Sinusitis is the inflammation of the mucous membranes lining the paranasal sinuses. This inflammation leads to a buildup of mucus, causing symptoms such as facial pressure, nasal congestion, and thick discharge. Determining the appropriate healthcare professional depends on the severity and persistence of these symptoms. Acute sinusitis typically lasts less than four weeks, while chronic sinusitis involves symptoms that continue for twelve weeks or longer, indicating a more complex underlying problem. The duration of the condition dictates whether a general practitioner or a specialized physician is needed for effective diagnosis and management.
Initial Medical Consultation
For most people experiencing a recent onset of symptoms, the initial consultation should be with a primary care physician (PCP), family doctor, pediatrician, or at an urgent care clinic. These providers manage the vast majority of acute sinusitis cases, which often begin after a common cold or upper respiratory infection. Diagnosis typically involves a review of symptoms, a physical examination, and sometimes a simple assessment of the nasal passages.
Since acute sinusitis is often caused by a virus, treatment focuses on symptom relief and monitoring. Therapies include decongestants to reduce swelling, saline nasal irrigation to aid drainage, and steroid nasal sprays to lessen local inflammation. If symptoms persist beyond seven to ten days, or if they worsen, the physician may suspect a secondary bacterial infection.
If a bacterial infection is likely, the provider may prescribe oral antibiotics, though most acute cases resolve on their own. If the infection is recurrent (four or more episodes within one year) or if symptoms become chronic (crossing the twelve-week threshold), the PCP will recommend a referral to a specialist. This referral is necessary for advanced diagnostic tools and specialized treatment options beyond general practice.
Role of the Otolaryngologist
For individuals with complex, recurrent, or chronic sinusitis, the next step involves consulting an otolaryngologist, a physician specializing in disorders of the ear, nose, and throat (ENT). These specialists evaluate the internal structure of the nasal cavity and sinuses for anatomical issues or persistent disease. The ENT examination often begins with a nasal endoscopy, using a thin, flexible tube with a camera to inspect sinus openings for polyps, inflammation, or discharge.
To gain a detailed view of the underlying bone structure and inflammation, the otolaryngologist may order a Computed Tomography (CT) scan. This imaging helps identify structural problems, such as a deviated septum or a narrowed sinus drainage pathway, contributing to the chronic condition. With this comprehensive diagnostic information, the ENT tailors a treatment plan addressing the specific cause of persistent symptoms.
Treatment options range from advanced medical regimens to surgical intervention. They may prescribe long-term high-dose nasal steroids or specialized rinses to manage inflammation. When conservative treatments fail, surgical procedures are recommended to improve drainage and airflow. These procedures include Functional Endoscopic Sinus Surgery (FESS) to remove blockages, or balloon sinuplasty, a less invasive technique that widens sinus openings.
Consulting Allergy and Immunology Specialists
In many cases of chronic sinusitis, the underlying cause is related to the body’s immune response rather than being purely structural or infectious. Consulting an allergist and immunologist is appropriate when chronic inflammation is suspected to be triggered by environmental factors or a compromised immune system. These specialists focus on identifying hypersensitivities that cause the lining of the nasal passages to swell, contributing to congestion and infection.
Diagnostic testing often includes skin prick tests or blood tests to pinpoint specific environmental allergens, such as dust mites, mold, or pollen. Identifying these triggers allows for the creation of a targeted management strategy. Patients may be advised on environmental control measures or prescribed specific medication to minimize the allergic response.
Beyond allergies, an immunologist investigates whether a primary immunodeficiency is making the patient susceptible to recurrent, severe infections. Conditions like IgG subclass deficiency or selective antibody deficiencies can impair the body’s ability to fight off common pathogens, leading to chronic sinus issues. Treatment for identified immunodeficiencies may involve specialized therapies, such as immunoglobulin replacement therapy, to support the immune system and break the cycle of persistent infection.