses plays an important role, which is why treatment often focuses on controlling inflammation as well as improving sinus drainage.

How is sinusitis assessed?

Assessment begins with the pattern, duration and severity of symptoms and any previous treatment.

The nose may be examined using nasal endoscopy. This allows areas deeper within the nasal cavity to be examined and may identify inflammation, nasal polyps, discharge or other abnormalities.

CT imaging of the sinuses may be useful when symptoms persist, when the diagnosis remains uncertain or when sinus surgery is being considered.

Other factors can sometimes contribute to persistent sinus symptoms. Depending on the individual patient, these may include allergy, asthma, dental disease and other inflammatory conditions.

How is sinusitis treated?

Treatment depends on whether the problem is acute, recurrent or chronic and on the findings during assessment.

For chronic rhinosinusitis, treatment may include saline nasal irrigation and topical nasal corticosteroid medication. Other medications may be appropriate in selected circumstances.

The aim is to control inflammation, improve symptoms and maintain the normal function of the nose and sinuses.

Endoscopic sinus surgery

Endoscopic sinus surgery may be considered when appropriate medical treatment has not adequately controlled chronic sinus disease, or when there is another clear indication for surgery.

The operation is performed through the nostrils using an endoscope. The aim is to open affected sinus drainage pathways, improve ventilation and allow topical treatments to reach the sinuses more effectively.

Surgery does not remove an underlying tendency towards inflammation. Some patients therefore continue nasal irrigation or topical medication after surgery as part of their longer-term treatment.

Nasal polyps

Nasal polyps are soft inflammatory swellings that develop from the lining of the nose and sinuses. They can contribute to nasal obstruction, reduced sense of smell and chronic sinus symptoms.

Treatment may involve topical medication, other medical therapies or surgery depending on the extent of the disease, the symptoms and the response to previous treatment.

Because nasal polyps can recur, ongoing medical treatment and follow-up may sometimes be recommended even after surgery.

Sinusitis at Hawthorn ENT

Dr Philip Michael has a particular interest in rhinology and the management of nasal and sinus conditions.

Assessment may include nasal endoscopy and review of CT imaging where appropriate. Treatment is tailored to the underlying condition and may involve medical treatment, endoscopic sinus surgery or a combination of approaches.

Appointments for sinus and nasal symptoms

Persistent nasal blockage, discharge, reduced sense of smell or recurrent sinus problems can have several possible causes. Specialist assessment can help establish the diagnosis and determine whether further investigation or treatment is appropriate.