Sinusitis in the aged. Optimal management strategies

Sinusitis is a common medical condition in the elderly; however, the clinical presentation is often subtle and the condition may not be readily diagnosed. The most important clinical clue to the diagnosis of acute sinusitis is the continuation of symptoms after a typical cold has subsided. In chronic sinusitis there is often a distinct lack of symptoms, although most patients will have nasal obstruction and purulent post-nasal drip. On physical examination, the patient with sinusitis will have thick, purulent, green or deep yellow secretions in the nasal passages. The use of radiographic imaging, such as sinus roentgenograms or CT scans, will help confirm the diagnosis. The goal of treatment of sinusitis is eradication of infection with clearance of the infected material from the sinuses. While the use of an appropriate antibiotic is necessary, the use of ancillary therapy is also of utmost importance. Steam and nasal saline, decongestants, topical corticosteroids and mucoevacuants are given in an attempt to reduce nasal obstruction, increase sinus ostia size, promote improved mucociliary function, decrease mucosal inflammation and thin secretions. In selected patients who fail to respond to aggressive medical therapy, functional endoscopic surgery can often provide relief. In patients with poorly controlled asthma, treatment of underlying sinusitis has been shown to dramatically improve the asthmatic state.