What is sinus sensitivity?

Sinus Sensitivity: Understanding and Management

Sinus sensitivity refers to inflammation of the paranasal sinuses, which can cause symptoms including facial pain, pressure, nasal congestion, and discharge. This condition is formally known as sinusitis or rhinosinusitis and can be classified based on duration as acute, subacute, chronic, or recurrent 1.

Definition and Classification

Sinusitis is inflammation of one or more paranasal sinuses, most commonly caused by infection. The term "rhinosinusitis" is increasingly preferred as it acknowledges that rhinitis typically precedes sinusitis, the mucosa of the nose and sinuses are contiguous, and nasal symptoms are prominent 1.

Classification based on duration:

• Acute sinusitis: Symptoms for less than 4 weeks
• Subacute sinusitis: Symptoms from 4 to 8 weeks
• Chronic sinusitis: Symptoms for 8 weeks or longer
• Recurrent sinusitis: 3 or more episodes of acute sinusitis per year 1

Symptoms of Sinus Sensitivity

Common symptoms include:

• Persistent upper respiratory symptoms
• Purulent rhinorrhea (nasal discharge)
• Postnasal drainage
• Nasal congestion
• Facial pain or pressure
• Headache
• Cough (often worse at night)
• Decreased sense of smell (hyposmia)
• Fatigue and malaise 1

Causes and Risk Factors

1. Infectious causes:

   • Viral infections (most common initial cause)
   • Bacterial infections (often secondary)
   • Fungal infections (less common)

2. Non-infectious causes:

   • Allergic rhinitis
   • Non-allergic rhinitis
   • Anatomical abnormalities (septal deviation, nasal polyps)
   • Immunodeficiency
   • Aspirin sensitivity 1, 2

Types of Sinusitis

1. Acute infectious sinusitis: Typically follows viral upper respiratory infection, with bacterial superinfection in some cases.

2. Chronic infectious sinusitis: May involve anaerobic bacteria such as gram-positive streptococcus, bacteroides, and Fusobacterium species or Staphylococcus aureus 1.

3. Chronic hyperplastic eosinophilic sinusitis: A non-infectious form marked by eosinophils and mixed mononuclear cells, often associated with nasal polyps, asthma, and aspirin sensitivity 1.

Diagnosis

Diagnosis is primarily clinical, based on:

• Duration and pattern of symptoms
• Physical examination findings including nasal mucosa assessment
• Nasal endoscopy when available

Imaging is not routinely needed for acute sinusitis but may be helpful for:

• Chronic or recurrent cases
• Suspected complications
• Treatment failures 1, 2

Treatment Approach

Acute Sinusitis

1. Antibiotics:

   • Indicated for symptoms lasting 10-14 days or severe symptoms with fever, purulent discharge, and facial pain
   • First-line: Amoxicillin for 10-14 days
   • For poor response or high resistance areas: Amoxicillin-clavulanate, cefuroxime, cefpodoxime, cefprozil, or cefdinir
   • For penicillin allergy: Trimethoprim-sulfamethoxazole, macrolides, or quinolones 1, 2, 3

2. Adjunctive treatments:

   • Intranasal corticosteroids
   • Saline nasal irrigation
   • Decongestants (short-term use)
   • Analgesics for pain 1, 2

Chronic Sinusitis

1. Medical management:

   • Continued topical nasal steroids
   • Saline irrigation
   • Antibiotics targeting likely pathogens (including anaerobes for chronic cases)
   • Short course of systemic corticosteroids, especially for chronic hyperplastic eosinophilic sinusitis 1, 2

2. Surgical options (for medically resistant cases):

   • Functional endoscopic sinus surgery (FESS)
   • Balloon sinuplasty for appropriate candidates 2

Special Considerations

1. Allergic factors: Patients with suspected allergic rhinitis contributing to sinusitis should be evaluated for IgE sensitization to inhalant allergens 1.

2. Immunodeficiency: Consider evaluation in patients with recurrent sinusitis, especially when associated with other recurrent infections 1.

3. Warning signs requiring urgent evaluation:

   • Orbital swelling or pain
   • Forehead swelling
   • Visual changes or diplopia
   • Neurological symptoms 1

Common Pitfalls in Management

1. Overdiagnosis and unnecessary antibiotics: Reserve antibiotics for appropriate cases with persistent or severe symptoms 2.

2. Failure to identify underlying conditions: Allergic rhinitis, immunodeficiency, or anatomical abnormalities may contribute to recurrent or chronic sinusitis 1.

3. Inadequate duration of therapy: Ensure complete antibiotic courses to prevent relapse 1.

4. Missing complications: Be vigilant for orbital or intracranial complications, especially with frontal or sphenoid sinusitis 1.

Sinus sensitivity (sinusitis) requires a systematic approach to diagnosis and treatment, with consideration of both infectious and non-infectious causes. Proper management can significantly improve symptoms and quality of life while preventing complications.