Medical management of sinusitis.

Sinusitis is both prevalent and costly, affecting more than 14% of the population and costing more than $3.5 billion. The signs and symptoms of sinusitis can be subtle: a night cough, chronic nasal congestion, postnasal drip, or recurring headaches. Diagnosis requires a comprehensive understanding of nasal physiology, anatomy, and allergic and immunologic abnormalities, and sinonasal microbiology. The most common events leading to sinusitis are colds, allergic and nonallergic rhinitis, and anatomic defects which interfere with the sinus outflow tracks. Treatment involves drainage of the congested sinuses and elimination of the pathogenic bacteria. Drainage can be accomplished medically by opening the sinus ostia through the use of decongestants and topical corticosteroids; bacteria are effectively eliminated by washing the sinuses with saline and through use of appropriate antibiotics. In patients with recurrent disease, it may be appropriate to continue nasal washing and topical corticosteroids for extended periods of time, or even permanently. With proper medical treatments, most patients do extremely well and do not require surgery. Surgery is aimed at facilitating sinus drainage by widening the outflow tracks and removing anatomic obstructions to adequate drainage. Although we now understand some of the dynamics of sinusitis, more research is needed to clarify our unanswered questions.