Diagnosis and management of sinusitis in the allergic patient.

Allergy is often associated with sinusitis because the inflamed nasal mucosa may block ostial drainage from the sinus and the resulting stasis in the sinuses encourages development of infection. The new tools of nasal evaluation, endoscopy and computed tomographic scanning, are becoming essential in the evaluation of patients who have acute and chronic sinusitis. Nasal endoscopy provides a view of the nose, nasopharynx, sphenoethmoidal recess, and middle meatus to detect areas of inflammation or pathologic drainage. This examination should be followed by computed tomographic scanning, which reveals the fine structures and disease of the area. First-line treatment includes antibiotics and decongestants to control the infection, reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical steroids (or cromolyn sodium) are helpful to reduce the mucosal swelling, particularly in allergic patients. Antihistamines are indicated to reduce the rhinorrhea in allergic patients but not in those with suppurative sinusitis. Functional endoscopic sinus surgery to facilitate drainage and permit appropriate ventilation should be reserved for patients no longer responsive to pharmacotherapy and those with anatomic deformities.