Chronic Sinusitis

Overview

Chronic sinusitis is a common condition characterized by persistent inflammation and swelling of the spaces inside the nose and head (sinuses) for three months or longer, despite treatment. This interferes with the normal drainage of mucus, causing symptoms such as a stuffy nose, difficulty breathing through the nose, swelling around the eyes, and discolored nasal discharge. Chronic sinusitis can be caused by infections, nasal polyps, or swelling of the sinus lining. It can affect both adults and children and may lead to complications in rare cases. Symptoms of chronic sinusitis are similar to those of acute sinusitis, but the latter is a temporary infection often associated with a cold and typically lasts for less than 12 weeks.

Understanding the disease

Symptoms

Symptoms of chronic sinusitis include nasal inflammation, thick, discolored discharge from the nose, drainage down the back of the throat, blocked or stuffy nose causing difficulty breathing, pain, tenderness, and swelling around the eyes, cheeks, nose, or forehead, reduced sense of smell and taste, ear pain, headache, aching in the upper jaw and teeth, cough or throat clearing, sore throat, bad breath, and fatigue. Chronic sinusitis can lead to serious complications such as vision problems, infections, or meningitis, but these are rare. If you experience symptoms for more than 10 days or if you have a fever, see a doctor immediately.

Risk Factors

Risk factors for developing chronic sinusitis include:

1. A deviated nasal septum
2. Nasal polyps
3. Asthma
4. Aspirin sensitivity
5. A dental infection
6. A fungal infection
7. Tumors
8. An immune system disorder such as HIV/AIDS or cystic fibrosis
9. Hay fever or another allergic condition
10. Regular exposure to pollutants such as cigarette smoke. Remember that these risk factors do not guarantee the development of chronic sinusitis. Individual susceptibility and other factors may also play a role.

Development

Chronic sinusitis develops when the spaces inside the nose and head (sinuses) become swollen and inflamed for three months or longer, despite treatment. There are several factors that can contribute to the development of chronic sinusitis:

1. Infections: Bacterial, viral, or fungal infections can cause sinusitis, leading to inflammation and blockage of the sinuses.
2. Nasal polyps: These tissue growths can obstruct the nasal passages or sinuses, contributing to chronic sinusitis.
3. Deviated nasal septum: A crooked septum can restrict or block sinus passages, exacerbating sinusitis symptoms.
4. Other medical conditions: Conditions like cystic fibrosis, HIV, and other immune system-related diseases can lead to nasal blockage and increase the risk of chronic sinusitis.
5. Allergies: Inflammation caused by allergies can block the sinuses, contributing to chronic sinusitis.
6. Exposure to pollutants: Regular exposure to pollutants such as cigarette smoke can increase the risk of developing chronic sinusitis.
7. Nasal obstruction: Structural issues, dental infections, or tumors can obstruct the nasal passages, leading to chronic sinusitis. Chronic sinusitis can be caused by a combination of these factors, and it is essential to identify and address the underlying causes to effectively treat the condition.

Assessment and Diagnosis

Triage

You should see a doctor if chronic sinusitis is suspected if you have symptoms that last more than 10 days or if you've had sinusitis a number of times, and the condition doesn't respond to treatment. Additionally, if your symptoms don't improve after seeing your doctor, you should schedule an appointment. In some cases, severe symptoms such as fever, swelling or redness around the eyes, severe headache, forehead swelling, confusion, double vision or other vision changes, stiff neck, and difficulty breathing may require immediate medical attention.

Diagnosis

To diagnose chronic sinusitis, your doctor may ask about your symptoms, perform a physical exam, and use imaging tests such as a CT or MRI. They may also use a thin, flexible tube with a fiber-optic light to examine your sinuses, and in some cases, perform an allergy test. In cases where treatment fails to respond or worsens, your doctor may collect samples from your nasal and sinus discharge for analysis.

Management and Treatment

Complications

Complications of chronic sinusitis can be rare but may include:

1. Vision problems: If the sinus infection spreads to the eye socket, it can lead to reduced vision or even permanent blindness.
2. Infections: People with chronic sinusitis may develop inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis), an infection in the bones, or a serious skin infection.

