Feature Article

Sinusitis: understanding the current rationale of treatment

Sylvester Fernandes



The management of sinusitis has altered dramatically in the last decade, offering new hope to sufferers. There is a clearer understanding of the pathophysiology of sinus disease and new investigative technology. New surgical skills have allowed restoration of ventilation and drainage of the sinuses with functional endoscopic sinus surgery.

Key Points

  • Sinusitis may be underdiagnosed in both children and adults.
  • Occlusion of the sinus ostia initiates the sinusitis cycle which, if untreated, leads to the development of chronic sinusitis; ostial blockage creates an ideal culture medium within the sinus; keeping the ostial passages open is essential to allow resolution of sinusitis.
  • New methods – nasal endoscopy and CT scanning – can help evaluate patients with both acute and chronic sinusitis. Nasal endoscopy should be performed before CT scanning.
  • First-line treatment involves antibiotics and decongestants to control infection, reduce tissue oedema, facilitate drainage and maintain ostial patency.
  • Functional endoscopic sinus surgery offers new hope of permanent symptoms relief and possible cure.