Chronic Sinusitis

chronic sinusitis

Chronic sinusitis is a recurrent inflammatory condition of one or more sinuses. It is less common than acute sinusitis but appears to be getting more common in all age groups. Various treatments may be tried. Surgery is also an option.

What are the sinuses?

The sinuses are small, air filled spaces inside the cheekbones and forehead. They make some mucus which drains into the nose through small channels.

What role sinuses have in our body?

The sinuses are small, air-filled spaces inside the cheekbones and forehead. They make mucus, which drains into the nose through small channels.

What do you understand by sinusitis?

Inflammation of sinuses is called as sinusitis. They are generally 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.

How does one have chronic sinusitis?

Most cases of chronic sinusitis develop following an acute sinusitis infection. The following are causes of acute sinusitis that may progress into a chronic sinusitis:

  • Cold or the flu, in most people, is known to lead to acute sinusitis. Colds and flu are caused by viruses, which may spread to the sinuses. In a small number of cases, bacteria add on to an infection that started with a virus. This can cause a bacterial sinus infection, which can make the infection worse and last longer.
  • Spread from a dental infection
  • In some cases, infection spreads to a maxillary sinus from an infected tooth.
  • Other risk factors for sinus infection In some people, one or more factors are present that may cause the sinuses to be more prone to infection. These include:
    • Allergic rhinitis (nasal allergy). The allergy may cause swelling of the tissues on the inside lining of the nose and block the sinus drainage channels. This makes the sinuses more susceptible to infection
    • Other causes of a blockage to the sinus drainage channels, such as nasal polyps, objects pushed into the nose (especially in children, such as peas or plastic beads), facial injury or surgery and certain congenital abnormalities in children.
    • Asthma.
    • Cystic fibrosis.
    • A poor immune system - for example, people with HIV, people on chemotherapy, etc.
    • Inflammatory disorders such as Wegener's granulomatosis or sarcoidosis.
    • Pregnancy, which makes you more prone to rhinitis (nasal inflammation).
    • Rare tumours of the nose.
    • Previous injuries to the nose or cheeks.
    • Medical procedures such as ventilation or the insertion of a tube through the nose into the stomach (nasogastric tube).
    • Previous injury to the nose or cheeks may affect the drainage of mucus after an episode of acute sinusitis, thus leading to chronic sinusitis.
How does chronic sinusitis present?

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. 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.
  • 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.
What tests are required?

Doctor can diagnose chronic sinusitis by the history of the patient and by examining the patient. Investigations are not usually needed to diagnose acute sinusitis. Occasionally, blood tests, X-rays or scans are advised if the diagnosis is not clear.

How is chronic sinusitis treated?
  • Treatment of any underlying problem can treat chronic sinusitis. 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, stopping it would help.
  • 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).
  • 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 treatmentsthat 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.
    • 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.
  • Surgery is used mainly if the condition does not improve with the above medical treatments. The most common operation is called functional endoscopic sinus surgery (FESS) and 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.
  • 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.

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

What are the complications from chronic sinusitis?

Living with untreated chronic sinusitis can be unpleasant with the persistent symptoms but serious complications are uncommon. Rarely, a sinus infection may spread to nearby areas, such as around an eye, into adjoining bones, into the blood, or into the brain. Children are more prone to complications than adults. Swelling or redness of an eyelid or cheek in a child with sinusitis should be reported to a doctor urgently.

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