Identifying and Managing Chronic Sinusitus
Chronic sinusitis can present as a true chronic condition or as a series of acute flares. Impaired quality of life after ‘triple treatment’ may indicate surgical referral.
Two Presentations: A Chronic Condition or Recurrent Acute Flares
Chronic sinusitis can present in two ways: as a true chronic condition or as a series of apparent acute infections.
In the first scenario, patients experience upper-respiratory infection-like symptoms that don’t improve over months or years.
In the second scenario, patients often make repeated calls or visits with a series of apparent acute infections that recur every few weeks, after the course of antibiotics is complete. The infection never really clears up between acute flares, and is thought of as multiple acute exacerbations of chronic sinusitis.
‘Triple Treatment’ and Surgical Referral
Medical treatment for chronic sinusitis includes:
• Antibiotics to treat the infection;
If chronic sinusitis cannot be managed with “triple treatment,” a referral to an otolaryngologist is appropriate. Surgery may be indicated for patients who have impaired quality of life despite medical treatment.
The goal of surgical intervention is to allow medical treatment to be more successful. Intraoperative CT guidance allows for a safe procedure and minimizes the risk of complications.
Fungal Infections are Rare
Fungal infections may be a concern for patients who have symptoms of chronic sinusitis. However, fungal infections are very uncommon, and have distinct appearances on computed tomography (CT) scans and within patient populations.
If characteristics of any of the three types of fungal infection are noted, fungal cultures are obtained at the time of surgery.
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For More Information
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