Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen for at least 3 months, despite treatment attempts.
Also known as chronic rhinosinusitis, this condition interferes with drainage and causes mucus buildup. Breathing through your nose might be difficult. The area around your eyes and face might feel swollen, and you might have facial pain or tenderness.
Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or by a deviated nasal septum. The condition most commonly affects young and middle-aged adults, but it also can affect children.
At least two of the four primary signs and symptoms of chronic sinusitis must be present with confirmation of nasal inflammation for a diagnosis of the condition. They are:
- Thick, discolored discharge from the nose or drainage down the back of the throat (postnasal drainage)
- Nasal obstruction or congestion, causing difficulty breathing through your nose
- Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
- Reduced sense of smell and taste in adults or cough in children
Other signs and symptoms can include:
- Ear pain
- Aching in your upper jaw and teeth
- Cough that might worsen at night
- Sore throat
- Bad breath (halitosis)
- Fatigue or irritability
Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn’t a common sign of chronic sinusitis, but you might have one with acute sinusitis.
When to see a doctor
You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment.
Schedule an appointment with Dr Economou:
- You’ve had sinusitis a number of times, and the condition doesn’t respond to treatment
- You have sinusitis symptoms that last more than seven days
- Your symptoms don’t improve after you see your doctor
See Dr Economou immediately if you have any of the following, which could indicate a serious infection:
- High fever
- Swelling or redness around your eyes
- Severe headache
- Double vision or other vision changes
- Stiff neck
Common causes of chronic sinusitis include:
- Nasal polyps.These tissue growths can block the nasal passages or sinuses.
- Deviated nasal septum.A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
- Other medical conditions.The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases can result in nasal blockage.
- Respiratory tract infections.Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
- Allergies such as hay fever.Inflammation that occurs with allergies can block your sinuses.
High risk patients
You’re at increased risk of getting chronic or recurrent sinusitis if you have:
- A nasal passage abnormality,such as a deviated nasal septum or nasal polyps
- Asthma,which is highly connected to chronic sinusitis
- Aspirin sensitivitythat causes respiratory symptoms
- An immune system disorder,such as HIV/AIDS or cystic fibrosis
- Hay fever or another allergic conditionthat affects your sinuses
- Regular exposure to pollutants such as cigarette smoke
Chronic sinusitis complications include:
- This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
- Other infections.Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
- Partial or complete loss of sense of smell.Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
- Vision problems.If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.
The goal of treating chronic sinusitis is to:
- Reduce sinus inflammation
- Keep your nasal passages draining
- Eliminate the underlying cause
- Reduce the number of sinusitis flare-ups
There are two major Treatment categories of chronic Rhinosinusitis to relieve symptoms
These treatments include:
Corticosteroids & Saline solutions
- Saline nasal irrigation,with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
- Nasal corticosteroids.These nasal sprays help prevent and treat inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone and beclomethasone.
If the sprays aren’t effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide or using a nasal mist of the solution.
- Oral or injected corticosteroids.These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long term, so they’re used only to treat severe symptoms.
Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. If an underlying infection cannot ruled out, your doctor may recommend an antibiotic, sometimes with other medications.
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body’s reaction to specific allergens might improve the condition.
Aspirin desensitization treatment
if you have reactions to aspirin that cause sinusitis. Under medical supervision, you’re gradually given larger doses of aspirin to increase your tolerance.
Endoscopic sinus surgery
In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.
Depending on the source of obstruction, the doctor might use various instruments to remove tissue or shave away a polyp that’s causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.