Chronic sinusitis occurs when there are episodes of sinusitis lasting more than 3 months. The disease isn’t usually serious, but it does have a very negative impact on quality of life.
Chronic sinusitis is often accompanied by inflammation of the nose, known as rhinitis. It doesn’t always occur, but it is very common. This is why it is sometimes referred to as chronic rhinosinusitis.
It can affect both children and adults and sometimes requires different treatment.
When is Chronic Sinusitis?
Sinusitis is the inflammation of all the tissue lining the sinuses. This condition interferes with the normal drainage of mucus and leads to a stuffy nose. Breathing through the nose becomes more difficult.
Sinuses are air-filled cavities connected by narrow channels. They produce mucus that drains through these channels. If they fill with fluid and become blocked, they can become infected. This is where sinusitis occurs.
There are 3 types:
- Acute: occurs when symptoms are present for 4 weeks or less. Eventually, they disappear completely.
- Chronic: symptoms last 3 months or more and then flare-ups occur. Although the manifestations are usually less severe, it may cause damage to sinus tissues.
- Subacute: episodes last between 1 and 3 months. Symptoms remit completely.
Chronic sinusitis isn’t the same as recurrent acute sinusitis. In the former, symptoms never disappear completely, even if they are mild. In the second, episodes recur up to 4 times per year, but there are stages when they are not.
Causes
The accumulation of too much mucus or any form of sinus blockage leads to bacteria and other microorganisms growing more easily. That said, it’s safe to say that the main causes of chronic sinusitis are as follows:
- Blockage of the nose due to allergies: An allergy causes inflammation of the area. This blocks the normal elimination of mucus and causes sinusitis. The underlying agent is usually the fungus Aspergillus.
- Immune system abnormalities: Fewer defenses to fight bacteria.
- Anatomical problems in the nasal cavity: It may be a deviated nasal septum, nasal polyps, nasal bone spur, or similar structural problems.
- Respiratory tract infections: When colds aren’t treated properly, they can evolve into sinusitis.
- Dental infections: these can spread to the sinuses.
- Gastroesophageal reflux: Refluxed material causes an irritating effect on the mucous membranes of the sinuses, limiting the drainage capacity in the area.
Risk factors
Some people are at increased risk of developing chronic sinusitis because they have some of the following conditions:
- Asthma.
- Large adenoids.
- Aspirin sensitivity.
- Allergic rhinitis or hay fever.
- Changes in altitude, such as when flying or scuba diving.
- Weakened immune system due to chemotherapy or HIV.
- Regular exposure to pollutants, such as cigarette smoke.
Symptoms of chronic sinusitis
The symptoms of chronic sinusitis vary widely and depend on the individual’s general health condition. However, there are 3 essential manifestations:
- Nasal obstruction: This occurs in one or both nasal passages and generates difficulty breathing through the nose.
- Facial pain: This is of varying intensities and is experienced as pressure in the nose and around the eyes.
- Purulent drainage: a green or yellow nasal discharge.
All three symptoms are usually present in people with chronic sinusitis. Sometimes, they’re accompanied by other manifestations:
- Headache, earache and sore throat.
- Decreased sense of smell.
- Halitosis or bad breath.
- Nasal voice and snoring.
- Retronasal drip.
- Fever.
- Coughing.
Diagnosis
The first thing the doctor does is to carry out an interview with the patient to find out about the symptoms. Then, they’ll perform an examination in which they’ll touch the nose and face to determine if there’s pain. They will also examine the inside of the nose.
To establish whether chronic sinusitis is present, tests will most likely be ordered:
- Imaging tests: A computed tomography (CT) or magnetic resonance imaging (MRI) gets to show in detail the state of the sinuses.
- Allergy testing: If there’s suspicion that the trigger is an allergen, this test is performed to corroborate it.
- Nasal and sinus discharge culture: This type of test is only performed if chronic sinusitis doesn’t respond to treatment or worsens.
Treatment
The first treatment option for chronic sinusitis is drugs. Antibiotics may be required if there’s an ongoing bacterial infection. Likewise, if there’s an allergy, an anti-allergic will be used.
Medication such as the following are usually prescribed:
- Nasal corticosteroids: These are sprays that help prevent and treat inflammation.
- Oral or injectable corticosteroids: These are only used to treat severe symptoms.
- Others: Depending on the case, drugs may be prescribed to treat nasal polyps or antifungal drugs when the infection is caused by fungus.
Saline nasal irrigation, sprays, or solutions may be prescribed if warranted. Sometimes injectable allergy shots are used.
If none of these measures are effective, surgery is usually considered. Surgery can remove tissue, remove polyps or widen the narrow sinus opening.
Can chronic sinusitis be prevented?
The best way to prevent chronic sinusitis is to treat colds properly. A diet rich in fruits and vegetables helps to strengthen the immune system. Likewise, smoke or similar pollutants should be avoided.
Humidifiers can be a great help to a person with chronic sinusitis. They keep the nose moist and help drain mucus. It’s also important to be vaccinated against influenza.
A person with chronic sinusitis should adopt a lifestyle that helps to avoid exacerbation of symptoms. The most recommended way is to hydrate continuously and get enough rest.
