What is the recommended approach for diagnosing and treating chronic sinusitis?

From the Guidelines

The diagnosis of chronic sinusitis should be based on a combination of clinical evaluation, nasal endoscopy, and CT imaging, as these methods provide the most accurate assessment of the condition, as suggested by 1. The clinical evaluation should include a thorough assessment of symptoms, such as nasal congestion, purulent rhinorrhea, facial-dental pain, post-nasal drainage, headache, and cough, which are commonly associated with chronic sinusitis, as noted in 1. Nasal endoscopy can provide valuable information about the presence of mucosal erythema, purulent nasal secretions, and other signs of inflammation, as mentioned in 1. CT imaging, particularly of the ostiomeatal complex and sinus cavities, can confirm the diagnosis and identify any underlying anatomical abnormalities that may be contributing to the condition, as recommended in 1.

Some key points to consider in the diagnosis of chronic sinusitis include:

• The use of nasal cytology, nasal-sinus biopsy, or tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction, as mentioned in 1
• The consideration of factors associated with sinusitis, such as viral upper respiratory tract infections, allergic rhinitis, and gastroesophageal reflux disease, as discussed in 1
• The potential for overlap between symptoms of chronic sinusitis and those of other conditions, such as perennial rhinitis, and the need for careful evaluation to confirm the diagnosis, as noted in 1

In terms of treatment, a stepped approach is recommended, starting with intranasal corticosteroids and saline nasal irrigation, and progressing to oral antibiotics and/or oral corticosteroids as needed, as suggested by 1. This approach is effective because it addresses the underlying pathophysiology of chronic sinusitis, which involves persistent inflammation, impaired mucociliary clearance, and often bacterial infection in the paranasal sinuses, as discussed in 1. Referral to an otolaryngologist for consideration of endoscopic sinus surgery may be necessary if medical therapy fails after 6-12 weeks, as recommended in 1.

Overall, the diagnosis and treatment of chronic sinusitis require a comprehensive and individualized approach, taking into account the unique needs and circumstances of each patient, as emphasized in 1.

From the Research

Diagnosis of Chronic Sinusitis

The diagnosis of chronic sinusitis involves a combination of clinical evaluation, physical examination, and adjunctive tests. The symptoms of chronic sinusitis are nonspecific and can overlap with other diseases, making diagnosis challenging 2.

• A thorough medical history and physical examination are essential to exclude anatomic causes of symptoms and to detect any signs of sinus disease.
• Adjunctive tests, such as nasal cytologic studies, ultrasound studies, and flexible or rigid nasal endoscopes, can be used to support the diagnosis.
• Imaging tests, such as radiology and computed tomography (CT) scans, can help to detect the presence and extent of disease in the paranasal sinus cavities.

Role of Nasal Endoscopy

Nasal endoscopy is a valid and objective diagnostic tool in the workup of patients with symptomatic chronic rhinosinusitis 3.

• The sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% and 44%, respectively.
• A positive nasal endoscopy can diagnose chronic rhinosinusitis in >90% of patients when clinical suspicion is high.
• However, a negative endoscopy does not totally exclude the sinus disease, and a CT scan may be needed on follow-up if symptoms persist.

Treatment Approach

The treatment approach for chronic sinusitis typically involves medical management, with surgical intervention reserved for complicated or refractory cases 4, 5.

• The goal of treatment is to reduce inflammation, improve mucociliary function, and prevent complications.
• Antibiotics, such as amoxicillin/clavulanate, may be effective in treating chronic rhinosinusitis, especially in patients with acute episodes 6.
• Other treatment options, such as nasal corticosteroids and saline irrigation, can help to reduce symptoms and improve quality of life.