Acute Sinusitis Specialist

What is acute sinusitis?

Acute sinusitis, also known as acute rhinosinusitis, occurs when your nose and sinuses become swollen and overproduce mucous. The general adult population suffers from 1-3 episodes of acute sinusitis per year. The symptoms typically last for less than 4 weeks and develop suddenly.

Acute sinusitis can be viral or bacterial. In acute viral sinusitis, nasal symptoms are present for less than 10 days. In contrast, patients suffering from acute bacterial sinusitis have symptoms lasting for more than 10 days. In some cases, an episode of acute bacterial sinusitis may follow viral sinusitis. This process is characterized by a worsening of symptoms after about 5 days and/or worsening symptoms after a period of initial improvement.  Common viruses causing acute sinusitis include Rhinovirus, Influenza and Parainfluenza viruses. Acute bacterial sinusitis is typically caused by Streptococcus pneumoniae (also known as Pneumococcus), Haemophilus influenzae and Moraxella catarrhalis. Acute viral sinusitis can be treated at home, but acute bacterial sinusitis usually requires medical care.

Some patients suffer from these episodes 4 or more times per year. This is called Recurrent Acute Rhinosinusitis Sinusitis. Patients with recurrent acute sinusitis may need more aggressive medical and surgical management than those suffering from non-recurrent acute bacterial sinusitis.

What are the symptoms of acute sinusitis?

If you have acute sinusitis, you’ll likely have one or more of these symptoms:

• Nasal blockage, stuffiness, and congestion
• Thick green- or yellow-tinged discharge out of your nose or down your throat (postnasal drip)
• Pressure, tenderness, and pain around your nose, eyes, forehead, or cheeks that feels worse when you bend over
• Reduction or loss of smell
  
  

Patients with acute sinusitis may also experience generalized fatigue, malaise, low-grade fever, sore throat, hoarseness, and coughing.

What puts you at risk for acute sinusitis?

Certain factors increase the likelihood of developing acute sinusitis:

• Hay fever or other allergic conditions that affect your nose and sinuses
• Environmental irritants such as cigarette smoke and air pollution
• Anatomic abnormalities, like a deviated septum, aeration of the middle turbinate (concha bullosa), narrowed maxillary infundibulum, aerated uncinate processes, and Haller cells.
• Dental infections (usually of maxillary molars) and periodontal disease.
• Barotrauma from scuba diving or air travel
• Immune system disorders like Specific Antibody Deficiency, Common Variable Immunodeficiency
• Immunosuppressant medications such as HUMIRA® (Adalimumab) and Methotrexate
  
  

Similar to acute sinusitis, several factors may predispose you to developing Recurrent Acute Rhinosinusitis. These include allergic rhinitis, viral infection, environmental factors, anatomic abnormalities, and immune deficiency.

How is acute sinusitis treated?

Uncomplicated cases of Acute Sinusitis do not always require antibiotics, especially when the symptoms are caused by a viral infection. If a bacterial infection is suspected, antibiotics are typically recommended. There are several different antibiotics that can be prescribed, and a “ladder” approach is generally followed.

The first line antibiotic is Amoxicillin, either alone or in combination with Clavulanic acid (Augmentin®). Patients allergic to penicillin may be prescribed trimethoprim-sulfamethoxazole (Bactrim®), doxycycline, Ciprofloxacin or Levofloxacin (Levaquin ®).  Antibiotics are usually prescribed for 7 to 10 days. It is important to supplement your diet with probiotics while on antibiotics to prevent a yeast infection or a severe bacterial infection in your gut called C. difficile diarrhea. In addition to antibiotics, Dr. Caballero recommends saline (salt water) sinus irrigations and a steroid nasal spray like Flonase® or Rhinocort ®. Depending on the severity of your symptoms, she may also recommend a brief course of oral steroids like Medrol or Prednisone.

Patients with Recurrent Acute Rhinosinusitis (RARS) may need longer courses of oral antibiotics and systemic steroids. A sinus culture may be obtained to determine the exact bacteria causing the infection and to enable Dr. Caballero to prescribe culture-directed antibiotic therapy.  Imaging studies like a CT sinus scan are typically performed to identify any sites of obstruction and evaluate the overall status of the sinuses.

A dental evaluation will be recommended if an odontogenic source if suspected. Several medications are used to manage RARS, including intranasal steroid sprays, nasal irrigations with saline and also with steroids such as Budesonide and Mometasone. Antihistamines (orally or intranasally) and leukotriene modifiers may be added if the patient has allergic rhinitis contributing to the inflammation in the sinuses. Blood work may be done to evaluate for an immune deficiency, such as IgA deficiency or Specific Antibody Deficiency. If symptoms persist despite appropriate medical therapy, surgery may be considered.