Ear-Nose and Throat Doctor (ENT) Questions Sinusitis

What could be the reason for chronic sinusitis?

My daughter is 12 years old and she is suffering from chronic sinusitis. None of us in the family suffer from sinusitis and otherwise she is reasonably healthy. So, what could be triggering this in her?

4 Answers

Plain Language Summary: Adult Sinusitis (Sinus Infection)
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Leslie A. Caspersen, MBA
Leslie A. Caspersen

American Academy of Otolaryngology—Head and Neck, Alexandria, Virginia, USA
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, Lindsey M. Walter, Sandra A. Walsh, ...
First Published July 21, 2015 Research Article Find in PubMed
https://doi.org/10.1177/0194599815587677
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Article has an altmetric score of 5 Full Access
Abstract
Objective. This plain language summary serves as an overview in explaining sinusitis (pronounced sign-you-side-tis). The purpose of this plain language summary is to provide patients with standard language explaining their condition in an easy-to-read format. This summary applies to those 18 years of age or older with sinusitis. The summary is featured as an FAQ (frequently asked question) format. The summary addresses how to manage and treat sinusitis symptoms. Adult sinusitis is often called a sinus infection. A healthcare provider may refer to a sinus infection as rhinosinusitis (pronounced rhi-no-sign-you-side-tis). This includes the nose as well as the sinuses in the name. A sinus infection is the swelling of the sinuses and nasal cavity.

The summary is based on the published 2015 “Clinical Practice Guideline: Adult Sinusitis.” The evidence-based guideline includes research to support more effective diagnosis and treatment of adult sinus infections. The guideline was developed as a quality improvement opportunity for managing sinus infections by creating clear recommendations to use in medical practice.

Keywords
sinusitis, sinus infection, rhinosinusitis
What Is Sinusitis?
Sinus infections are one of the common conditions with which adults may be diagnosed. Sinus infections affect millions of adults in the United States each year.1,2 The sinuses are a group of hollow spaces that surround the nose and are also found above and between the eyes. Sinus infections include cloudy or colored runny nose with nasal blockage or clogging, facial pain/pressure, or both. Other symptoms include fever, cough, loss of energy, lack of or reduced sense of smell, tooth pain, and ear fullness. The symptoms can be severe enough to disturb your quality of life or general well-being. See Table 1 for a summary of evidence-based statements and recommendations of diagnosis and treatment.

Table
Table 1. Summary of Evidence-Based Statements.

Table 1. Summary of Evidence-Based Statements.


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Sinus infections can be caused by viruses, bacteria, or fungi. A viral sinus infection has similar symptoms as bacterial infections but improves within 10 days and does not get worse. A bacterial sinus infection is defined by how long the symptoms last. The 3 types are acute (short course), recurrent (repeated), or chronic (long lasting). An acute bacterial sinus infection is one that either fails to get better within 10 days or has suddenly gotten worse after an initial period of getting better. Acute bacterial sinus infection lasts less than 4 weeks. See Figure 1 for more information on acute sinus infections. Recurrent bacterial sinus infections are when an acute sinus infection occurs 4 or more times in a 1-year period. A chronic sinus infection is when 2 or more symptoms and swelling lasts for 12 weeks or longer. A fungal sinus infection is one that is linked with chronic symptoms. Fungal sinus infections usually occur with people who have weak immune systems. Fungal sinus infections can also occur with people who have used long-term antibiotics.


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Figure 1. Patient information sheet on diagnosis of acute sinusitis.

What Causes Adult Sinusitis?
A sinus infection is typically caused by a viral upper respiratory infection, like a cold. A viral infection does not get better from taking antibiotics. Acute bacterial sinus infections are caused by a bacterial infection. Some people with bacterial infections can benefit from the use of antibiotics, although antibiotics are not necessary for everyone.

What Can You Do?
You should see a healthcare provider soon after symptoms occur. Early diagnosis may help avoid misdiagnosis or delayed treatment and worse results. There are several types of sinus infections, so it is important to get the correct diagnosis for proper treatment. Treatment options should be discussed with the healthcare provider after diagnosis. Antibiotics do not work for viral sinus infections. Antibiotics are not recommended for all types of bacterial infections.

