Sinusitis

Disease Description (Causes and Symptoms)

• Definition summary: A disease in which inflammation develops in the paranasal sinuses (air-filled spaces around the nose), causing secretion retention and mucosal thickening. It is classified as acute (usually lasting several days to several weeks after a cold) or chronic (symptoms persisting for 12 weeks or longer).
• Causes and pathophysiology: It begins with a viral upper respiratory tract infection, which blocks the sinus ostia and causes impaired ventilation and drainage. This can lead secondarily to a bacterial infection or chronic inflammation (mucosal thickening and reduced ciliary function). Allergies, anatomical abnormalities (deviated nasal septum and turbinate hypertrophy), immunodeficiency, and odontogenic infections are aggravating factors.
• Main symptoms: Nasal congestion, nasal discharge (especially yellow or yellow-green), facial pain or pressure (especially in the frontal, cheek, and maxillary sinus areas), headache, postnasal drip (secretions draining down the back of the throat), fever, reduced sense of smell, cough, and malaise. In children, it may present as a prolonged cold (10–14 days or longer), vomiting or irritability, and, rarely, headache.
• Diagnostic clues: Duration of symptoms (for acute/chronic classification), observation of purulent nasal discharge by nasal endoscopy, confirmation of anatomical abnormalities or retained fluid with sinus CT when necessary, and consideration of culture or biopsy in chronic or treatment-resistant cases.

Treatment Methods (Standard Treatment, Medications, Procedures, Lifestyle Management, and Precautions)

• Medication treatment (primary and adjunctive)
  • Acute viral sinusitis: Symptomatic treatment (adequate fluid intake, saline nasal irrigation, analgesics, etc.).
  • Suspected bacterial infection or severe symptoms: Appropriate oral antibiotics (used at the physician’s discretion). Treatment is generally decided after a short period of observation.
  • Topical steroid nasal sprays: Reduce mucosal inflammation and swelling, helping to keep the sinus ostia open.
  • Nasal decongestant sprays: Used for symptom relief for a short period (usually 3–5 days). Long-term use carries a risk of rhinitis medicamentosa (rebound or dependency rhinitis).
  • Analgesics/antipyretics and mucolytics may be used when necessary.
  • In chronic, treatment-resistant, or severe cases, long-term antibiotic therapy may be considered; antifungal treatment may be considered when a fungal infection is suspected.
• Procedures and surgery
  • Surgical treatment may be considered when medical treatment is ineffective or when there is anatomical obstruction or complications.
  • Functional endoscopic sinus surgery (FESS): Widens the sinus ostia to restore drainage and ventilation. Diseased mucosa may be removed when necessary.
  • Balloon sinuplasty: Widens the sinus ostia to improve drainage in selected patients.
  • Maxillary sinus puncture: Rarely performed for treatment and drainage.
• Lifestyle management and self-care
  • Use saline nasal irrigation to remove secretions and prevent crust formation.
  • Drink sufficient fluids and use a humidifier to reduce mucus viscosity.
  • Avoid allergens (dust, pollen, pets, etc.) and receive concurrent allergy treatment.
  • Prevent nasal pressure-related symptoms during air travel (if necessary, use a decongestant for a short period before takeoff) — consult a doctor.
• Precautions and risk of complications
  • Do not use nasal decongestants long-term (they can cause recurrent congestion and rhinitis medicamentosa).
  • Emergency signs (eye pain, visual impairment, severe facial swelling, confusion, high fever, or neurological abnormalities) require an immediate visit to the emergency department (possible orbital or intracranial complications).
  • Chronic disease may cause impaired sense of smell, complications involving adjacent structures (the orbit and cranial cavity), osteomyelitis, and other problems.

Checklist Before an Outpatient Visit (What to Bring and Sample Questions)

• Recommended items to bring
  • A list of current medications (including nasal sprays), and information on any recent antibiotic or steroid use
  • Previous examination results and imaging (such as sinus CT) and surgical records, if available
  • Notes summarizing when symptoms began and how they have progressed (duration of each symptom and factors that worsen or improve them)
  • A record of whether fever, vision problems, facial swelling, or neurological symptoms have occurred
  • Allergy history (including allergy test results)
• Key items the doctor will check during the visit (patients can check these themselves)
  • When symptoms began and how long they have lasted (for example, whether they have lasted 10 days or longer)
  • Nasal discharge color (clear/yellow-green), postnasal drip, and whether there is difficulty breathing or worsening asthma
  • Response to recent antibiotic treatment and history of steroid use
  • History of previous sinus surgery or odontogenic (dental) infection

General Sample Questions to Ask the Doctor

• "Do my current symptoms appear to be caused by a bacterial infection? Do I need antibiotics?"
• "How should I use the recommended nasal irrigation and nasal spray, and for how long?"
• "If my symptoms continue, will I need surgery, and which surgical method would be appropriate?"
• "What specific symptoms should I watch for to prevent complications (emergency signs)?"

Disease-Specific Sample Questions

• "If I have chronic sinusitis, which would be more suitable for my situation: surgery (endoscopic surgery vs. balloon sinuplasty)? What are the expected benefits and recovery time?"
• "If I also have allergies (or asthma), how will my sinusitis management plan change? Can allergy treatment reduce the risk of complications?"

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Emergency signs (immediate emergency medical care required): Sudden changes in vision, severe eye pain/facial swelling, altered consciousness, severe headache, speech or movement impairment, or persistent high fever.