Problem With Your Sinus

Rhinosinusitis poses a major health problem. Its effect on quality of life, productivity and finances are substantial.

It affects one in eight adults and accounts for close to 16 million doctor visits per year.

In Asia, the infection rates reported in Korea, China and Singapore are 7%, 8% and 2.7% respectively.

The direct cost of managing acute and chronic rhinosinusitis exceeds US$11 billion (RM45.2 billion) per year, not including the cost from lost productivity, reduced job effectiveness and impaired quality of life.

More than one in five antibiotics prescribed for adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy.

An accurate diagnosis and management contribute to improved treatment outcome and reduce the financial burden of the disease.

Although it is a common illness, rhinosinusitis presents a number of diagnostic and management challenges to doctors.

Its diagnosis is usually based on symptoms, supported by diagnostic imaging or nasal endoscopy, which is difficult to access in primary care clinics because of limited radiological and endoscopy facilities.

The most common cause of acute rhinosinusitis is a viral infection associated with the common cold, which is usually self-limiting in nature (will improve by itself).

Supportive care with medications to alleviate the symptoms are the main aim of treatment. Antibiotics are not necessary.

However, distinguishing between acute viral rhinosinusitis related to colds and influenza-like illnesses from bacterial infection is a frequent challenge to the primary care doctor or general practitioner (GP).

A thorough history-taking and clinical examination are important to reach the diagnosis.

As a general guide, symptoms that last less than 10 days are likely to be viral in origin.

Acute bacterial rhinosinusitis is diagnosed when the symptoms and signs of acute rhinosinusitis – greenish or yellowish nasal discharge with blocked nose and/or facial pain/pressure/fullness – persist without improvement for at least 10 days.

Anterior rhinoscopy can be done in primary care when acute rhinosinusitis is suspected.

However, it has limited value in diagnosing chronic rhinosinusitis, compared to nasal endoscopy, due to its limited visualisation of the nasal cavity.

Nasal endoscopy allows the doctor to better see problems in the nose, like anatomical variations, mucosa inflammation, polyps and nasal discharge.

In recurrent rhinosinusitis, the doctor may test for allergies and immune function, as well as look for nasal polyps.

Radiographic imaging is unnecessary if the diagnostic criteria for acute rhinosinusitis are met.

The most common imaging study done to evaluate the paranasal sinuses is a CT (computed tomography) scan, supplemented by an MRI (magnetic resonance imaging), if complications are suspected.