Just reading the litany of symptoms is enough to make you sick – stuffy nose, post-nasal drainage, discolored mucus from the nose, facial pain and pressure, a toothache, cough, loss of smell, bad breath, headache and fatigue. Those are most, though not all, the woes caused by sinusitis, one of the most often diagnosed diseases in the United States. But when physicians diagnose sinusitis, are they all singing from the same page of the hymnal? Not necessarily, according to the American Academy of Allergy, Asthma & Immunology. That's why the academy late last year released an updated practice parameter with an agreed-upon definition of sinusitis and new recommendations for diagnosis and management of the disease. One of the reviewers of this new parameter was Dr. Brian A. Smart, allergist at the Asthma and Allergy Center of DuPage Medical Group in Glen Ellyn, Ill. An active member of AAAAI, Smart explains that sinusitis is "a very active field of research right now. Not so recently, we used to think of it as a problem of sinus infections only. More recently, we've come to realize that sinus infections are for many people a secondary process that comes from the primary process." And the primary process, quite simply, is inflammation of the sinus linings. The inflammation is usually caused by inadequate draining due to allergy, infection or obstruction. According to AAAAI, physicians identify basically two categories of sinusitis: acute and chronic. Sinusitis is usually preceded by a cold, allergy attack or irritation from environmental pollutants. The resulting symptoms normally run their course in a few days. However, if symptoms persist, a bacterial infection or acute sinusitis may develop. If the condition occurs frequently or lasts three months or more, it may be chronic sinusitis. "I think the major breakthrough is simply in identifying sinusitis in most people as a chronic inflammatory problem and in making it clear that a sinus infection does happen and is a problem but is not the most common problem with most people with sinusitis," Smart says. He explains that even among scientific studies regarding sinusitis, definitions of the malady may vary. Thus, comparisons of research findings are skewed. The new parameters help physicians "compare outcomes in a useful way," he says. "With these practice parameters, hopefully, we can tell people as clearly as possible what sinusitis is and how we should measure it for our patients so the results of research will be easier to understand." Smart says that acute sinusitis usually has a bacterial or viral trigger and the symptoms "mimic a very persistent cold." However, with chronic sinusitis, the diagnosis may be "much more subtle" and with abnormal CT or MRI findings. Pharmaceutical treatments include antibiotics, nasal corticosteroids, saline solutions and decongestants. The use of antibiotics "depends on the circumstances," Smart says. "When I see a patient who has had chronic sinusitis and is really suffering from the symptoms, I'll oftentimes treat with antibiotics for three solid weeks. One reason for that long treatment is that the blood flow that serves the sinuses isn't very good. You have to treat longer sometimes to be sure the antibiotics really make it up there." Even after three weeks of antibiotic therapy, patients may improve and then relapse. "Every so often we have patients who need antibiotics for two to three months going. Obviously, we don't want to overtreat people, but for some people with chronic sinusitis, they really need sustained antibiotics to really get better," he says. Smart adds that individuals who suffer from allergies are more prone to be diagnosed with chronic sinusitis. "For many people, it's not entirely clear what the link is. The conventional thinking is that there's nasal inflammation from the allergies, which leads to thickening around the openings from which the sinuses drain. If the sinuses can't drain normally, then the mucous inside will get trapped. That mucous is a great place for bacteria to grow, and the inflammation gets even worse," he explains. "It's a self-perpetuating process." About 50 percent of patients with chronic sinusitis have allergies, and that's more than twice the rate for the general population. Smart looks at surgery as a last resort for sinusitis treatment, although he acknowledges that it's an option if a blockage is contributing to the problem. Blockages might include a severe deviation of the nasal septum, an air cell in the nose called a concha bullosa, widespread polyps or an anatomical abnormality of the outflow passages from the sinuses. To lessen the symptoms of chronic sinusitis, the AAAAI recommends rest, sleeping with the head elevated, a humidifier and staying hydrated by drinking lots of fluids.