More than 37 million Americans suffer from at least one episode of sinusitis each year. The number of people afflicted with sinus infections has soared over the last decade. This is thought due to increased pollution, an enlarging urban population, and increasing resistance to antibiotics. Sinusitis is an inflammation of the membranes that line the hollow air containing cavities located within the facial and skull bones known as the paranasal sinuses.  Sinus infections can be acute or chronic.

Acute Sinusitis
 Acute sinus infection almost always presents with fever, facial or sinus pressure, nasal congestion and drainage, headache and upper dental pain, and cough from thick post nasal drainage. Acute sinus infections can occur after airtravel with nasal congestion due to an allergy or viral infection at time of flying. The infection causes painful sinus obstruction with descent and landing. Swimming, snorkling, or scuba diving with the above conditions also trigger acute sinusitis. Acute sinusitis is usually a short term infection but can last for longer than 4 weeks. Acute sinusitis may be present when symptoms worsen after 5 days, persist beyond ten days, or symptoms are more severe than those of a viral infection.  Acute sinusitis usually responds well to antibiotics and decongestants taken for ten to fourteen days.

Chronic Sinusitis
 Chronic sinusitis is described as at least four recurrences of acute sinusitis or persistent symptoms despite antibiotics and decongestants for over three months. Chronic sinus infection, more than acute sinusitis, can mimic allergies or upper respiratory viral infection with nasal congestion, bronchitis and chronic cough. This type of infection is usually not painful and fever is rarely present. A condition called sinobronchial syndrome presents with chronic sinusitis and a cyclical pattern of nasal congestion, purulent postnasal drainage, and recurring cough and bronchitis. Chronic sinusitis is more difficult to treat than acute sinusitis.  If persistent, it often will require endoscopic sinus surgery to open obstructed sinus ducts caused by thickened mucus membranes due to longstanding inflammation.  

Other Types of Sinus Infections
 
There are other types of chronic sinus conditions that are more commonly seen today than in the past. These infections are defined by the type of organisms or tissues that are associated with the chronic sinus infection.
 Polypoid Sinusitis
is characterized by gelatinous, oyster like tissue derived from the lining membranes of the affected sinuses. These polyps can be isolated to the sinuses or nasal cavity only but commonly involve both locations.  They are filled with thin serous fluid (mucoceles) or purulent infection (pyoceles). The former is associated with allergies and the latter with bacterial infection. The treatment for each is different:
     Allergic or inflammatory polyps respond well to allergy medications:oral or nasal decongestants, oral or nasal antihistamines, oral or nasal steroids, or allergy shots ( immunotherapy) containing small amounts of the responsible allergens.
     Infective pus filled polyps (pyoceles) and diseased tissues are removed at time of endoscopic sinus surgery. Sterile cultures are taken from the sinuses for DNA genomic marker testing that is 99.97% accurate. Results are available within 36 hrs after surgery. This guarantees that only an effective culture proven antibiotic is used for treating the infection present. 
 Allergic Fungal Sinusitis
is characterized by filamentous, thick green-brownish tissue that is encountered within chronic diseased mucus membranes removed at time of surgery. Two main types of fungus are usually involved: Aspergillus niger, and Candida albicans. Treatment involves total removal of the fungal tissue from within the sinuses and postoperative oral antifungal medications. Often post operative allergy testing will detect multiple fungal allergies. It is important that immunotherapy (allergy shots) be taken by the patient who is found to have an allergy to the fungus found at surgery. Long term cures are common, with allergy therapy taken on a regular weekly basis, for patients with fungal sinusitis in our practice.

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