regular X-rays, once the standard of diagnosis,
because the results are not reliable. For chronic
sinusitis the otolaryngologist conducts an exten-
sive examination that includes a COMPUTED TOMOG-
RAPHY(CT) SCANand ENDOSCOPYto directly evaluate
the condition of the sinuses. The doctor may also
culture a sample of the nasal discharge to identify
the BACTERIAthat are present.
Treatment Options and OutlookAcute bacterial sinusitis requires to treatment with
an ANTIBIOTIC MEDICATIONS. Decongestant medica-
tions help relieve stuffiness and congestion by
constricting the blood vessels that supply the
mucous tissue within the nose. ANTIHISTAMINE MED-
ICATIONSmitigate the body’s immune response to
allergens such as dust and pollen that cause local
irritation of the nasal tissues.
Chronic bacterial sinusitis often requires irriga-
tion of the sinuses with a solution of antibiotic
and decongestant, which the otolaryngologist does
as an office procedure. Home treatment may
include an oral antibiotic, humidifier to add mois-
ture to the air, and saline nose drops to keep the
nasal passages moist. Moisture helps reduce irrita-
tion and swelling. Surgery may be necessary to
correct any problems such as septal defect, SEPTAL
PERFORATION, and NASAL POLYP, or to widen the nasal
ostia (openings in the sinuses).
Risk Factors and Preventive Measures
Sinusitis is more common in people who have
seasonal rhinitis (allergies). The presence of aller-
gens causes the nasal passages to swell, establish-
ing ideal conditions for bacteria to grow. Keeping
seasonal rhinitis symptoms under control helps
reduce congestion. Sinusitis is also more common
in people with structural anomalies of the nose
such as SEPTAL DEVIATION. Untreated, chronic, or
recurrent OTITISmedia (ear infection) can funnel
bacteria to the base of the nose via the EUSTACHIAN
TUBE. Prompt, appropriate treatment for acute
sinusitis helps limit recurrent and chronic infec-
tions.
See also ALLERGEN; SNEEZE; X-RAY.
smell and taste disturbances Dysfunctions of
smell and taste result in the inability to perceive
odors and tastes or the BRAINinterpreting smell
and taste messages incorrectly. Dysfunctions that
affect the perceptions of smell and taste are com-
mon side effects of medications, consequences of
health conditions such as STROKE, and dimensions
of aging. Disturbances of smell and taste affect
one’s ability to enjoy daily pleasures such as the
fragrances of flowers and the flavors of foods. But
smell and taste are not only matters of QUALITY OF
LIFE. These chemosenses, as researchers refer to
them, also provide early warning of potentially
hazardous circumstances. Many spoiled foods, for
example, smell and taste rancid. In the United
States, natural gas distributors add the chemical
mercaptan, which smells strongly like rotten eggs,
to pipelines and storage tanks to warn of gas leaks.
Because the functions and disturbances of smell
and taste are nearly inseparable, disturbances of
one affect the other. Most commonly, diminished
smell reduces the ability to perceive flavors.
Though the taste cells within the taste buds may
remain fully functional, the brain requires the
detailed NERVEsignals the olfactory bulb gathers
and sends to interpret flavors. The brain perceives
primarily bitterness when taste is the only sense
sending messages about chocolate, for example,
because cocoa, chocolate’s key ingredient, is a bit-
ter substance. The brain interprets the distinctive
sweetness and flavor of chocolate only when the
olfactory sensors detect and report the hundreds
of odor molecules that chewing releases from the
chocolate, which then swarm into the NOSEfrom
the back of the THROAT. As much as 80 percent of
the perception of flavor derives from smell.Symptoms and Diagnostic Path
Though about 200,000 Americans seek medical
care for disturbances of taste and smell, health
experts believe millions live with diminished or
altered chemosenses without realizing it. People
are most likely to notice disturbances that come
on suddenly or involve distinctive changes. Most
people report problems with taste, though typi-
cally the culprit is more often related to smell.
Symptoms can range from isolated to total loss of
smell, taste, or both. People may notice they no
longer taste the seasonings in foods or smell the
flowers in a garden. With some health conditions
such as PARKINSON’S DISEASE, perceptions of flavor
change. People who have DIABETESor HYPERTENSION52 The Ear, Nose, Mouth and Throat