What is Chronic Sinusitis (Chronic Inflammation of the Sinuses)?
Sinusitis is a condition that causes the sinus or nasal passage to become inflamed. When this inflammation lasts for more than 12 weeks, it’s referred to as chronic sinusitis. If a person experiences more than four instances of sinusitis within a year, it’s known as recurrent sinusitis. The approach to diagnosing and treating both acute and chronic sinusitis is generally the same. Chronic sinusitis can manifest in three different ways: without nasal polyps, with nasal polyps, or as a result of allergic fungal rhinosinusitis.
What Causes Chronic Sinusitis (Chronic Inflammation of the Sinuses)?
As highlighted in the section about acute sinusitis, viruses and bacteria are most often the cause of sinusitis. The most common bacteria involved are Streptococcus, pneumococcus, Hemophilus, and Moraxella.
Chronic sinusitis, on the other hand, can be caused by a mix of factors. These can include infections, inflammation, or structural issues within the nose. As a result, other things like allergies (from dust mites or mold) or exposure to airborne irritants or toxins (like cigarette smoke) can also lead to sinusitis. Structural issues in the nose such as nasal polyps or a deviated septum can also be a cause. Dysfunction of the tiny hair-like structures in the nose (cilia), immune deficiencies, and fungal infections should also be taken into account.
It’s important to note that chronic sinusitis can also be associated with other medical conditions like ear infections, asthma, AIDS, and cystic fibrosis.
Risk Factors and Frequency for Chronic Sinusitis (Chronic Inflammation of the Sinuses)
Sinusitis is the inflammation of the paranasal sinus. It often comes with inflammation in the nasal airway as well, and when both are involved, it’s called rhinosinusitis. Chronic rhinosinusitis is quite common, affecting people of all ages. It’s actually the fifth most common reason doctors prescribe antibiotics.
Signs and Symptoms of Chronic Sinusitis (Chronic Inflammation of the Sinuses)
Sinusitis, also known as a sinus infection, typically presents with three main symptoms. These include:
- Purulent drainage: This is a green or yellow discharge from the nose.
- Facial or dental pain: Patients may experience aches, a sense of fullness, or a pressure-like feeling in the face or teeth.
- Nasal obstruction: This can result in difficulty breathing through one or both nasal passages, or may cause the person to breathe through their mouth.
Other signs of chronic sinusitis might include a decreased sense of smell (hyposmia), headaches, ear pain, bad breath (halitosis), dental pain, cough, or fatigue. Fever may also occur but is seen in only 50% of the cases. However, it is an important factor in determining the severity of sinusitis. Chronic sinusitis is diagnosed when these symptoms persist for more than 12 weeks. Recurrent sinusitis, on the other hand, is defined by four or more sinusitis episodes within a year.
Testing for Chronic Sinusitis (Chronic Inflammation of the Sinuses)
Chronic sinusitis is identified when you have at least two out of four specific symptoms for more than three months. These symptoms include: thick, colored nasal discharge, facial or dental pain, blocked nose, or diminished sense of smell. The Infectious Disease Society of America (IDSA) uses a similar checklist, adding facial congestion, pressure, and fullness. Alternatively, the IDSA may consider you have sinusitis if you have one of these significant symptoms plus two additional minor symptoms such as a headache, ear pain, bad breath, dental pain, cough, or tiredness.
During a check-up, your doctor will look for other potential causes like nasal polyps. Chronic sinusitis, which lasts twelve weeks or longer, is less frequent than acute sinusitis which can last up to four weeks. Other potential non-infection causes your doctor may consider include acid reflux, structural problems of the nasal cavity, immune system deficiencies, ciliary (small hair-like structures) issues, and fungal infections.
To confirm a chronic sinusitis diagnosis, it’s necessary to show inflammation – either through a CT scan or nasal endoscopy. CT scans are more sensitive but also more expensive than nasal endoscopies. Rhinoscopy, a technique that checks the front part of the nasal cavity, isn’t as accurate and shouldn’t be used to confirm chronic sinusitis. There’s a relatively new type of CT scan – a Cone-beam CT – that can be done during a single doctor’s visit and might be an option to consider.
Routine lab work isn’t necessary to diagnose chronic sinusitis. Your doctor might recommend cultures, which can guide the choice of antibiotic treatment. If an endoscopy is performed, cultures taken from the sinuses during this procedure are more precise than swabs taken from the back of the nose and throat. Allergy testing can also be useful and may be offered as an option.
Treatment Options for Chronic Sinusitis (Chronic Inflammation of the Sinuses)
There isn’t a one-size-fits-all approach to managing chronic sinusitis. Instead, the treatment aims to control triggers, lessen inflammation, and clear the infection.
Reducing Triggers
Allergy tests can help discover what environmental factors need to be avoided by patients.
Medical Management
Nasal steroids, used alone or alongside nasal saline irrigation, can help treat chronic sinusitis. Make sure to use the treatment correctly for a minimum of eight to twelve weeks. Although nasal saline irrigation isn’t as effective as nasal steroids, it can still complement the treatment. High volumes of nasal saline irrigation works better than low-volume nasal spray techniques.
Antihistamines are recommended only if an allergy is suspected. Decongestants can provide some symptom relief, but there isn’t strong evidence to support their use in treating chronic sinusitis. For severe cases, doctors can prescribe antibiotics for about three weeks. However, there isn’t universal agreement on when and which antibiotics to use for chronic sinusitis treatment.
Anti-fungal medicines are not recommended for starting therapy. Although oral steroids can be given, their regular use isn’t usually suggested. Doctors and patients should discuss together the pros and cons of using oral steroids.
Nasal Polyps
In the case of chronic sinusitis with polyps, topical nasal steroids are typically used. If there is no response or the case is severe after 12 weeks, a brief course of oral steroids can be considered. Using leukotriene antagonists can also be an option.
Surgical Management
If medication doesn’t offer relief, functional endoscopic sinus surgery can be an option. This surgery is useful in complex cases and aids in relieving blockages, restoring drainage, clearing mucus, and ventilating the sinuses.
If chronic sinusitis is caused by an underlying medical condition, the treatment should also address this condition, which may involve both medical and surgical approaches. Treating accompanying medical conditions, like asthma, otitis media, or cystic fibrosis, is also crucial.
What else can Chronic Sinusitis (Chronic Inflammation of the Sinuses) be?
When looking at conditions that might cause similar symptoms, doctors will also consider:
- Asthma
- Growths in the sinuses (sinus tumors)
- Infections in the mouth (oral cavity infections)
- Growths in the nose and sinuses (nasal and sinus papillomas)
Like in previous cases, thorough examination and tests are necessary to make the correct diagnosis.
Possible Complications When Diagnosed with Chronic Sinusitis (Chronic Inflammation of the Sinuses)
These are some medical conditions that people may experience:
- Laryngitis
- Dacryocystitis
- Orbital cellulitis/abscess
- Cavernous sinus thrombosis
- Meningitis, subdural abscess, brain abscess
- Frontal bone osteomyelitis
