Chronic Sinusitis

Definition

Chronic sinusitis is one of the most commonly diagnosed chronic illnesses in the United States, affecting 30 million to 40 million Americans each year.

Chronic sinusitis begins with an inflammation of the mucous membranes in your sinuses — the air-filled passages around your nose and throat. The inflammation causes fluid buildup eventually plugging the sinus cavity and preventing normal mucus drainage.

Chronic sinusitis can be a miserable condition that significantly impairs your quality of life. If you have chronic sinusitis, you may have difficulty breathing through the nose, experience frequent headaches and tenderness in the face or aching behind the eyes. You may also have frequent yellow or greenish discharge from your nose or drainage down the back of your throat.

Chronic sinusitis can be caused by infections of the upper respiratory tract — the nose, pharynx, sinuses and throat — but there are noninfectious triggers too. Allergies are a common cause, and anatomical problems such as a deviated nasal septum can bring on chronic sinusitis. Other suspected causes include mold or fungi in the sinuses.

Most cases of sinusitis are acute, meaning they resolve in less than four weeks. However, when the condition recurs or endures longer than 12 consecutive weeks, you’ve developed a case of chronic sinusitis.

Symptoms


The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except they last longer and often cause more significant fatigue. Chronic sinusitis usually does not cause fever.

The signs and symptoms of chronic sinusitis include:

  • Facial pain and pressure especially in the forehead, temples, cheeks, nose and behind the eyes
  • Difficulty breathing through the nose
  • Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat
  • Reduced sense of smell or taste
  • Nasal obstruction or congestion
  • Aching in your upper jaw and teeth
  • Headache
  • Teeth pain
  • Bad breath (halitosis)
  • Ear pain
  • Fatigue
  • Cough
  • Nausea
  • Sore throat

Causes

Anything that inflames the membranes of the sinus cavity or blocks the sinus passages from draining normally can cause sinusitis.

Common causes of sinus blockage include allergies, viral and bacterial infections, and nasal polyps.

  • Allergies. Anything that causes an allergic reaction, such as pollen, pet dander or dust mites, can trigger an attack response from your body. The results of this battle mimic the signs and symptoms of a cold, such as stuffy nose, itchy eyes and cough, and can cause congestion in the sinuses.
  • Respiratory tract infections. Infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, impeding mucus drainage and creating conditions ripe for growth of bacteria. These infections can be viral, bacterial or fungal in nature.
  • Nasal or sinus obstructions. Nasal polyps are small growths that can obstruct the sinus passages. Sinus blockagecan also be triggered by other anatomical problems such as a deviated or crooked septum — the wall between your nostrils — or particularly small openings between your sinuses and nasal cavity.
  • Other medical conditions. The complications of cystic fibrosis, HIV and other immunodeficiency diseases can result in nasal blockage. For example, with cystic fibrosis your body’s secretions become thick and sticky in your sinuses as well as in your lungs.
  • Trauma to the face. A fractured or broken facial bone may cause obstruction of the sinus passages.
  • Mold in the sinuses. Some experts believe that chronic sinusitis is triggered by an allergic reaction to mold in the nasal cavity.
  • Airborne fungus. Some experts believe that the cause of chronic sinusitis is due to an inflammatory reaction to certain types of airborne fungi. These fungi are present in virtually everyone. However, sufferers of chronic sinusitis may react to the fungi by producing cytokines or elevated levels of eosinophils in the sinuses. Cytokines are compounds that cause or regulate inflammation and other immune responses. Eosinophils are a type of white blood cell that can cause inflammation in the sinuses. This reaction may trigger the inflammation that leads to chronic sinusitis in some people.

When to seek medical advice

People may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. If you’ve had sinusitis a number of times and the condition fails to respond to treatment, or if your infection has lasted more than three months, ask your doctor to test for chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist.

Complications

Chronic sinusitis can increase the frequency and severity of asthmatic flare-ups in people with asthma. In cases where sinusitis is caused by an underlying infection, complications may include meningitis, in which infection spreads to the lining of the brain, and vision problems should the infection spread to the eye socket.

Tests and diagnosis

Because the symptoms of chronic sinusitis can resemble those of colds or allergies, chronic sinusitis can be difficult to diagnose. Tell your doctor as much as possible about your symptoms.

Your doctor may use several methods to help screen for chronic sinusitis:

  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
  • Imaging studies. Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical obstruction that’s difficult to detect using an endoscope.
  • Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing chronic sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial pathogen.
  • An allergy test. If your doctor suspects that the condition may be brought on by allergies, an allergy skin test may be recommended. A skin test is safe and quick and can help pinpoint the allergen that’s responsible for your nasal flare-ups.

Treatments and drugs


A doctor’s approach to treating chronic sinusitis will aim to clear the nasal passages and also eliminate the underlying cause.

Treatments for chronic sinusitis include:

  • Antibiotics. A course of antibiotics can help eliminate sinusitis caused by a bacterial infection. Your doctor may prescribe antibiotic therapy for three to 12 weeks, or until you’ve been symptom-free for seven days.
  • Corticosteroids. Your doctor may prescribe corticosteroids to reduce swelling if you have severe inflammation of your sinuses. Corticosteroids may be delivered through the nose, such as Flonase, Beconase or Nasacort, or taken orally, as in the case of prednisone.
  • Decongestants and antihistamines. Taken orally or in the form of a nasal spray, decongestants or antihistamines can help dry up or shrink the backed-up mucus and give temporary relief by helping to drain the sinuses. Examples of these medications include Afrin, Sudafed, Allegra and Claritin.
  • Moisture and humidification. Flushing the nasal cavity with saline nasal sprays can help loosen dried mucus. In dry climates, installing misters or humidifiers in the home can promote nasal drainage.
  • Immunotherapy. If allergies are contributing to the sinusitis, stimulating the antibodies that block the body’s reaction to specific allergens may help alleviate the condition.

In cases that continue to resist treatment or medication, endoscopic sinus surgery may be an option. For this procedure, the doctor uses an endoscope, a thin, flexible tube with an attached light, to explore your sinus passages. Then, depending on the source of obstruction, the doctor may use various tools to remove tissue or shave away a bone or polyp that’s causing nasal blockage. Enlarging a narrow sinus opening may also be an option to promote drainage.

Another treatment method that may become more common is balloon rhinoplasty which helps open the sinuses by inserting and then inflating a balloon inside the sinus cavities. The procedure is less invasive than is sinus surgery. However, it’s relatively new and long-term results are still unclear.

Prevention

You can reduce your risk of developing chronic sinusitis by:

  • Good hygiene. Wash your hands frequently, especially before meals, to avoid contracting viral, bacterial or fungal infections.
  • Carefully managing allergies. Work with your doctor to get symptoms quickly under control.
  • Treating cold symptoms immediately. Drink plenty of fluids and keep your nasal passages clear when you contract a cold. Use decongestants and try to prevent a cold from lingering.
  • Avoiding cigarette smoke and polluted air. These contaminants can irritate and inflame your nasal passages.
  • Using a humidifier. Adding moisture to the air can keep your nasal passages clear.
  • Taking care to prevent asthma attacks. Try to eliminate potential triggers of an asthma attack. Limit exposure to allergens, tobacco smoke and other causes.

Lifestyle and home remedies

You can help alleviate the symptoms of chronic sinusitis:

  • Avoid bending over, which may increase the pressure or pain you feel in the face.
  • Apply warm facial packs to relieve discomfort.
  • Inhale steam from a kettle or basin of boiling water to help clear the nasal passages.
  • Install a humidifier to keep the air in your home moist and clean.
  • Drink plenty of fluids to help dilute your nasal secretions.