Prevention

Chronic sinusitis can be prevented to some extent by taking certain precautions. Here are some ways to help prevent chronic sinusitis:

1. Avoid upper respiratory infections: Reducing contact with people who have colds or other infections, washing your hands frequently, and practicing good hygiene can help prevent the spread of infections.
2. Manage your allergies: Work with your doctor to keep your allergies under control. Avoiding exposure to allergens whenever possible can help reduce the risk of sinusitis.
3. Regular exposure to pollutants: Minimize exposure to pollutants such as cigarette smoke, air contaminants, and other irritants that can cause sinus inflammation and infections.
4. Practice good hygiene: Maintaining good hygiene can help prevent the spread of infections. Regularly washing your hands and keeping your living space clean can help reduce the risk of sinus infections.
5. Treat sinus infections promptly: If you have acute sinusitis, it's important to seek treatment to prevent it from becoming chronic. Antibiotics, nasal corticosteroids, or other medications can help manage sinus infections and prevent complications. Remember that chronic sinusitis can still occur even with preventive measures. If you experience persistent symptoms of sinusitis, consult with your healthcare provider for appropriate evaluation and treatment.

Home Remedies

Home remedies for chronic sinusitis may include:

1. Nasal irrigation: Using a saline spray or a neti pot to flush out your nasal passages can help remove excess mucus and alleviate sinus pressure.
2. Steam inhalation: Breathing in steam from a hot shower or a bowl of hot water can help moisturize the nasal passages and relieve congestion.
3. Oral decongestants and antihistamines: Over-the-counter decongestants and antihistamines can help reduce nasal inflammation and congestion. However, avoid prolonged use as they may cause side effects, and always follow the instructions on the packaging.
4. Nasal decongestants: Decongestant sprays can help reduce nasal congestion, but be cautious as overuse can lead to dependence and worsen symptoms.
5. Humidifiers: Using a humidifier in your bedroom can help keep the air moist, which may help prevent sinusitis. Be sure to clean it regularly to avoid mold buildup.
6. Avoiding irritants: Stay away from cigarette smoke, polluted air, and other allergens that can aggravate sinusitis symptoms. It is essential to consult your doctor before starting any home remedies or medications, especially if you are experiencing severe symptoms, have underlying medical conditions, or are pregnant or breastfeeding.

Treatment

Treatments for chronic sinusitis include medications, lifestyle changes, and in some cases, surgery. Here are some options:

1. Medications: Over-the-counter pain relievers, decongestants, and saline nasal sprays can help alleviate symptoms. Prescription medications like antibiotics, corticosteroids, and nasal corticosteroid sprays may be prescribed to reduce inflammation and clear infection.
2. Nasal irrigation: Using a saline solution to flush out the nasal passages can help remove mucus and bacteria. This can be done with a neti pot or a specially designed irrigation system.
3. Oral inhalers and steroids: In some cases, inhaled corticosteroids may be recommended to reduce inflammation in the nasal passages.
4. Sinus flush: A doctor may perform a sinus flush to clear out the nasal passages and remove any blockages or growths.
5. Lifestyle changes: Avoiding allergens, tobacco smoke, and polluted air, and using a humidifier can help prevent sinusitis from recurring. It's important to consult with a doctor to determine the best course of treatment for your specific case of chronic sinusitis.

Preparing for medical consultation

To prepare for an appointment for chronic sinusitis, you should make a list of your symptoms, including any that seem unrelated to the reason for your appointment. Gather information about your personal history, such as any allergies or asthma, and your family medical history. Additionally, create a list of all medications, vitamins, or supplements you've recently taken, including doses. Prepare a list of questions to ask your doctor, such as the cause of your symptoms, recommended tests, treatment options, and whether you should see a specialist. Lastly, be aware of any pre- or post-appointment restrictions and write down any recent moves, vacations, interactions with animals, and your vaccination history.