What Is Chronic Sinusitis: Symptoms, Causes, and Treatment

Introduction

Chronic sinusitis is the inflammation of the sinuses that tend to persist for 12 weeks or more, despite treatment attempts. Another term for chronic sinusitis is chronic rhinosinusitis, which causes mucus buildup due to an impaired drainage of the sinuses. People with chronic sinusitis often experience facial pain, especially around their eyes along with difficulty breathing through their nose. 

Chronic sinusitis can be a result of an infection, nasal polyps, or a deviated septum. Although chronic sinusitis is commonly observed in both young and middle-aged adults, the condition can also affect children. 

Symptoms

Sinusitis is considered chronic if the symptoms last for more than 12 weeks. The major signs and symptoms of chronic sinusitis include:

• Headache
• Facial pain and swelling around the eyes, nose, forehead, and cheeks
• Nasal congestion
• Difficulty breathing through the nose
• Thick and yellowish-green nasal discharge 
• Post-nasal drip
• Loss of smell and taste (in adults)
• Coughing (in children)

Other signs and symptoms of chronic sinusitis are:

• Nausea
• Halitosis (bad breath)
• Ear pain
• Sore throat
• Fatigue 
• Irritability
• Upper jaw pain
• Worsening cough at night

Both acute and chronic sinusitis tend to have the same symptoms. However, acute sinusitis is usually associated with a cold and is a temporary infection. Fever, which is uncommon in chronic sinusitis, may also occur in people with acute sinusitis. Since chronic sinusitis tends to last longer, it usually causes more fatigue than acute sinusitis.  

Causes

Below are some of the common causes of chronic sinusitis:

• Respiratory Tract Infections: The common cold is the most common respiratory tract infection in humans that can cause clogging and inflammation of the sinuses. Respiratory tract infections can also be due to bacteria, viruses, or fungi. 

• Deviated Septum: The nasal septum (the wall that divides the nasal cavity in half) is crooked and can restrict the drainage of sinuses, which lead to frequent sinus infections.

• Nasal Polyps: These noncancerous growths can block the sinuses leading to inflammation. 

• Allergies: Certain allergies, such as hay fever and asthma, can cause inflammation and blockage of the sinuses. 

• Other Health Conditions: Nasal congestion or blockage can also be a complication of certain medical conditions, such as gastroesophageal reflux disease (GERD), cystic fibrosis, immune-related diseases, or HIV. 

Diagnosis

Your healthcare provider will check for any facial and nasal tenderness and will also take a look inside your nose. Chronic sinusitis can be diagnosed with the following tests:

• Allergy Testing: When allergy is suspected as the cause of your condition, your healthcare provider might recommend an allergy test. An allergy skin test can help your doctor identify the specific allergen that's causing your sinusitis. 

• Nasal Endoscopy: In this procedure, an endoscope, which is a thin and flexible tube with fiber optics is inserted through the nose to visualize the inside of the sinuses. Nasal endoscopy is also called rhinoscopy. 

• Imaging Studies: An MRI and a CT scan are imaging studies that can show detailed pictures of your nasal area and sinuses. These imaging techniques are helpful when obstruction and deep inflammation are difficult to detect through endoscopy. 

• Sinus Cultures: Generally, sinus cultures are not always required when it comes to diagnosing chronic sinusitis. However, tissue cultures may help identify the cause of chronic sinusitis, especially when a patient's condition worsens or fails to respond to treatment. 

Treatment

Chronic sinusitis treatment helps relieve or eliminate the following:

• Sinus inflammation
• Blocked sinuses
• The underlying cause of the condition
• Sinusitis flare-ups

The symptoms of chronic sinusitis can be relieved using the following treatments:

• Saline Nasal Irrigation: Uses solutions and nasal sprays that can help rinse irritants, promote drainage, and reduce allergies. 

• Nasal Corticosteroids: These medications are usually in the form of nasal sprays. They help treat and prevent inflammation. Some examples of nasal corticosteroid sprays are fluticasone (Veramyst, Flonase), budesonide (Rhinocort), beclomethasone (Beconase AQ), mometasone (Nasonex), and triamcinolone (Nasacort 24). In some cases, a solution of saline mixed with budesonide (Pulmicort Respules) is recommended by healthcare providers if nasal sprays are not effective enough. 

• Injected or Oral Corticosteroids: These medications are often prescribed to people with nasal polyps and severe sinusitis. However, oral corticosteroids should only be used for the treatment of severe symptoms since they can cause serious side effects if they are used for a long time. 

• Aspirin Desensitization: This treatment option is for people who have aspirin sensitivity. To increase one's tolerance, larger doses of aspirin is gradually given under medical supervision. 

• Antibiotics: Sometimes, antibiotics are given when the cause of sinusitis is a bacterial infection. 

• Immunotherapy: If chronic sinusitis is caused by allergies, immunotherapy or allergy shots can help reduce the body's reaction to certain allergens and improve the condition. 

Surgery

When chronic sinusitis is not relieved using medications and certain other treatments, your doctor might recommend an endoscopic sinus surgery. This surgical procedure involves the use of an endoscope to help visualize the sinus passages. Surgical treatment may involve enlarging narrow sinuses to promote drainage or removing tissues that are causing the blockages. 

Home Remedies

Aside from the above-mentioned treatment options, chronic sinusitis can also be relieved using self-help home remedies, such as:

• Drinking plenty of fluids
• Getting enough rest
• Sleeping with your head raised
• Applying warm compresses on the affected area
• Rinsing your sinuses
• Moisturizing your nasal cavity

Complications

Although untreated chronic sinusitis can be quite unpleasant because of its persistent symptoms, serious health complications are often uncommon in people who have the condition. In rare cases, a sinus infection may spread to its neighboring areas, such as the adjoining bones, around the eyes, blood, or brain.

Children are more susceptible to developing complications than adults. A child with sinusitis and has a swollen eyelid or cheek needs to be evaluated by a doctor right away. 

Prognosis

The outcomes of treatment may widely vary and often depend on certain underlying factors. People with chronic sinusitis may fully recover if the underlying cause of the condition is treated. Patients with cystic fibrosis may need multiple surgeries and frequent antibiotics. Those who have a bony obstruction of the sinus outflow tract may no longer experience problems after undergoing one surgery.