Chronic Sinusitis

Chronic sinusitis or rhinosinusitis is an inflammation of your sinuses or cavities of nasal passage that lasts for minimum of eight weeks and doesn’t respond to treatments.

Accumulation of mucus due to blocked mucus drainage can cause breathing difficulties.

Pain and inflammation in the area around your eyes may be present along with headache.

Infection, nasal polyps (growth of lining of sinus) or crooked nasal septum can cause chronic sinusitis.

Mostly young and middle-aged adults suffer from chronic sinusitis but it can develop in children as well.

Signs and symptoms of chronic sinusitis and acute sinusitis are quite similar.

You may have chronic sinusitis if you experience at two of the following signs and symptoms:

• Thick, yellow or greenish discharge from the nose or down the back of the throat
• Nasal blockage or congestion, that causes breathing difficulty
• Pain and inflammation around your eyes, cheeks, nose or forehead
• Impaired sense of smell and taste

Some other symptoms likely to be present are:

• Ear pain
• Pain felt in your upper jaw and teeth
• Cough that usually worsens at night
• Sore throat
• Foul-smelling breath (halitosis)
• Extreme tiredness or irritability
• Nausea

Usually, similar symptoms are experienced in chronic and acute sinusitis but chronic sinusitis persists for longer time and causes extreme tiredness. Fever is common in acute sinusitis but not in chronic sinusitis.

When to see a doctor?

If you are frequently having acute sinusitis that lasts less than four weeks, you are likely to develop chronic sinusitis. Your doctor may refer you to an allergist (a specialist in asthma and other allergic disease) or an ENT specialist (a doctor who treats infections of ear, nose and throat). Schedule an appointment with your doctor if:

• You have frequent unresponsive episodes of sinusitis
• Symptoms do not improve after a week

Visit your doctor promptly if you have symptoms indicative of serious infections, such as:

• Pain and inflammation around your eyes
• An inflamed forehead
• Severe headache
• Confusion
• Double vision or any disturbances in vision
• Stiff neck
• Shortness of breath

Some of the common causes of chronic sinusitis are:

• Nasal polyps: Nasal polyps, noncancerous growth of lining of nasal passages or sinuses, may block your nasal passage.

• Allergic reactions: Fungal infections can elicit allergic reaction leading to sinusitis.

• Deviated nasal septum: The wall between the nostrils is crooked, so also called crooked septum, can obstruct nasal passage.

• Trauma to the face: A fractured or broken facial bone may cause obstruction of the sinus passages.

• Other medical conditions: Complications of different diseases, such as cystic fibrosis, gastroesophageal reflux, or HIV and other disease that affects immune system.

• Respiratory tract infections: Respiratory tract infections, especially common cold, can make your sinus membranes inflamed. The mucus cannot be drained and provides a suitable media for bacterial growth. Respiratory tract infections can be caused by virus, bacteria or fungi.

• Allergies such as hay fever: Allergic reaction can cause inflammation which leads to blockage of your sinuses.

• Immune system cells: Sinus can be swollen by activation of eosinophils, immune cells, in certain medical conditions.

Your doctor will examine your sinuses, eyes, ears, nose and throats to diagnose the cause of chronic sinusitis.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.

Write down your key medical information. Mention if you smoke or have allergies. Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

• Do my symptoms indicate chronic sinusitis?
• What could be other possible causes for my symptoms?
• What tests do I need?
• Do I need to follow any restrictions?
• Do you advise consulting a specialist?

Your doctor will examine your nose or throat to determine the possible cause of your symptoms. During examination, your doctor may:

• Open your nose with a tool.
• Constrict the blood vessels in your nasal passage by applying medication.
• View your nasal passage, with the help of light, to check if it inflamed

This helps your doctor to detect the cause of chronic sinusitis, such as nasal polyps or any other abnormalities.

Some other diagnostic methods include:

• Nasal endoscopy: Also called rhinoscopy, it involves inserting an endoscope (a thin, flexible tube consisting of a light) into your nasal cavity to view abnormality in your sinuses.

• Imaging studies: Computerized tomography (CT) or magnetic resonance imaging (MRI) scan are performed to obtain detailed image of your sinuses and nasal area which can be helpful in detecting a deep inflammation or physical obstruction that's difficult to detect using an endoscope.