How Is Adult Sinusitis Diagnosed?
A healthcare provider can diagnose a sinus infection by reviewing the medical history and doing a physical exam. The exam should review and document the conditions in your medical record. A healthcare provider will take note of how long symptoms have been present.

The healthcare provider should decide between acute bacterial sinus infection from viral sinus infection or noninfectious conditions. Your healthcare provider should diagnose an acute bacterial sinus infection when (1) symptoms (facial pain-pressure-fullness, nasal blockage) or signs (cloudy or colored nasal drainage) or both continue without getting better for at least 10 days after the onset of upper respiratory symptoms like a cold or (2) symptoms or signs of a sinus infection worsen within 10 days after getting better (double worsening).

Other conditions can seem like a sinus infection. For instance, a headache alone may not mean a sinus infection. With a sinus infection, there is usually cloudy or colored nose drainage.

An acute sinus infection is diagnosed when there are up to 4 weeks of colored or cloudy runny nose with nasal blockage, facial pain-pressure-fullness, or both. A healthcare provider should decide between chronic and recurrent sinus infections from single-incident of acute bacterial sinus infections and other causes of sinonasal (nose and sinus) symptoms.

The healthcare provider cannot diagnose chronic sinus infection based on symptoms alone. The healthcare provider will also need to see nasal swelling or inflammation on exam. The healthcare provider may use tools such as cameras (an endoscope or rhinoscope). These types of tools can offer a better view of your sinuses. The healthcare provider may also order a special radiology test called a CT (CAT) scan to view sinonasal swelling. The CT scan may confirm a diagnosis of chronic sinus infections. For chronic sinus infections, the healthcare provider should confirm whether nasal polyps are present. Nasal polyps are harmless growths. Having nasal polyps will modify care of your symptoms.

Instead of prescribing antibiotics right away for your acute bacterial sinus infection, your healthcare provider may suggest a treatment option known as watchful waiting. This option usually includes a 7-day waiting period without antibiotics to see if you get better on your own.

You may be tested for allergies and immune function. This testing will help tell chronic or recurrent sinus infections from allergies.

What Treatments Are Available?
It is important to properly diagnose viral and bacterial sinusitis because antibiotics are not for a viral sinus infection. If you have heart, kidney, or liver disease, your healthcare provider may consider different treatment.

For a viral sinus infection: Talking with your healthcare provider can help you make decisions about the treatment of symptoms. To relieve symptoms, pain relievers, nasal steroid sprays, and/or nasal saline rinse (irrigation) may be recommended. Nasal saline rinse can be purchased or homemade. Nasal saline rinse involves using a bulb, squeeze bottle, or Neti pot with a mixture of water, baking soda, and a noniodized salt.

For an acute bacterial sinus infection: The healthcare provider should offer either watchful waiting without antibiotics or an antibiotic. If a decision is made to treat acute bacterial sinus infection with an antibiotic, amoxicillin will likely be prescribed. A combination of amoxicillin with clavulanate for 5 to 10 days may also be prescribed as a different treatment. If you feel worse or do not improve with the antibiotic treatment after 7 days, you should see your healthcare provider. The healthcare provider will review the diagnosis and will rule out other causes. The healthcare provider may also decide to change the antibiotic. To relieve your symptoms, your healthcare provider may recommend over-the-counter treatments. These treatments may include pain relievers, nasal steroid sprays, and/or nasal saline rinse. Nasal saline rinse can be purchased or homemade. Nasal saline rinse involves using a bulb, squeeze bottle, or Neti pot with a mixture of water, baking soda, and a noniodized salt. See Figure 2 for more information on acute bacterial sinus infections.


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Figure 2. Patient information sheet on treating acute bacterial rhinosinusitis (ABRS).

For a chronic sinus infection: Your healthcare provider may recommend saline nasal rinse, topical intranasal corticosteroids, or both for symptom relief. Your healthcare provider should not prescribe antifungal therapy for chronic sinus infections. Your treatment will be modified if you have asthma, cystic fibrosis, a weakened immune system, or ciliary dyskinesia.

