Chronic Sinusitis

Chronic rhinosinusitis is a group of different diseases that affect nasal mucosa and paranasal sinuses. These diseases last 12 weeks or longer, in spite of medical treatment.

Chronic sinusitis is divided into 3 syndromes since treatments are different. The 3 syndromes are:

1. Chronic sinusitis without nasal polyps which accounts for about 65 percent of cases


2. Chronic sinusitis with nasal polyps which account for about 25 percent


3. Allergic fungal sinusitis which accounts for about 10 percent

Those who are inflicted with chronic sinusitis must have at least 2 of the following 4 symptoms:

1. Yellow or greenish runny nose
2. Facial pain or pressure
3. Stuffy nose or nasal obstruction
4. Diminished sense of smell

CT scans of sinuses are usually required to make an accurate diagnosis (see picture).

Treatment of chronic sinusitis usually involves multiple therapies, most of which have not been validated in randomized trials. In most cases, the goal of treatment is to alleviate symptoms since chronic sinusitis may not be cured.

Greenfield by The Brothers Four

Acute Sinusitis

Sinusitis, also known as rhinosinusitis, is commonly caused by viruses. Viruses initially infect nasal mucosa then spread to paranasal sinuses (see picture). Interestingly, nose blowing may propel infected nasal fluid into sinuses.

In 0.5 to 2 percent of viral sinusitis cases, bacteria impose more complicated infection. The most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. It may be difficult to tell viral from bacterial sinusitis, since existing clinical criteria are not reliable. Abnormal vision, swelling of eyes, or confusion are worrisome symptoms that require urgent referral to specialists.

Sinus CT scan is not helpful in differentiating between viral and bacterial sinusitis. CT may help exclude diagnosis of sinusitis if there are no evidence of edema or gaseous bubbles. Sinus CT should be done without contrast.

Antibiotics are indicated for bacterial sinusitis, but not recommended for viral cases.

Vivo Per Lei by Andrea Bocelli

Body Mass Index (BMI) and Obesity

Obesity has been associated with at least 15 well-known health problems and been documented in medical literature for at least 2000 years. The Framingham Study concluded that those who were obese at age 40 lived 6 to 7 years less than those who were not [Ann Intern Med 2003 Jan 7;138(1):24-32].

In Japan, people over 40 have to undergo waistline measurement to see if they are too fat or not. Those who are deemed too fat have to go through diet counseling. If chubby Japanese fail to get slender, they may be fined.

New Zealanders go even more extreme: Goverment can restrict those who are deemed "too fat" from immigrating to the country. It is unclear, however, which criteria New Zealand goverment uses to determine a "fat" individual from "non-fat" one .

In the U.S., obesity is a big public health problem. Data from the National Health and Nutrition Examination Survey 1999-2000 shows that the prevalence of overweight and obesity in adults is 64.5 percent and 30.5 percent, respectively. Even though there is no fine or immigration restriction policy yet in the U.S., life-style changes and weight-loss treatment are recommended for men and women whose waistlines are greater than 40 inches (102 cm) and 35 inches (89 cm), respectively.

The body mass index (BMI) is used to evaluate obesity. Overweight is defined as a BMI between 25 and 30; obesity between 30 and 35; morbid obesity greater than 35.

If you are curious about where you stand in the BMI spectrum, you may want to use the calculator located in the lower right-sided corner of vietshealth blog home page.