Chronic sinusitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 25, 2016
StartDiseasesChronic sinusitis

Sinusitis is a condition where the cavities around nasal passages swell and become inflamed. When this occurs for twelve weeks or more despite attempts to treat the condition, it is known as chronic sinusitis. Often referred to as chronic rhinosinusitis (CRS), the condition may develop with nasal polyps, without nasal polyps or as allergic fungal rhinosinusitis. The type of CRS largely determines how it will be treated.

Contents

Definition & Facts

A common chronic illness in the United States, chronic sinusitis persists for 12 weeks or more. It is an inflammation of paranasal sinuses and almost always includes nasal airway inflammation. As part of chronic sinusitis, mucus builds up in the sinuses and it becomes difficult to breathe through the nose. Throbbing pain in the face or head often accompanies this condition, and the eyes and the face may feel swollen.

Chronic sinusitis usually manifests as a continuation of untreated or unsuccessfully addressed acute sinusitis. This is often a noninfectious condition derived from allergies, cystic fibrosis, pollutant exposure or gastroesophageal reflux. Other risk factors include immune disorders, nonallergic rhinitis, allergic rhinitis, and anatomic obstruction in the ostiomeatal complex.

Young adults and those in middle age are most often affected by the condition, but children may also have chronic sinusitis. It is often the result of an infection or growths in the sinuses, also called nasal polyps. A deviated septum of the nose may also be a contributing factor to chronic sinusitis.

Symptoms & Complaints

Symptoms are usually quite consistent between patients diagnosed with chronic sinusitis or CRS. The symptoms include:

Most or all of the above signs and symptoms occur for 12 weeks or more. Some doctors diagnose chronic sinusitis when symptoms have been present for eight weeks or more, while others look for 12 weeks of symptom presence before diagnosing the condition as chronic sinusitis. Some symptoms that sometimes accompany the above, primary issues include:

Children with chronic sinusitis are often irritable, breathe through their mouth, snore, and are difficult to feed when symptoms are present. They may also sound nasal when speaking.

Causes

Patients with the following conditions are at increased risk of chronic sinusitis:

  • Abnormalities of the nasal passages, such as a deviated septum or nasal polyps
  • Sensitivity to aspirin that results in respiratory symptoms
  • Immune system disorder
  • Allergic conditions affecting sinuses, such as hay fever (also called 'allergies' and 'allergic rhinitis').
  • Asthma
  • Consistent exposure to environmental pollutants, such as secondhand cigarette smoke

Trauma to the face can also cause chronic sinusitis due to obstruction of sinus passages. Viral infections, bacterial infections, or fungal infections of the respiratory tract can precede chronic sinusitis. These conditions inflame and thicken sinus membranes, block drainage of mucus and otherwise enable growth of bacteria

Diagnosis & Tests

A physical examination by a doctor is the most common means of diagnosing chronic sinusitis. The doctor first feels for tenderness in the patient's nose and throat, then examines nasal passages. Such an exam of the nasal passages may include using a tool to hold the nose open, application of medication that constricts nasal passage blood vessels, or shining a light into the nose to look for fluid or inflammation. While looking at the nasal passages, the doctor will also be checking for nasal polyps or other abnormalities that may trigger sinusitis. Other means of diagnosing chronic sinusitis include:

Treatment & Therapy

Treatment for chronic sinusitis is focused upon the following actions:

  • Reduction of inflammation in the sinuses
  • Consistency in nasal passage draining
  • Elimination of underlying causes of the chronic sinusitis
  • Reduction in the number of CRS flare-ups

To relieve symptoms, the doctor may use one or more of the following treatments:

  • Nasal irrigation using saline sprayed into the nostrils to rinse nasal passages
  • Nasal sprays called corticosteroids to reduce inflammation
  • Injected or oral corticosteroids, if symptoms are severe
  • Over-the-counter decongestants or prescription tablets, liquids or nasal sprays
  • Over-the-counter pain relievers
  • Aspirin desensitization treatment when aspirin reaction is the cause of chronic sinusitis
  • Prescription antibiotics
  • Immunotherapy, when allergies are contributing to the condition
  • Surgery, when other methods of treatment fail

Patients can help reduce the symptoms of chronic sinusitis through the following measures:

  • Adequate rest to allow the body to fight inflammation
  • Drinking plenty of water and juice to dilute mucus secretions and promote healthy drainage
  • Avoiding caffeine and alcohol
  • Moisturizing the sinus cavities through breathing of warm, moist air
  • Applying warm compresses to the face to ease pain
  • Rinsing of nasal passages using a sinus rinse, saline canister or neti pot
  • Sleeping with head elevated to reduce congestion

Prevention & Prophylaxis

Prevention of chronic sinusitis often includes the following means:

  • Avoiding infections of the respiratory tract by avoiding others with contagious illnesses, such as common colds
  • Careful management of allergies
  • Avoidance of cigarette smoke and other pollutants
  • Use of a well-maintained and mold-free humidifier