Where Can I Find Help?
Patients and healthcare providers should discuss the benefits and potential risks or harms of treatments. Engaging in shared decision making helps achieve better health outcomes. To learn more about sinus infections, there are a number of resources available. Go to http://www.entnet.org/AdultSinusitisCPG to see printable patient resources and tables. There are tables that will explain when to use home remedies, such as salt water rinses in the nose. The tables will also explain when it is ok to take an antibiotic and the side effects of antibiotics.

How the Guideline Was Developed
The adult sinusitis guideline was developed using the methods outlined in the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s (AAO-HNSF’s) “Otolaryngology–Head and Neck Surgery Guideline Development Manual, Third Edition.”3 A literature search was performed by an information specialist to identify research studies (systematic reviews, clinical practice guidelines, and randomized controlled trials) published since the prior guideline. The AAO-HNSF assembled a guideline update group from the fields of otolaryngology–head and neck surgery, infectious disease, family medicine, allergy and immunology, advanced practice nursing, and a consumer advocate. The group also included a staff member from the AAO-HNSF. Although radiology was represented on the original guideline development group, they were excluded from the update since the AAO-HNSF had recently published a clinical consensus statement on imaging for sinusitis. The group solicited feedback from radiology about important statements to ensure that they stayed valid and current. Prior to publication, the guideline underwent extensive peer review, including open public comment.

This plain language summary was developed from the 2015 AAO-HNSF’s “Clinical Practice Guideline: Adult Sinusitis.”4 The multidisciplinary guideline development group represented the fields of otolaryngology–head and neck surgery, including, infectious disease, family medicine, allergy and immunology, advanced practice nursing, and a consumer advocate. Literature searches for the guideline were conducted up through March 2014. For more information on allergic sinusitis, visit http://www.entnet.org/AdultSinusitisCPG.

About the American Academy of Otolaryngology—Head and Neck Surgery
The American Academy of Otolaryngology—Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNSF works to advance the art, science, and ethical practice of otolaryngology–head and neck surgery through education, research, and lifelong learning. The organization’s vision: “Empowering otolaryngologist–head and neck surgeons to deliver the best patient care.”

Author Contributions
Leslie A. Caspersen, writer, American Academy of Otolaryngology—Head and Neck Surgery Foundation staff liaison; Lindsey M. Walter, writer, American Academy of Otolaryngology— Head and Neck Surgery; Sandra A. Walsh, writer, panel member; Richard M. Rosenfeld, writer, chair; Jay F. Piccirillo, writer, assistant chair.

Disclosures
Competing interests: Leslie A. Caspersen, salaried employee of American Academy of Otolaryngology—Head and Neck Surgery Foundation; Lindsey M. Walter, salaried employee of American Academy of Otolaryngology—Head and Neck Surgery.

Sponsorships: American Academy of Otolaryngology—Head and Neck Surgery Foundation.

Funding source: American Academy of Otolaryngology—Head and Neck Surgery Foundation.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

References
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2. Blackwell, DL, Lucas, JW, Clarke, TC. Summary health statistics for US adults: National Health Interview Survey, 2012. Vital Health Stat. 2014;10(260):1-171.
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3. Rosenfeld, RM, Shiffman, RN, Robertson, P. Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2013;148(suppl 1):S1-S55.
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Google Scholar | SAGE Journals | ISIOpenURL Rowan University
This is a complicated question, as in a child we need to consider congenital issues as well. But the first thought has to be an allergy, and allergy testing is important here. Immune deficiencies, especially IgA, should be evaluated. Nasal obstruction can do this so an exam for a deviated septum or choanal atresia is needed. If nasal polyps are present, then she should have a sweat chloride test to rule out cystic fibrosis; although this can exist even in the absence of polyps. Or, the simplest explanation is that just as in many adults, this is the end result of a bad viral infection and should eventually respond to medical treatment. She should be evaluated by an ENT physician to look for these answers.
Have a question aboutSinusitis?Ask a doctor now
In the absence of direct sick contacts, your daughter's sinusitis may be triggered by underlying allergies. A quick blood test can be done to assess her risk for allergies.
Most common cause in children is allergy and recurring viral infections with bacterial secondary infection. Anyone in the house smokes, any mold in house? See ENT for evaluation.