By David L. Schneider M.D., Allergist & Immunologist
Sinusitis, or rhinosinusitis, is inflammation of one or more nasal sinuses. Sinus infections are the most common problem associated with inflamed sinuses. Under normal conditions, the sinuses are filled with air. However, if they become blocked and filled with fluid from viruses or allergies, bacteria may invade the sinus space and cause an infection. Sinus disease can also occur due to underlying allergy, immune deficiency, anatomical issues affecting proper drainage or ventilation or more rarely auto-immune conditions. A 2010 article in the American Journal of Medicine notes that over 24 million cases of acute bacterial sinusitis occur annually in the United States.
Sinusitis occurs and lingers with different duration and is categorized as follows:
Acute, which lasts up to 4 weeks
Subacute, which lasts 4 to 12 weeks
Chronic, which lasts more than 12 weeks and can continue for months or even years
Recurrent, with several attacks within a year
According to the National Institute of Allergy and Infectious Diseases, "Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip." Sinusitis can often be diagnosed based upon patient history and an examination made by a qualified physician, such as an allergist/immunologist. In many cases a review of a patient's history and an examination are not sufficient to provide a comprehensive medical assessment of the condition. In those cases, medical imaging may be prescribed by your physician as a valuable tool to your treatment plan. Physicians widely agreed that computer tomography (CT) scanning is the best method to view sinuses and diagnose chronic or recurrent sinusitis. CT scans are special X-ray tests that produce cross-sectional images of the body using X-rays and a computer. CT scans can show structural blockages, inflammatory swelling and the extent of an infection with much more detail than a conventional x-ray.
Some patients have raised concerns about the amount of radiation received during a CT. Standard x-ray procedures, such as routine chest x-rays and mammography, use relatively low levels of radiation. The radiation exposure from CT is higher than that from standard x-ray procedures, however, according to the National Cancer Institute, "The increase in cancer risk from one CT scan is still small." As radiation exposure may increase the risk for some people, our allergists are very judicious in the use of CTs. Unfortunately, this practice is not the case throughout the medical system. In fact, the United States ranks higher in its use of CT scans than any other industrialized country. An article that appeared last year in the New York Times noted that “The amount of "high-dose radiation — CT scans in particular — has soared in the last 20 years." The same article points out the fact that many of the CT scans ordered are being done despite the finding that "there is distressingly little evidence of better health outcomes associated with the current high rate of scans."
As specialty-trained physicians, we are aware and concerned about excess radiation exposure to our patients and we consider the following before ordering a sinus CT:
Are there anatomical or structural reasons sinusitis does not clear or continues to recur?
Are we reasonably certain that the sinus disease is chronic enough to justify the expense and potential radiation exposure while avoiding false positive findings in patients with simple viral Upper Respiratory Infections?
Are certain conditions present such as severe asthma, chronic coughs or immune deficiencies to warrant confirming its presence in difficult to control situations?
Has the clinical course been so complicated in treating a difficult case that radiographic confirmation of disease eradication is indicated?
Has the patient failed maximal medical treatment for sinusitis whereby a CT ordered specifically with surgical landmarks will confirm the diagnosis, help the patient see the disease present on the image and give the ENT surgeon appropriate information to treat the patient while avoiding more imaging?
Since a CT scan is at times necessary, I am proud to say our practice takes a proactive approach to minimize radiation exposure.
A few months ago, I collaborated with a local ENT and 3 New Orleans Area Radiology practices to implement a low-dose radiation protocol to image diseased sinuses. This protocol was deemed acceptable by all parties to accurately image the sinuses to make both medical and surgical diagnoses and treatment decisions. This approach makes CT imaging, when necessary, a safer experience for our patients and ensures that they receive the highest possible level of care.
If you are experiencing sinus problems or have concerns about sinusitis, come see us in New Orleans or Hammond. We are happy to provide a medical consult for your personal situation, work with you to discover the root cause and help get you on the road to feeling better soon.