• Nasal and sinus cultures: Cultures, though unnecessary, are done to check if chronic sinusitis is caused by bacteria or fungi.

• An allergy test: An allergy skin test is done it your allergy is thought to be the cause of your sinusitis. It helps identifying the allergen (allergy causing substance) responsible for recurrent sinusitis.

Treatment of chronic sinusitis focuses on:

• Reducing inflammation of sinuses
• Facilitating drainage of mucus
• Treating the cause of sinusitis
• Reducing the incidence of recurrent sinusitis attacks

Treatments to relieve symptoms

Your doctor may prescribe medications to relieve your symptoms. The treatments include:

• Saline nasal irrigation: Salt solution is sprayed into your nose to rinse your nasal passages.

• Nasal corticosteroids: Nasal corticosteroids like fluticasone, budesonide, triamcinolone, mometasone and beclomethasone are prescribed for prevention and treatment of inflammation. Different drugs.

• Corticosteroids: Drugs containing steroids may be given orally or by injection if you are suffering from severe sinusitis or if you have nasal polyps. Oral corticosteroids are reserved only for severe symptoms since they can cause serious side effects when used for longer period of time.

• Decongestants: Over-the-counter (OTC) and prescription decongestants, available in liquids, tablets and nasal sprays may be given to clear nasal congestions. Oxymetazoline is available as OTC nasal spray. Rebound congestion (returned severe congestion) are common with these drugs. So, they are not used for a long period of time.

• Pain killers: OTC pain medication such as aspirin, acetaminophen or ibuprofen can be used. Aspirin should be avoided in people younger than 18 years old because it may cause potentially life-threatening condition called Reye's syndrome. Some pain killers can exacerbate chronic sinusitis, ask your physician if it's safe to take the pain killer.

Antibiotics

Antibiotics are prescribed if you have a bacterial infection. If chronic sinusitis is not caused by bacteria, antibiotics are of no use.

Immunotherapy

Immunotherapy, to suppress the allergic reaction, is used if sinusitis is caused by allergies.

Surgery

When all other medications become useless, you may have an endoscopic sinus surgery. It involves surgical removal of nasal polyp or any tissue responsible for nasal blockage. A narrow sinus opening may be expanded to improve mucus drainage.

There is little information about about the prevention of chronic sinusitis,but the following measures may help:

• Avoid respiratory tract infections.
• Avoid contact with people who are suffering from cold.
• Wash your hands properly, before your meals.
• Avoid factors that can elicit allergic reaction.
• Avoid exposure to cigarette smoke and air pollutants.
• Use a clean humidifier to add moisture to dry air.

There are different ways to adapt your lifestyle in managing the symptoms of chronic sinusitis.

Here are some tips that may provide relief from sinusitis symptoms:

• Take sufficient rest

• Stay hydrated

• Avoid dehydrating drinks, such as caffeine or alcohol

• Moisturize sinus cavities. Place your head above a bowl of medium-hot water and cover your head with towel. Allow the vapor to spread over your face or breathe in the warm.

• Use warm, wet towels around your nose, cheeks and eyes to reduce facial pain.

• Rinse your nasal passages with saline. Special squeeze bottle, saline canister or neti pot can be used to rinse your nasal passages. You may also prepare a nasal lavage, also called home remedy, using purified water. Do not forget to rinse the device after each use with pure water.

• Raising your head may help to drain your sinuses.

There are several risks and complications associated with chronic sinusitis.

Risk

• Deviated nasal septum or nasal polyps
• Aspirin allergy
• Diseases of immune system, such as HIV/AIDS or cystic fibrosis
• Hay fever or other allergic conditions.
• Cigarette smoking and exposure to second hand smoke

Complications

• Asthma attack: Chronic sinusitis may trigger an asthma attack.
• Meningitis: Infections that cause sinusitis may also cause inflammation of meninges (membranes and fluids that surround your brain and spinal cord).
• Vision problems: Vision may be impaired if the infection spreads to your eyes. In rare cases, permanent blindness may result.
• Aneurysms or blood clots