The sinuses are eight air-filled cavities within the facial skeleton that drain into the nose.
Sinusitis is an inflammatory disease of the mucous membranes lining the sinuses. Inflammation of the mucous membranes can be due to infectious agents such as viruses, bacteria or fungi. Visit our FAQ page to learn more about causes and classifications of sinusitis.
The classic symptoms of sinusitis are facial pain or tenderness, and yellow or green nasal drainage.
A careful history analysis and physical examination are essential to diagnosing sinusitis. The history consists of seeking the onset and course of the present illness. Evaluating prior treatment is an important element of this process because response or lack of response to antibiotics, or prior sinus surgery, characterizes the illness as acute, chronic or recurrent chronic, and the severity of the infection.
Another important element of the history is the review of systems, in which the physician surveys the general health of the patient. For example, insulin-dependent diabetes or HIV AIDS would predispose the patient to recurrent infections. After completing the history, the patient should undergo examination of the head and neck.
The physical examination of the patient expands or confirms the physician’s clinical impression of sinusitis. This includes an examination of the mouth, throat, neck, face, ears and nose.
Swollen, inflamed mucous membranes with discharging mucous are indicative of bacterial sinusitis. Further examination of the nose and the drainage pathways of the sinuses into the nose require special training and equipment.
As part of this additional examination, the physician may conduct a nasal endoscopy, which is an examination of the nose with an optical endoscope. The patient may also require a facial x-ray or computed tomography (CT) scan to view an image of the area of interest for diagnosis.
Polyps occur in multiple organs throughout the body. Most nasal polyps are benign growths arising from the mucus membranes of the nose and sinuses, which may be associated with allergy, cystic fibrosis, aspirin sensitivity, allergic fungal sinusitis, asthma and several syndromes involving the respiratory tract.
Nasal Polyp Symptoms
The primary symptoms of nasal polyps are obstruction of the nasal airway and potentially sinusitis as the polyps obstruct the drainage pathways of the sinuses. Loss of the sense of smell may accompany nasal polyps, but may not be the result of the nasal airway obstruction. That is, removing polyps may restore the airway but not alter the fundamental mechanisms causing the polyps and the loss of the sense of smell.
Polyps appear to have life of their own because some are associated with asthma and respond well to similar treatments and surgical removal, while others respond poorly to most medications and allergy therapy. This complex interaction between white blood cells, such as T cells and eosinophils, and the chemical products of these cells in the presence of chronic infection remains to be fully understood. However, it is clear that many patients benefit most from surgical treatment when followed by careful management.