Chronic Sinusitis

What is Chronic Sinusitis?

Chronic sinusitis, also known as chronic rhinosinusitis, is a medical condition characterised by long-lasting inflammation of the sinuses, which are the air-filled cavities in the bones of the face and skull connected to the nasal passages. This inflammation can lead to various symptoms and discomfort for an extended period, typically lasting at least 12 weeks, despite appropriate medical treatment.

Causes and Risk Factors for Chronic Sinusitis

The exact cause of chronic sinusitis is unclear and can result from a combination of factors. Some common causes and contributing factors include:

• Allergies: People with allergic conditions, such as allergic rhinitis (hay fever), are more prone to chronic sinusitis.
• Nasal Polyps: Nasal polyps are small growths inside the nasal passages or sinuses that obstruct airflow and contribute to chronic sinusitis.
• Respiratory Infections: Frequent respiratory infections, especially if not adequately treated, can lead to chronic sinusitis.
• Structural Abnormalities: Structural issues within the nasal passages or sinuses, such as a deviated septum, can hinder proper drainage and ventilation, increasing the risk of chronic sinusitis.
• Asthma: People with asthma may be more susceptible to chronic sinusitis.
• Immunodeficiency: Individuals with weakened immune systems due to conditions like HIV/AIDS or certain medications may be at higher risk.
• Cystic Fibrosis: This genetic disorder can lead to thick, sticky mucus production, blocking the sinuses and increasing the risk of chronic sinusitis.
• Environmental Factors: Exposure to environmental irritants, such as smoke, pollution, or occupational hazards, can contribute to chronic sinusitis.
• Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can irritate the throat and nasal passages, potentially contributing to sinusitis.

Symptoms of Chronic Sinusitis

Chronic sinusitis can cause various symptoms that may persist for an extended period, typically 12 weeks or more. Common symptoms include:

• Nasal Congestion: Persistent stuffiness or blockage in the nose.
• Nasal Discharge: Thick, discoloured nasal discharge (postnasal drip) that may drain down the back of the throat.
• Facial Pain or Pressure: Discomfort or pain in the face, particularly around the eyes, cheeks, forehead, or nose.
• Headache: Recurrent headaches, often characterised as sinus headaches, due to pressure and inflammation in the sinuses.
• Loss of Smell (Anosmia): A reduced or complete loss of the sense of smell (olfactory dysfunction).
• Loss of Taste: Altered or reduced sense of taste (gustatory dysfunction).
• Cough: A persistent cough, especially at night, due to postnasal drip.
• Sore Throat: Irritation and discomfort in the throat, often associated with post-nasal drip.
• Bad Breath: Foul-smelling breath (halitosis) due to bacteria in the nasal passages and sinuses.
• Fatigue: Chronic sinusitis can lead to fatigue and general malaise.
• Ear Pressure: Some individuals with chronic sinusitis may experience ear pressure, fullness, or mild hearing loss.

Types of Chronic Sinusitis

Chronic sinusitis can be categorised into different types based on its underlying causes and characteristics:

• Chronic Rhinosinusitis without Nasal Polyps: This is the most common form of chronic sinusitis. It involves persistent inflammation of the sinuses without the presence of nasal polyps.
• Chronic Rhinosinusitis with Nasal Polyps: In this type, chronic sinusitis is accompanied by nasal polyps, soft, non-cancerous growths that can block the nasal passages and sinuses.
• Allergic Fungal Rhinosinusitis (AFRS): AFRS is a specific type of chronic sinusitis that occurs in individuals with allergies to certain fungi. Fungal elements in the sinuses characterise it and may require specialised treatment.

Diagnosis of Chronic Sinusitis

Here's how chronic sinusitis is diagnosed:

• Medical History: Your doctor will ask about your symptoms, their duration, and any relevant medical history, such as allergies or previous sinus infections.
• Physical Examination: A physical examination may involve checking for signs of nasal polyps, evaluating the nasal passages for signs of inflammation, and assessing the throat and neck for tenderness or swelling.
• Nasal Endoscopy: In some cases, a nasal endoscopy may be performed. During this procedure, a thin, flexible tube with a tiny camera on the end (endoscope) is inserted into the nasal passages to provide a detailed view of the sinuses and nasal cavity.
• Imaging Studies: Your doctor may order imaging studies, such as a CT (computed tomography) scan or MRI (magnetic resonance imaging), to better examine the sinuses and confirm the diagnosis. Imaging can help identify structural abnormalities, nasal polyps, or other factors contributing to chronic sinusitis.
• Allergy Testing: If allergies are suspected as a contributing factor, allergy testing, such as skin prick tests or blood tests (specific IgE tests), may be recommended.

Treatment of Chronic Sinusitis

The treatment of chronic sinusitis aims to reduce inflammation, relieve symptoms, and address any underlying causes. Treatment options may include:

• Nasal Corticosteroids: These topical nasal sprays help reduce inflammation in the nasal passages and sinuses.
• Oral Corticosteroids: In severe cases or when nasal corticosteroids alone are ineffective, oral corticosteroids may be prescribed briefly to reduce inflammation.
• Nasal Saline Irrigation: Regular saline nasal rinses can help flush out mucus and irritants from the nasal passages, providing symptom relief.
• Antibiotics: Antibiotics may be prescribed if a bacterial infection is suspected or identified.
• Antifungal Medications: Antifungal medications may be necessary in cases of allergic fungal rhinosinusitis.
• Allergy Management: Managing underlying allergies with allergen avoidance strategies, allergen immunotherapy (allergy shots), or antihistamines may be recommended.
• Surgery: In cases where medical treatment is ineffective or if there are structural abnormalities, nasal polyps, or chronic infections that need surgical intervention, various surgical procedures may be considered. These can include endoscopic sinus surgery to remove polyps or open blocked sinuses and septoplasty to correct a deviated septum.

What if Chronic Sinusitis is Untreated?

Leaving chronic sinusitis untreated can lead to several potential complications and a reduced quality of life. Some of the risks and consequences of untreated chronic sinusitis include:

• Worsening Symptoms: Symptoms will likely persist or worsen over time, leading to ongoing discomfort and reduced quality of life.
• Recurrent Infections: Untreated sinusitis can lead to recurrent sinus infections, which may require multiple rounds of antibiotics.
• Complications: In severe cases, chronic sinusitis can lead to complications such as sinus abscesses, orbital cellulitis (infection of the tissues around the eyes), or even brain infections (rare but serious).
• Impaired Quality of Life: Chronic sinusitis can significantly affect daily functioning, sleep, and overall well-being, leading to fatigue, reduced productivity, and emotional distress.
• Chronic Pain: Facial pain, pressure, and headaches associated with sinusitis can become debilitating.

It's important to seek medical attention if you suspect you have chronic sinusitis or are experiencing persistent sinus symptoms. Effective treatment can help manage symptoms, prevent complications, and improve your quality of life. Your doctor can work with you to develop a personalised treatment plan based on your condition's underlying causes and severity.