Definition

Chronic sinusitis refers to the prolonged inflammation and swelling of the sinuses (cavities surrounding the nose) that persists for three months or longer despite treatment. Due to the concurrent inflammation of the nasal passages, this condition is often referred to as chronic rhinosinusitis. It can affect both adults and children.

Causes

Common causes of chronic sinusitis include:

• Nasal polyps. These abnormal tissue growths obstruct airflow through the nasal cavity and block the sinuses.
• Deviated nasal septum. A misalignment of the nasal septum can impede airflow and worsen sinusitis symptoms.
• Underlying medical conditions. Diseases such as cystic fibrosis, HIV, and other immune system disorders can lead to nasal congestion.
• Respiratory tract infections. Infections, often colds, can inflame and thicken the sinus linings, blocking mucus flow. These infections may be viral, bacterial, or fungal.
• Allergies can cause inflammation that blocks the sinuses.

Risk factor

Factors that can increase the risk of developing chronic sinusitis include:

• Deviated nasal septum
• Nasal polyps
• Asthma
• Aspirin sensitivity
• Dental infections
• Fungal infections
• Tumors
• Immune system deficiency that can be found in HIV/AIDS or cystic fibrosis for example
• Allergies
• Continuous exposure to pollutants, such as cigarette smoke

Symptoms

Common symptoms of chronic sinusitis include:

• Nasal inflammation
• Runny nose with thick, yellow, or greenish discharge
• Postnasal drip (mucus flowing down the back of the throat)
• Nasal congestion, making it difficult to breathe through the nose
• Swelling or pain around the eyes, cheeks, nose, or forehead
• Reduced sense of smell and taste

Fever is not a symptom often found, it is more typical of acute sinusitis than chronic sinusitis. Additional symptoms may include:

• Ear pain
• Headache
• Pain in the upper jaw and teeth
• Frequent coughing or throat clearing
• Sore throat
• Bad breath
• Fatigue

While chronic and acute sinusitis share similar signs and symptoms, acute sinusitis is a temporary infection often resulting from an upper respiratory tract infection. Symptoms of chronic sinusitis last for three months or more, and individuals may experience multiple episodes of acute sinusitis before developing chronic sinusitis.

Diagnosis

A doctor will review your medical history and assess your symptoms to diagnose chronic sinusitis. The examination will include an evaluation of your face and nasal cavity. To confirm if the individual has chronic sinusitis, the following diagnostic tests may be performed:

• Radiologic examinations, such as CT scans or MRIs can provide clear images of the sinus and nasal cavities, revealing inflammation in deep nasal passage, obstructions such as nasal polyps and tumors, or fungal infections that are not easily detected with endoscopy.
• Nasal endoscopy uses a flexible fiber-optic tube with a camera inserted through the nose. During this procedure, the doctor can visually inspect the sinuses for deviations in the nasal septum, nasal polyps, or tumors.
• Allergy testing. If allergies are suspected to cause chronic sinusitis, a skin test can be recommended to help identify specific allergens. This test is quick, safe, and effective in diagnosing nasal allergies.
• Nasal and sinus fluid culture. This involves growing microorganisms from nasal and sinus fluid samples in a laboratory to identify the causative agent, whether it be bacteria, fungi, or other pathogens. Samples are collected using a nasopharyngeal swab, although this test is not commonly needed for sinusitis diagnosis.

Management

Treatment for chronic sinusitis includes:

• Nasal corticosteroid sprays. These medications help reduce and prevent inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone, and beclomethasone. If nasal corticosteroid sprays are ineffective, nasal irrigation using saline solution and corticosteroid budesonide drops may be recommended.
• A saline solution to rinse the nasal passages can help clear mucus, irritants, and allergens.
• Oral or injectable corticosteroids. These are used for severe inflammation, particularly in cases involving nasal polyps. Due to potential serious side effects with long-term use, they are reserved for severe symptoms.
• Treatment based on cause:
• Allergy medication. These medicines are prescribed if allergies are the trigger of sinusitis.
• Aspirin desensitization therapy. This therapy is given for patients who react to aspirin, which may contribute to sinusitis or nasal polyps.
• Antifungal medications for fungal infections.
• Antibiotics for bacterial infections.
• Specific treatments for nasal polyps causing chronic sinusitis.

In cases where medication and other therapies are ineffective, endoscopic sinus surgery may be considered. This procedure uses a flexible tube with a camera and light to navigate the sinus passages. Depending on the cause of the blockage, tools are used to remove obstructive tissue or polyps and to enlarge the sinus openings to improve mucus drainage.

Complications

While chronic sinusitis rarely leads to serious complications, it can potentially cause:

• Visual impairment. If the infection spreads to the ocular region, it can impair vision or even permanent blindness.
• CNS infection. Rarely, chronic sinusitis can lead to meningitis, which is the inflammation of the membranes and fluid surrounding the brain.
• The infection can spread to the bones.
• The infection might spread to the skin, causing significant complications.\

Prevention

To prevent chronic sinusitis:

• Stay away from individuals with colds or flu, and practice good hand hygiene by washing hands regularly with soap and water, especially before eating or touching your face.
• Manage allergies. Consult a physician to manage allergies and avoid known allergens.
• Avoid irritants. Cigarette smoke and polluted air can irritate the nasal passages and lungs, leading to inflammation.
• Use a humidifier if the air in your home is dry, but ensure it is kept clean and mold-free through regular maintenance.

When to see a doctor?

You should consult a physician if:

• You have recurrent sinusitis that does not respond to treatment.
• Your symptoms last more than 10 days.
• Your symptoms persist despite medical consultation.

Seek immediate medical attention if you experience signs of a serious infection, such as:

• Fever
• Periorbital swelling or redness
• Severe headache
• Forehead swelling
• Confusion
• Double vision or other visual disturbances
• Neck stiffness

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