Rhinosinusitis is the medical term for inflammation of the nose and sinuses, caused by infection or allergies. It is a major health problem in the United States. Dr. Eli O. Meltzer of the Allergy and Asthma Medical Group and Research Center, San Diego, California, and Dr. Daniel L. Hamilos of Massachusetts General Hospital, Boston, Massachusetts, provided a review of guidelines for diagnosis and treatment.
“Rhinosinusitis poses a major health problem, substantially affecting quality of life, productivity, and finances,” Meltzer and Hamilos wrote. To add perspective, they compared rhinosinusitis to other health issues:
1. The number of work days missed is similar to those from acute asthma.
2. The financial cost is greater than that for chronic bronchitis, ulcer disease, asthma, and hay fever.
3. The cost in terms of social functioning and bodily pain can be higher than that from angina, chronic heart failure, chronic obstructive pulmonary disease, or chronic back pain.
Treatment options depend on classification by duration of symptoms, severity of symptoms, and cause of inflammation. Acute illness is most commonly caused by viruses. Secondary bacterial sinus infection occurs in an estimated 0.5 to 2.0 percent of cases. For chronic illness, allergies and nasal polyps are important possibilities.
Guidelines have been written by the Joint Task Force on Practice Parameters, The Rhinosinusitis Initiative, the Clinical Practice Guideline: Adult Sinusitis, and the European Position Paper on Rhinosinusitis and Nasal Polyps. “The key features for evaluating antibiotic appropriateness should be symptoms severity and duration,” Meltzer and Hamilos summarized.
According to recent surveys, antibiotics are prescribed for 81 to 92 percent of acute rhinosinusitis cases, while only 2 percent or less involve bacterial infections that respond to these drugs.
Corticosteroids, either in the form of nasal sprays or pills, may be useful for treating symptoms. However, they are not recommended for bacterial sinus infections.
Decongestants and antihistamines are in common use, but Meltzer and Hamilos reported that there is not enough data to demonstrate their usefulness for sinus infections. Antihistamines may be useful for allergies, however.
Nasal saline irrigation is recommended in one set of guidelines. This can be done with over-the-counter nasal sprays or neti pots.
The term rhinosinusitis has been in common use for only the last decade. Many references still use the older term sinusitis. Meltzer and Hamilos explained that the name has been changed to reflect the importance of nasal conditions in relation to sinus inflammation and infection.
The U. S. National Library of Medicines' PubMed web site provides more details about nose and sinus problems.
1. Meltzer EO et al, “Rhinosiusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines”, Mayo Clinic Proceedings 2011; 86(5): 427-43.
2. U. S. National Library of Medicine. PubMed. Sinusitis. Web. Dec. 9, 2011.
Reviewed December 15, 2011
by Michele Blacksberg RN
Edited by Jody Smith