The pathophysiology and treatment of sinusitis.

When faced with the diagnosis of sinusitis, the physician should carefully review the clinical setting from which the condition arose, its potential origins, as well as initiate management. In most instances, medical management will suffice for acute and subacute disease although some surgical intervention is occasionally helpful. If nasal polyps are present with radiographic evidence of sinus obstruction, standard medical treatment is initiated with the addition of systemic corticosteroids once the suppurative component is controlled. A lack of response in each of these circumstances is evaluated on an ongoing basis. If successful treatment is seen clinically, repeat radiographs with those views which best reveal the sinus involved are obtained in approximately 6 weeks to hopefully demonstrate normality. Persistent radiographic abnormalities can then be either treated surgically or, if clinical judgement dictates, further medical management can be pursued. However, in the chronic phase of sinusitis or after the patient has been followed with persistent abnormalities for over three months, irreversibly diseased mucosa is generally present and surgical intervention is commonly indicated. We would like to emphasize that during the course of treatment, frequently consider the origin of the sinusitis. Commonly it is infectious (e. g. viral) and no further investigation is necessary. However, anatomic abnormalities or systemic disease may be present whose correction can prevent the recurrence of acute sinusitis or, more importantly, the evolution into chronic irreversible sinus disease.