Chronic sinusitis Causes, Symptoms, Diagnosis, Treatment, Prevention

Chronic sinusitis Causes, Symptoms, Diagnosis, Treatment, Prevention

What is sinusitis?

Sinusitis means inflammation of a sinus. Most bouts of sinusitis are caused by an infection. The cheekbone (maxillary) sinuses are the most commonly affected.

Acute sinusitis means that the infection develops quickly (over a few days) and lasts a short time. Many cases of acute sinusitis last a week or so but it is not unusual for it to last 2-3 weeks (that is, longer than most colds). Sometimes it lasts longer. Sinusitis is said to be acute if it lasts from 4-30 days and subacute if it lasts 4-12 weeks.

Chronic sinusitis means that a sinusitis becomes persistent and lasts for longer than 12 weeks. Chronic sinusitis is uncommon.

What is chronic sinusitis?

Sinusitis, commonly called a sinus infection, is inflammation and infection of the air-filled spaces that are located within the bones in and around the nose (paranasal sinuses). This results in swelling of the mucus membranes that line the sinuses, pain and pressure in and around the eyes and cheekbones, and a thick green discharge from the nose.

Generally, chronic sinusitis is diagnosed when symptoms of sinusitis persist for longer than 12 weeks despite treatment. In chronic sinusitis, also called chronic rhinosinusitis, the mucous membranes in the nose and paranasal sinuses are constantly inflamed and become thickened. The inflamed membranes can be seen upon examination of the inside of your nose by your health care provider.

In contrast to acute sinusitis, most health experts believe that chronic sinusitis is not an infectious disease. However, if you suffer from frequent episodes of acute sinusitis, you are at risk for developing chronic sinusitis.

In some cases, sinusitis can spread from the sinuses to the nervous system and lead to life-threatening infections and complications, such as meningitis or brain abscess. Seek immediate medical care if you, or someone you are with, have symptoms of sinusitis that are accompanied by a change in alertness or consciousness, high fever, seizure, severe headache, or a stiff neck.

What causes and the risk factors for chronic sinusitis?

What causes chronic sinusitis?

Currently, most health experts believe that chronic sinusitis is a group of diseases that cause similar symptoms, rather than one disease that accounts for all cases of chronic sinusitis. Chronic sinusitis is not an infectious disease, which makes it different from acute sinusitis caused by an infection. However, frequent or recurrent episodes of acute sinusitis put you at risk for developing chronic sinusitis.

Chronic sinusitis is due to ongoing obstruction of the sinuses due to inflammation, difficulties with the normal flow of mucus, or a weakened immune system.

What are the risk factors for chronic sinusitis?

A number of factors contribute to or increase your risk of developing chronic sinusitis. Risk factors include:
  • Allergies, such as hay fever or allergic rhinitis
  • Asthma
  • Deviated septum
  • Immune disorders or having a weakened immune system
  • Nasal polyps or cysts
  • Nose injury or trauma
  • Recurrent acute sinusitis
  • Smoking

What are the symptoms of chronic sinusitis?

The most prominent symptom is usually a blocked nose (nasal obstruction). One or more of the following may also occur:

  • A runny nose. The discharge may be greeny/yellow.
  • A reduced sense of smell.
  • Pain over the affected sinus. However, pain is often not a main feature of chronic sinusitis (unlike acute sinusitis). In many cases, it is more of a feeling of facial fullness or mild discomfort rather than pain.
The severity of your symptoms may wax and wane. They may be worst during an initial acute sinusitis. They may then ease off and not be as severe leaving a background level of symptoms. (For example, you may just have nasal stuffiness rather than a fully blocked nose, as well as some mild facial discomfort.) You may then develop another episode of acute sinusitis making symptoms worse again. For a diagnosis of chronic sinusitis, symptoms must have been present for longer than 12 weeks.

Other symptoms that sometimes occur include: headache, bad breath, toothache, cough, a feeling of pressure or fullness in the ears and tiredness. In children, symptoms may include irritability, snoring, mouth breathing, feeding difficulty and nasal speech.

Chronic sinusitis symptoms can interfere with your daily life, and many people who suffer from chronic sinusitis find it may be difficult to concentrate at work or enjoy social activities. Many patients with chronic sinusitis find it difficult to get out of bed in the morning to start the day.

Seeking the help of an allergist is essential to finding relief from this constant, bothersome inflammation. A board certified allergist is trained to find the underlying cause of chronic sinusitis and to solve the problem.

How is acute sinusitis diagnosed?

Your doctor will ask about your symptoms, how long you have had them, and what you may be allergic to in your environment. He or she will examine you, paying special attention to your nose and throat. During this examination, your doctor will check for:

  • Fever
  • Tenderness in the areas of your face overlying your sinuses
  • Inflammation and mucus in your nose and throat
  • Nasal polyps or a deviated septum
  • Enlarged lymph nodes
Your doctor usually can diagnose chronic sinusitis and start treatment based on your symptoms and the physical examination. Further tests usually are not necessary. If the diagnosis is not clear, or if your doctor suspects you may have a structural blockage, he or she may order tests to look at the sinuses — usually computed tomography (CT) or magnetic resonance imaging (MRI) of your sinuses. You also may be referred to a specialist for further tests. An ear, nose and throat specialist can take a closer look inside your nose and throat with a tiny scope that has a camera lens at the end. An allergy specialist can perform skin-prick or blood (RAST) tests to find out what you are allergic to.

What are the treatments for chronic sinusitis?

