Understanding Chronic Sinusitis

Chronic sinusitis is an illness that causes inflammation in the nose and sinuses, which lasts for more than three months. Aside from these two symptoms, people with chronic sinusitis may have pus and polyps in their nose. An otolaryngologist is a medical specialist that specializes in the treatment of ear, nose, and throat (ENT) diseases. The doctor usually checks your nose by using a small nasal endoscope to identify if there is a mechanical damage, redness, inflammation, and drainage of the sinuses. Sinus mucus may be cultured if antibiotics do not help the patient. Chronic sinusitis is confirmed if a CT scan result shows thick mucus.

What leads to chronic sinusitis?

While acute sinusitis is usually caused by an infection, the causes for chronic sinusitis are more complex. Chronic sinusitis is divided into the following distinct types, depending on their symptoms:

• Chronic sinusitis without nasal polyps - is the most prominent type of chronic sinusitis. Depending on individuals, infections, allergic reactions, and irritation due to some elements in the air can make the lining of the sinuses be inflamed or feel irritated.

• Chronic sinusitis with nasal polyps - Sometimes, people with chronic sinusitis will have growths in their noses, which are referred to as nasal polyps. The growth of nasal polyps can eventually block the sinuses. This condition can be treated by medication, surgery, or both to reduce the growth or to completely remove them.

• Chronic sinusitis involving fungal allergies - At times, people who have chronic sinusitis may have serious allergic reactions to fungi, which are normally present in the air in small qualities. This type of allergy enables the lining of the sinuses to produce mucus that is heavy and thick, which will consequently block the sinuses. 

The Major Causes of Chronic Sinusitis 

The following are the major causes of chronic sinusitis: 

• Allergic reactions - Most people with chronic sinusitis experience more allergic reactions than people without the condition. They mostly react to irritants such as dust mites, molds, and cockroaches. Allergic reactions that are hard to manage can make the symptoms of chronic sinusitis severe.

• Cigarette smoke and other air irritants - frequent exposure to these elements can increase a person's risk of developing chronic sinusitis. The inhalation of tobacco smoke or specific air poisons such as formaldehyde can lead to a higher chronic sinusitis vulnerability.

• Impaired immune system - most people diagnosed with chronic sinusitis have a healthy immune system. However, people with an impaired immune system tend to be more vulnerable to chronic sinusitis. People with these issues may also suffer from other illnesses like ear and chest infections.

• Viral infections - Frequent viral infections can cause chronic sinusitis in some people. However, it remains unclear as to how these infections can lead to the development of chronic sinusitis.

• Deviated septum -  is a condition wherein the septum, which is a cartilage that separates the nostrils, is not entirely straight. A person can have it at birth or later on when his or her nose is injured. Although a deviated septum does not usually lead to chronic sinusitis, it normally causes nasal blockage.

The Symptoms of Chronic Sinusitis

Chronic sinusitis symptoms should comprise of at least two of the following:

• blockage of the nostril
• nasal mucus discharge or postnasal drainage
• painful swelling around the eyes, nose, and forehead
• reduced sense of smell

In children, the symptoms of chronic sinusitis include having a chronic cough and bad breath. Some people develop fatigue along with their chronic sinusitis.

Chronic Sinusitis Diagnosis

It is most likely for a person who has experienced at least two of the above symptoms for not less than three months to be diagnosed with chronic sinusitis. Moreover, a sinus CT scan or sinus endoscopy should be done to confirm the condition.

A sinus CT scan is an imaging test that takes detailed radiographs of the head and face. It takes approximately 15 minutes to do this procedure. Any mucus or growth in the sinus spaces, as well as a comprehensive view of the sinus linings, are shown in the radiographs.

A thin tube linked to a camera is used to see the interior of the sinuses during a sinus endoscopy. Through this procedure, a clinician takes a mucus sample and then examines it under a microscope. 

Health Conditions Associated with Chronic Sinusitis

The inner layers of the nose and sinuses are the same as the lungs' linings. One out of five people who have chronic sinusitis has asthma, too. People with chronic sinusitis and polyps of the nose are most vulnerable to asthma.

Aspirin intolerance is a condition that affects some people who have chronic sinusitis, nasal growths, and asthma. An individual who experiences chest and nasal symptoms become worse with time after the initial hours of taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium, among others.

If you feel that aspirin is worsening your symptoms, avoid the drug and other medications of the same type. It is best to consult your physician to avoid experiencing further symptoms.

Chronic Sinusitis Treatment

People who have chronic sinusitis normally require a continuing treatment to control the symptoms. However, not all treatments are suitable for all people with chronic sinusitis. There is a variety of treatments for the condition. Your physician will recommend specific treatments depending on the type of chronic sinusitis you have, how severe your symptoms are, and the presence of other associated conditions such as allergies.  

Chronic sinusitis treatment may consist of:

• Daily nasal washing using salty water - Washing the nasal canals with salty water on a daily basis will reduce the severity of chronic sinusitis symptoms. 

• Glucocorticoid nasal sprays and drops  - can help in reducing the irritation and swelling in the nostrils.

• Glucocorticoid tablets - Sometimes, your doctor may recommend that you take oral steroids such as prednisone. This type of medication is more effective in relieving the symptoms of chronic sinusitis faster than nasal sprays, rinses, and drops. Nevertheless, physicians limit the prescription of oral glucocorticoids since they can cause significant side effects.

• Antibiotic drugs - Your physician may prescribe some antibiotics that may last for a few weeks to treat any developed infections that could worsen the symptoms.

• Surgical procedure - Initially, doctors prescribe medications to manage chronic sinusitis. However, some people with the condition need surgery on their sinus canals to access and remove the clogged mucus or growths.

Surgery is needed in the following situations:

• When the symptoms of chronic sinusitis are not relieved after the patient takes the aforementioned medications and the computed tomography (CT) scan shows a persistent sinus illness such as total blockage of the sinuses.

• If the condition is suggestive of "allergic fungal sinusitis." On a CT scan, one or more sinuses of the person with allergic fungal sinusitis appear as fully blocked. Most of the time, a CT scan shows the sinuses as being clogged by heavy, thick mucus that can only be removed through a surgical procedure. Mucus samples are then collected during surgery to confirm if there is indeed the presence of a fungal infection. 

• When the septum is distorted leading to nasal congestion as well as sinus drainage difficulty.

After surgery, medications are still required to manage the inflammation of the sinuses.