Sinusitis

Sinusitis, also called rhinosinusitis, is inflammation of the mucosa of the paranasal sinuses and nasal cavities. It is classified as acute (<4 weeks), subacute (4–12 weeks), or chronic (>12 weeks). Common symptoms include nasal congestion, facial pressure or pain, reduced sense of smell, nasal discharge, and cough; fever may accompany acute illness.

Most cases begin with a viral upper respiratory infection that disrupts drainage and mucociliary function. Allergic rhinitis, nasal polyps, anatomical obstruction, dental infection, and immune disorders can contribute. Chronic sinusitis involves ongoing inflammation and may feature biofilms or persistent infection; antibiotics are less consistently effective than in acute disease and management focuses on inflammation control and drainage.

Diagnosis is clinical, supported by endoscopy or imaging in selected cases. Most acute cases are managed without antibiotics, but criteria for acute bacterial sinusitis include symptoms persisting beyond 10 days without improvement, severe fever and purulent discharge, or a double-sickening pattern. CT or nasal endoscopy is reserved for chronic or refractory cases.

Treatment for acute viral sinusitis emphasizes supportive care: nasal saline irrigation, humidification, analgesics, and decongestants if appropriate. If bacterial sinusitis is suspected or confirmed, first-line antibiotics such as amoxicillin-clavulanate are commonly used; duration typically ranges from 5 to 7 days for adults with mild to moderate disease, longer for children or more severe cases. Intranasal corticosteroids can help with inflammation; saline sprays aid drainage.

Chronic sinusitis treatment centers on ongoing intranasal steroids, saline irrigation, management of contributing factors (allergies, asthma, pollution), and addressing structural issues. Antibiotics may be used for flares, and surgery (endoscopic sinus surgery) is considered when medical therapy fails.

Prognosis varies; most improve with treatment, but chronic disease can persist. Prevention focuses on avoiding irritants, treating allergies, vaccination, and good nasal hygiene.