Sinus: Overview of Sinusitis
Guest: Dr. Rod Schlosser - Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. Today, I’m interviewing Dr. Rod Schlosser, who is Associate Professor of Ear, Nose, and Throat and Director of the Sinus Surgery program here. Dr. Schlosser, a lot of people talk about having sinusitis when, maybe, they just have a simple cold. What is the difference?
Dr. Rod Schlosser: A regular cold is simply a viral infection of the upper respiratory tract. Sometimes it can affect the sinuses secondarily. But sinusitis is more often thought of as a bacterial infection that is not simply just a viral infection.
Dr. Linda Austin: There must be a difference in how a doctor approaches treating a viral infection; a cold, versus a sinusitis, which is a bacterial infection. What is the difference?
Dr. Rod Schlosser: Well, with viral infections, we simply have to treat the symptoms; with pain relievers, ibuprofen, cough medicine, and things like that. Antibiotics are generally not going to be effective. If an infection has been progressing for longer than seven to ten days, that’s when we begin to think of bacterial infections and would consider treating with antibiotics.
Dr. Linda Austin: Other than duration, is there any way that one should begin to suspect that they have sinusitis?
Dr. Rod Schlosser: No. Typically, both conditions present very similarly; with low-grade fevers, thickened, discolored nasal drainage, congestion, just feeling worn out. Both of those present very similarly in the early stages.
Dr. Linda Austin: Sinuses are a part of the body that no one ever gets to see, except maybe you, as a surgeon. Just what are the sinuses?
Dr. Rod Schlosser: The sinuses are typically air-filled cavities that fill the cheek bones, the forehead area; the bones between the eyes.
Dr. Linda Austin: Are some people more prone, then, just for anatomic reasons?
Dr. Rod Schlosser: Sometimes it can, certainly, be anatomic abnormalities that play a role, such as a septal deviation, or other things. But more commonly, it’s thought of as patients having certain, probably, immunological abnormalities that may predispose them more so than anatomical abnormalities.
Dr. Linda Austin: Can allergies play a role?
Dr. Rod Schlosser: Yeah. Sometimes allergies can predispose a patient toward sinusitis. And sometimes it can be difficult to sort out. But, typically, if it’s only an allergic inflammation, the patients will have congestion, but the drainage will be clear and watery. They’ll also have itchy, watery eyes, and sneezing. If that inflammation, from an allergy, leads to a sinus infection, that’s when the color and the thickness of the drainage will change. The symptoms will get worse, and you’ll have more trouble with facial pain and pressure.
Dr. Linda Austin: So then, if you develop pain, let’s say, when you push mash, as we say in the South, over the cheekbones, that might be a sign that it’s sinusitis?
Dr. Rod Schlosser: That’s probably more indicative of sinusitis than an allergic inflammation, yes.
Dr. Linda Austin: And what are the medications you prescribe for that?
Dr. Rod Schlosser: Medications that are typically used for sinusitis are going to be antibiotics, sometimes systemic steroids; such as prednisone, or medrol. Depending on the patient and the type of inflammation that the physician sees, certainly topical nasal steroids; sprays, are useful. And then depending on the patient’s allergic status, we may add antihistamines, or leukotriene antagonists, or other considerations. Then, the short-term decongestants, either orally; Pseudoephedrine can be used, or sometimes topically; such as in a nasal spray that’s a decongestant.
Dr. Linda Austin: Dr. Schlosser, thank you so much.
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