Understanding Sinusitis and Allergy: The Asthma Center Education and Research Fund Manual Written by: Marc F. Goldstein, M.D. Irene C. Haralabatos, M.D. Nancy D. Gordon, M.D. Anar A. Dossumbekova, M.D., Ph.D. Edward A. Fernandez, M.D. Rebecca N. Mindel, B.A. 3rd Edition The Asthma Center Education and Research Fund Professional Arts Building Suite 300 • 205 North Broad Street • Philadelphia, PA 19107 • (215) 569-1111 ii The Asthma Center Education and Research Fund Sinusitis and Allergy Manual ©2020 The Asthma Center Education and Research Fund Understanding Sinusitis and Allergy: The Asthma Center Education and Re- search Fund Manual is the sole property of The Asthma Center Education and Research Fund and cannot be reproduced, used commercially, or redistributed for any reason without written permission from The Asthma Center Education and Research Fund. The Asthma Center Education and Research Fund Sinusitis and Allergy Manual iii Table of Contents PART ONE Sinusitis Chapter 1. Anatomy and Function....................................................................................................................................... 5 What are the Sinuses and How Do They Work?.............................................................................................. 5 Maxillary Sinuses .......................................................................................................................................... 6 Ethmoid Sinuses............................................................................................................................................. 7 Frontal Sinuses .............................................................................................................................................. 7 Sphenoid Sinuses............................................................................................................................................ 8 Nasal Turbinates.................................................................................................................................................... 8 Respiratory Mucous Membranes........................................................................................................................ 10 Mucociliary Clearance......................................................................................................................................... 11 How Do You Test for Mucociliary Clearance?................................................................................................. 13 Chapter 2. Sinusitis: Types, Diagnosis, and Treatment...................................................................................................... 15 Acute Sinusitis....................................................................................................................................................... 15 Symptoms of Acute Sinusitis....................................................................................................................... 17 Diagnosing Acute Sinusitis.......................................................................................................................... 17 Nasal Cytology (examination of nasal secretions) and Biopsy ..................................................... 19 CT Scan of Sinuses ............................................................................................................................... 20 MRI of Sinuses....................................................................................................................................... 21 Conventional X-ray, Ultrasound and PET Scans of Sinuses ......................................................... 22 Causes of Acute Sinusitis............................................................................................................................... 22 Viral Infections...................................................................................................................................... 22 Bacterial Sinusitis ................................................................................................................................. 24 Cultures.......................................................................................................................................................... 25 Natural Course and Complications of Acute Sinusitis............................................................................. 25 Antibiotic Treatment Guidelines for Acute Bacterial Sinusitis................................................................ 26 Chronic Sinusitis................................................................................................................................................... 28 Symptoms of Chronic Sinusitis .................................................................................................................. 29 Diagnosing Chronic Sinusitis...................................................................................................................... 29 Sinus Imaging for Chronic Sinusitis .................................................................................................. 29 Causes of Chronic Sinusitis.......................................................................................................................... 30 Nasal and Nebulized Antibiotics for Treatment of Chronic Sinusitis .................................................. 30 Intravenous Antibiotics for Chronic Sinusitis.......................................................................................... 31 Immunoglobulin Replacement Treatment for Chronic Sinusitis....................................................... 31 Noninfectious Chronic Sinus Disease......................................................................................................... 32 Chapter 3. Acute and Chronic Sinusitis Risk Factors.......................................................................................................... 33 Medical Risk Factors............................................................................................................................................. 33 Air Pollution.......................................................................................................................................................... 34 Post Nasal Drip...................................................................................................................................................... 35 Fungal Sinus Disease............................................................................................................................................ 35 Nasal Polyps and Sinus Disease............................................................................................................................ 37 Aspirin Hypersensitivity, Nasal Polyps and Sinus Disease............................................................................. 38 Sinus Headaches and Migraines......................................................................................................................... 39 Other Causes of Facial Headache....................................................................................................................... 41 Asthma and Sinus Disease.................................................................................................................................... 42 Chapter 4. Surgical Treatments for Sinusitis........................................................................................................................ 43 Functional Endoscopic Sinus Surgery................................................................................................................. 43 Other Types of Sinus Care................................................................................................................................... 44 Post Operative Care.............................................................................................................................................. 44 What Happens if Surgery Fails............................................................................................................................ 45 PART TWO Upper Respiratory Allergies............................................................................................................................... 46 Chapter 5. Mechanism of Allergic Reactions........................................................................................................ 47 Chapter 6. Environmental Airborne Allergens..................................................................................................... 48 Outdoor Allergens.................................................................................................................................. 48 Tree Pollen....................................................................................................................................... 49 Grass Pollen ................................................................................................................................... 49 Weed Pollen..................................................................................................................................... 50 Molds............................................................................................................................................... 50 Indoor Allergens....................................................................................................................................