Treatment of any underlying problem

If you have an underlying problem that may have caused or contributed to your chronic sinusitis, treating this will usually help your symptoms. For example, this may mean treatment for allergic rhinitis, treatment of a dental infection, treatment of asthma, treatment of a fungal infection, etc.

Avoidance of things that may make your symptoms worse

If you have chronic sinusitis and you are a smoker, you may find that if you stop smoking your symptoms improve. This may especially be the case if you have allergies as well. You should also practise good dental hygiene if you are prone to chronic sinusitis, as it can be caused by a dental infection.

Scuba divers with nasal or sinus problems should be aware of the possible serious consequences of sinus barotrauma (damage to your sinuses resulting from pressure differences when diving). Recurrent barotrauma to sinuses can cause knock-on complications, such as serious infection and damage to nerves in the face and eye. If you have had chronic sinusitis and wish to dive, you should seek advice from your doctor.

Flying in an aeroplane may cause an increase in pain if there is blockage of the sinus drainage channel. This is because, with the change in air pressure in an aeroplane, the pressure does not equalise between the sinus and outside, due to the blockage. Pain tends to be worse when the aeroplane is descending to land.

Medical treatments for Chronic sinusitis

The sort of medicines that may be considered include the following:

  • Steroids applied to the nasal lining using sprays or drops are recommended for all types of chronic sinusitis because they help to reduce inflammation. A long course may be advised, for example, for three-months. Occasionally, if symptoms are severe, a course of steroid tablets by mouth may be suggested. However, these are more likely to produce side-effects.
  • Prolonged courses of antibiotics (3-4 weeks) are sometimes helpful but are best prescribed after full assessment by an Ear, Nose and Throat specialist 
  • Antifungal medicines are needed if you have a fungal infection of a sinus (rare).
If you have a flare-up of more acute sinusitis symptoms on top of your background symptoms, one or more of the following may be helpful:

  • Painkillers, such as paracetamol or ibuprofen, will usually ease any pain. Sometimes stronger painkillers, such as codeine, are needed for a short time.
  • Decongestant nasal sprays or drops are sometimes used. You can buy these from pharmacies. They may briefly relieve a blocked nose. You should not use a decongestant spray or drops for more than 5-7 days at a time. If they are used for longer than this, they may cause a worse rebound congestion in the nose.
  • Warm face packs held over the sinuses may help to ease pain.
  • A saline nasal solution may help to relieve congestion and blockage within the nose.
  • A short course of antibiotics may sometimes be advised by your doctor if they suspect a bacterial infection.

Surgical treatments for Chronic sinusitis

Surgery is used mainly if the condition does not improve with the above medical treatments. The main purpose of surgery is to improve the drainage of the affected sinus.

The most common operation is called functional endoscopic sinus surgery (FESS). This involves a surgeon inserting an endoscope into the nose. The endoscope used for this procedure is a thin rigid instrument that contains lenses. The endoscope allows a detailed magnified view of inside the nose. The surgeon can see the opening of the sinus drainage channels. He or she can then remove any tissues that are blocking the drainage of the affected sinus. This can improve sinus drainage and ventilation and help to restore normal function to the sinus. This operation is minimally invasive (causes little damage) and usually has a high success rate in relieving symptoms of chronic sinusitis.

A more recently developed operation is called balloon catheter dilation of paranasal sinus ostia. This involves a surgeon pushing a small balloon through a flexible tube in the nostril, into the blocked sinus. The balloon is inflated which pushes wide the blocked area. The balloon is then deflated and removed. Following this procedure there is a good chance that the sinus drainage channel is widened and the sinus can drain properly.

Surgery may also sometimes be needed to remove nasal polyps or to correct problems with deviated bones inside the nose.

What are the potential complications of chronic sinusitis?

Left untreated, chronic sinusitis may cause potentially serious complications and damage to the sinuses that must be surgically repaired. It is important to contact your health care provider for sinusitis symptoms that are persistent or come back after treatment. With proper diagnosis of the underlying cause, chronic sinusitis can be managed and you can help avoid complications including:
  • Brain abscess
  • Damage to the sinuses
  • Loss of taste or smell, which can be permanent
  • Meningitis
  • Orbital cellulitis (invasive infection of the skin and tissues around the eye), abscess, and blindness
  • Osteomyelitis (bone infection)
  • Worsening asthma

Prevention for Chronic sinusitis

If you have chronic sinusitis, avoid cigarette smoking and exposure to secondhand smoke. You also should avoid spending long periods of time outdoors when there are high levels of airborne allergens or pollutants. Indoors, using air conditioners and humidifiers can sometimes help prevent symptoms of chronic sinusitis. If you have allergies, you can help to prevent episodes of sinusitis by identifying and avoiding triggers and by taking appropriate medications as directed. Several measures can be taken at home to remove many indoor airborne allergens that trigger sinus problems. Here are some things you can do:

  • Keep windows closed, especially bedroom windows. You can cut down your exposure to indoor contamination by using a HEPA filter (high-efficiency particulate air filter) on your air conditioner.
  • While traveling in your car, drive with your external vents closed and air conditioning on. Some newer vehicles can be equipped with a high-efficiency, air-filtration system.
  • Take a shower or wash your hair before going to bed at night to remove pollutants or airborne allergens that accumulated during the day.
  • Dry clothes inside, either in a dryer or on a line. Clothing drying on an outside line can gather allergens.
  • Minimize activities with heavy exposure to pollens, such as lawn mowing and leaf blowing.
  • Inhaling steam and rinsing your nose with a saline solution regularly also can help to avoid symptoms.
  • Make sure you drink enough fluids.