LAUSR

It seems that no one gets just a cold anymore. When people get acute symptoms of nasal congestion and stuffiness, they say they have got a “sinus infection.” Thirty-two million Americans were reported to have the diagnosis of sinusitis resulting in 11.6 million office visits per year. The diagnosis of sinusitis was reported at that time to cause 73 million restricted activity days, result in 13 million prescriptions, with direct medical costs of $2.1 billion. The mean number of visits for rhinosinusitis per annum in children was reported to be 5.6 million. But are symptoms attributed to sinusitis primarily symptoms of rhinitis, and are the frequent use of antibiotics for sinusitis justified? While guidelines have been generated by professional committees, they include complex algorithms that provide insufficient clarity for primary care clinical decision making. Let us start by considering definitions. First, what are the sinuses? They are essentially just hollow spaces in the skull. They are lined with mucosa similar to that in the nasal cavity, and they communicate with the nasal cavity through small openings. Sinusitis is swelling of the sinus mucous membrane and/or exudate into the sinuses. Rhinitis is inflammation, engorgement, or excessive secretions from the nasal mucous membranes that line the interior of the nasal cavity including the turbinates. Unlike sinusitis, which requires radiologic imaging to identify mucosal swelling and exudate, rhinitis causes readily identifiable symptoms. Increased nasal fluid of varying colors and consistency (rhinorrhea), congestion or blockage of the nasal passage from mucosal engorgement, and swelling of the turbinates combine to result in increased nasal airway resistance. While there is often concomitant inflammation of the sinus mucous membrane and exudate into the sinuses in association with rhinitis, what are the consequences of that sinus pathology? Do symptoms attributed to sinusitis relate to identified sinus pathology? And do antibiotics alter the symptoms and pathology? These questions are addressed by a review of literature relevant to those questions.