sphenoiditis

Symptoms. The common symptoms of sinusitis are headache, usually located near the sinuses most involved, and nasal discharge. These may be accompanied by a slight rise in temperature, dizziness, and a general feeling of weakness and discomfort.



When sinusitis is suspected as the cause of such symptoms, the health care provider may use a light to evaluate the patency of the sinuses. A bright light is held against the forehead and cheeks to determine the amount of light transmitted through the sinuses in these areas. If a sinus is filled with fluid and inflamed it will transmit little or no light. Radiologic tests also are used to confirm a diagnosis of sinusitis and to locate the extent of involvement. Specialized techniques such as multiple x-ray exposures (polytomography) and computed tomography are sometimes used to pinpoint the nature and scope of a sinus disorder.

The American Academy of Pediatrics has developed clinical practice guidelines called Management of Sinusitis, applicable for anyone up to age 21. They note that imaging studies are not necessary to confirm a diagnosis of clinical sinusitis in children younger than age 6. They further recommend that CT scans be used only for those patients in whom surgery is a likely management strategy.

Treatment. Acute sinusitis usually responds to antibiotic therapy and increased drainage from the sinuses through the use of decongestants, which are applied locally in the form of nosedrops and also taken systemically. Inhalation of steam or warm moisturized air and local applications of heat encourage drainage and help relieve discomfort. Because of the severe pain associated with inflamed and swollen sinus membranes, potent analgesics may be needed for the first few days to provide relief and permit rest.



Chronic sinusitis often develops following a particularly resistant case of acute sinusitis. The mucous membranes in the sinuses thicken and normal drainage is obstructed. If medical management such as that described previously for acute sinusitis does not relieve the condition, surgical intervention may be necessary. In some cases, repair of a deviated nasal septum or removal of nasal polyps may be all that is necessary to eliminate the source of the problem. Others may need to have a new outlet created in the sinus to allow for drainage into the nose. More extensive surgery involves removal of the thickened membranous lining of the sinus or obliteration of the sinus itself in order to prevent refilling with purulent drainage.

Since sinusitis can lead to more serious infections in nearby tissues, such as the bones of the ear and mastoid or the brain, it is important that it be treated aggressively to eliminate infection. Though a change of climate can sometimes help in cases of chronic sinusitis, it rarely is a necessity. Creating a better indoor climate with such devices as air conditioners and humidifiers often is equally beneficial in reducing the number and severity of sinus attacks. Psychotherapy may be of help to some patients with disabling, chronic sinusitis because continual emotional strain is one of the factors that can intensify the symptoms.