Allergy Sinusitis Sinusitis is one of the most common health care complaints in the United States accounting for nearly 25 million physician visits in 1993. The diagnosis of acute sinusitis is usually not difficult but the diagnosis of chronic sinusitis may be more challenging because nomenclature is not clear and the symptoms may be vague. Symptoms of chronic sinusitis can vary from mild headaches around the eyes and yellow to green phlegm in the throat to severe facial pain, headaches, chronic yellow-green nasal discharge, nasal congestion, chronic throat drainage, sore throats, and cough. The diagnosis of chronic sinusitis is made on the basis of the history and the physical exam, and may be confirmed by x-rays and cultures of the pus. Standard sinus x-rays are sufficient for the diagnosis of acute sinusitis in adults but are of limited value in the diagnosis of chronic sinusitis in adults and in most types of sinusitis in children.
Antibiotics are the mainstay of treatment for both acute and chronic sinusitis.
In acute, uncomplicated sinusitis, antibiotics combined with decongestants are effective in most cases. Recent studies of the underlying cause of chronic sinusitis has shown that the clearance of mucus from the maxillary, frontal, and anterior ethmoid sinuses is directed toward a structure called the ostiomeatal complex, which is an anatomical region about the size of a dime that is located about an inch inside the nose on the lateral wall. Recent technological advances have provided us with the tools to diagnose chronic sinusitis more accurately and to treat it more effectively. CT scans of the sinuses provide a much more detailed view of sinus anatomy and sinus disease than do the standard sinus x-rays. One of the most significant advances in the management of patients with sinusitis is the use of endoscopes to supplement the physical examination of the nose.