Chronic sinusitis is a condition characterized by inflammation and swelling of the sinuses, which are the air-filled cavities within the nose and head. This condition persists for 12 weeks or more, despite treatment efforts.
This disorder commonly obstructs mucus drainage, leading to nasal congestion and difficulty breathing through the nose. Swelling or tenderness may be experienced around the eyes.
Chronic sinusitis may involve infections, nasal polyps (growths within the sinuses), and inflammation of the sinus lining. It is also known as chronic rhinosinusitis and can affect individuals of all ages, including both adults and children.
Symptoms
Typical symptoms associated with chronic sinusitis include:
- Thick, discolored nasal mucus (runny nose)
- Mucus drainage down the back of the throat (postnasal drip)
- Nasal congestion or blockage, causing difficulty breathing through the nose
- Pain, swelling, and tenderness around the eyes, cheeks, nose, or forehead
- Decreased ability to smell and taste
Additional symptoms may consist of:
- Ear pain
- Headaches
- Toothache-like pain
- Persistent cough
- Sore throat
- Foul breath
- Fatigue
Chronic sinusitis shares many symptoms with acute sinusitis, though acute sinusitis is typically a shorter infection often associated with a cold. The symptoms of chronic sinusitis persist for at least 12 weeks. Patients may experience several episodes of acute sinusitis before it becomes chronic. Fever is uncommon in chronic sinusitis but may occur with acute infections.
When to Consult a Doctor
Medical consultation with an ENT doctor is advised in cases of recurrent sinus infections unresponsive to treatment or symptoms lasting longer than 10 days. Immediate medical attention is necessary if serious symptoms develop, such as:
- Fever
- Redness or swelling around the eyes
- Severe headaches
- Forehead swelling
- Confusion
- Double vision or other visual disturbances
- Neck stiffness
Causes
The exact cause of chronic sinusitis often remains unidentified. Certain medical conditions, such as cystic fibrosis, can predispose children and adolescents to develop this condition.
Factors that may exacerbate chronic sinusitis include:
- Viral or bacterial infections like the common cold affecting the sinuses
- Structural abnormalities inside the nose, such as a deviated septum, nasal polyps, or tumors
Risk Factors
Several factors can increase the likelihood of chronic sinusitis, including:
- Dental infections
- Fungal infections
- Frequent exposure to cigarette smoke or environmental pollutants
Complications
Although rare, serious complications may arise from chronic sinusitis, including:
- Vision issues: Infection spreading to the eye socket may impair vision or cause blindness
- Severe infections: In rare cases, infection may extend to the membranes and fluid surrounding the brain and spinal cord, causing meningitis. It may also spread to bones (osteomyelitis) or the skin (cellulitis).
Prevention
Preventive measures to reduce the risk of developing chronic sinusitis include:
- Avoiding contact with individuals who have colds or other infections, and maintaining frequent handwashing with soap and water
- Managing allergies under the care of an ENT specialist to keep symptoms controlled and minimizing exposure to allergens
- Steering clear of tobacco smoke and polluted air, which can irritate the nasal passages and lungs
- Using a humidifier in dry environments to add moisture to the air, ensuring regular cleaning of the device to prevent mold growth
Diagnosis
Diagnosis typically involves a detailed review of symptoms and a physical examination, which may include palpating for tenderness around the nose and face and inspection of the nasal passages.
Additional diagnostic methods may include:
- Nasal endoscopy: Insertion of a thin, flexible tube with a light (endoscope) into the nose to visualize the sinuses
- Imaging studies: CT or MRI scans provide detailed images of the sinuses and nasal area to identify the cause
- Nasal or sinus tissue sampling: Rarely used, but may help identify the cause if the condition worsens or does not respond to treatment
- Allergy testing: Skin tests may be conducted to identify allergic triggers contributing to sinusitis
Treatment
Treatment options for chronic sinusitis include:
- Nasal corticosteroid sprays to reduce swelling
- Saline nasal rinses or sprays to clear mucus and debris
- Corticosteroid pills or injections for severe cases, particularly when nasal polyps are present; these are used cautiously due to potential side effects
- Allergy medications to manage allergy-related symptoms
- Antibiotics may be prescribed if a bacterial infection is suspected or confirmed
- Immunotherapy (allergy shots) to treat sinusitis linked to allergies
Surgery
If chronic sinusitis does not improve with medical treatment, endoscopic sinus surgery may be performed by an ENT specialist. This minimally invasive procedure uses an endoscope and small instruments to remove obstructive tissue and improve sinus drainage.
Lifestyle and Home Remedies
Supportive measures that may alleviate symptoms include:
- Adequate rest aids the body’s healing process
- Maintaining hydration by drinking plenty of fluids
- Applying warm compresses to the nose and forehead to relieve sinus pressure
- Inhaling warm, moist air through steam inhalation or hot showers loosens mucus and soothes sinus pain.