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Chronic sinonasal disease is a significant part of any primary care practice. Up to 40% of patients present initially to the primary care practitioner for evaluation and treatment of an array of nasal complaints, from post nasal drip, nasal obstruction, facial fullness and pain, to sneezing, itchy eyes and throat, chronic cough and sinus headaches. Often patients leave with a “one-size fits all” treatment regimen, which may or may not be effective in alleviating the symptoms. Recent research even suggests that most sinusitis does not require antibiotics, yet most patients will leave the office with a prescription for the same. In children, some of OTC treatments for cough and cold are actually dangerous, and current recommendations to avoid such treatments do not offer patients alternatives for symptom relief. This is not satisfying or safe for either the patient or practitioner.
While this constellation of symptoms are often termed “sinusitis”, further evaluation often leads to a variety of diagnoses. More subtle complaints that are the result of nasal and sinus disease are often missed, including fatigue, sleep disruption, smell and taste abnormalities. Myofascial pain in the head and neck often presents as sinus pressure and sinus pain. Underlying conditions that can predispose to these symptoms include respiratory and food allergies, adenoid, tonsillar and nasal anatomical abnormalities, long term fungal infections, gastroesophageal reflux, and myofascial trigger points. Each of these can be approached with an integrative perspective, with the treatment individualized for the patient’s particular needs.
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