The second type is chronic sinusitis, which may be caused by bacterial infection, but more often is a chronic inflammatory disorder similar to bronchial asthma. Immunologic problems are another possible cause of chronic sinusitis. Researchers have found that the ability of children with chronic sinusitis to respond to immunizations correlates with their ability to fight bacteria that cause sinusitis. More than half of the children with chronic sinusitis in the study had abnormalities in their immune systems. However, the results of this study may not be conclusive. More research needs to be done before we can understand the relationship between chronic sinusitis and abnormalities in the immune system.

Structural problems in the nasal cavity may be another cause of recurring sinusitis. Narrow drainage passages within the nose or nasal obstruction from tumors, polyps or a deviated nasal septum are examples of structural problems. Although medications can often prevent recurring sinusitis, surgery is sometimes needed to remove the nasal obstruction. Many patients with recurring or chronic sinusitis have more than one of these factors that predispose them to infection, so addressing only one factor may not be sufficient.

  Diagnosis

Even if symptoms are localized to the sinuses, infection is not always present. To make a correct diagnosis, the physician will take a detailed history and conduct a physical examination. Tests may also be needed. These tests can include allergy skin testing, sinus x-ray, CT scans (which make precise images of the sinus cavities), and sampling of the nasal secretions or lining.

The physician may also perform an endoscopic examination. This is when a narrow, flexible fiber-optic scope is placed into the nasal cavity through the nostrils. It allows the physician to view the area where the sinuses and middle ear drain into the nose in an easy "patient friendly" manner.

  Treatment

Sinus infections generally require a combination of medications. In addition to an appropriate antibiotic when the sinusitis can be shown to be related to bacterial infection, a medicine may be prescribed to keep the sinus drainage passages open by reducing obstruction and controlling allergy. This drainage-opening medicine may be a decongestant, mucus-thinning medicine or a cortisone-like nasal spray. Antihistamines, cromolyn and topical steroids (sprayed into the nose) help control allergy and inflammation. Long-term treatment for controlling and reducing allergic sensitivity can be effective in preventing the development of sinusitis in people with allergies. This treatment may include immunotherapy, anti-inflammatory medications, decongestants, and environmental control measures. The preventative use of low dose antibiotics and sinus drainage medications during times of increased susceptibility, such as winter, also may prevent sinusitis from occurring. A variety of non-medicine mechanical treatments can be of value. These include steam inhalations, increasing the intake of fluids, hot packs and the use of an over-the-counter sterile salt water spray. In some cases of obstructed sinus passages, a referral to an otorhinolaryngologist (ENT) may be suggested.