Chronic Sinusitis

Despite therapy, chronic sinusitis happens when the areas within your nose and head (sinuses) are inflamed and swollen for three months or more.

Your nose becomes congested as a result of this widespread disorder, which disrupts the natural drainage of mucus. The region surrounding your eyes may feel swollen or irritated, and breathing through your nose could be challenging.

Nasal polyps, an infection, a swelling of the sinus lining, or any of these factors can cause chronic sinusitis. The illness, also known as chronic rhinosinusitis, can affect both adults and children.

Chronic Sinusitis: Causes

The probable causes of chronic sinusitis may include −

• Nose growths. The sinuses or nasal passageways may get blocked by these tissue growths.

• Nasal septum that is crooked. The wall between the nostrils, known as the septum, can become crooked and limit or obstruct nasal passageways, exacerbating sinusitis symptoms.

• Other health problems. Nasal obstruction can be caused by the side effects of illnesses including HIV, cystic fibrosis, and other immune system-related ailments.

• Infected respiratory tracts. Infections in your respiratory system — most often colds — can inflame and thicken your nasal membranes and obstruct mucus discharge. Bacteria or viruses may be at blame for these illnesses.

• Allergy symptoms like hay fever. Your sinuses may get blocked by the inflammation that comes with allergies.

Chronic Sinusitis: Symptoms

The major symptoms include −

• Nose irritation

• The nose is discharged in a thick, colorful manner (runny nose)

• Drainage down the throat's back (postnasal drainage)

• Obstructed or stuffed (congested) breathing via your nose is tough due to your nose

• The area around your eyes, cheeks, nose, or forehead may be painful, irritated, or swollen

• Reduced ability to taste and smell

Additional warning signs and symptoms might be −

• An earache

• Headache

• Your upper jaw and teeth may be hurting.

• Throat clearing or coughing

• Unwell throat

• Poor breath

• Fatigue

Similar signs and symptoms are present in both acute and chronic sinusitis. Yet, acute sinusitis is a brief sinus infection that is frequently related to a cold. Though you may experience many bouts of acute sinusitis before developing chronic sinusitis, the signs and symptoms of chronic sinusitis remain for at least 12 weeks.

Although it's not frequently present, fever can occur with acute sinusitis.

When to Visit a Doctor?

If any of the following apply, make an appointment with your doctor: You've experienced sinusitis more than once, and the problem doesn't improve after treatment. You have had sinusitis symptoms for more than ten days. If you have any of the following indications of a dangerous infection, consult a doctor right away −

• Fever

• Redness or swelling around your eyes

• Terrible headache

• Forehead enlargement

• Confusion

• Additional visual alterations, such as double vision

• Rigid neck

Chronic Sinusitis: Risk Factors

The major risk factors include −

• An atypical nasal septum

• Nasal polyps

• Asthma

• Sensitivity to aspirin

• Infection in the mouth

• A bacterial infection

• Tumors

• A disease of the immune system like HIV/AIDS or cystic fibrosis

• Hay fever or a different allergic disease

• Exposure to toxins like cigarette smoking.

Chronic Sinusitis: Diagnosis

Your physician could inquire about your symptoms. During a physical examination, he or she could feel for any soreness in your nose and face and examine your nose.

There are several ways to identify chronic sinusitis −

• Image-based exams. Your sinuses and nasal region can be seen in detail in CT or MRI images. They might identify a physical obstruction or deep inflammatory condition that is difficult to see with an endoscope, such as polyps, tumors, or fungus.

• Take a look at your sinuses. Your doctor can view the interior of your sinuses by inserting a small, flexible tube through your nose that has a fiber-optic light inside of it. This might help your doctor see a deviated nasal septum, polyps, or tumors.

• Test for allergies. A skin test for allergies may be advised by your doctor if they think they're the cause of your chronic sinusitis. Skin testing is rapid, safe, and can identify the allergen causing your nasal flare-ups.

• Samples of your sinus and nasal drainage (cultures). In most cases, cultures are not essential for the diagnosis of chronic sinusitis. Your doctor may take samples from inside your nose to help identify the cause, such as bacteria or fungi if the problem doesn't improve with therapy or is getting worse.

Chronic Sinusitis: Treatment

The doctor may prescribe the following treatments based on the severity of the condtion −

• Corticosteroid nasal spray. Inflammation is treated and prevented by using these nasal sprays. Fluticasone, triamcinolone, budesonide, mometasone, and beclomethasone are a few examples. Your doctor may advise using a nasal mist of the solution or washing with a saline solution containing drops of budesonide if the sprays are insufficiently effective.

• Saline nasal irrigation, with nasal sprays or solutions, decreases drainage and rinses away irritants and allergens.

• Either oral or intravenous corticosteroids. These drugs are used to treat severe sinusitis inflammation, especially if you also have nasal polyps. Only severe symptoms are treated with oral corticosteroids since prolonged use of these medications might have dangerous negative effects.

• Anti-allergy drugs. Your doctor could advise taking allergy drugs if allergies are the root cause of your sinusitis. If you experience aspirin responses that result in sinusitis and nasal polyps, you may benefit from aspirin desensitization therapy. To improve your tolerance, you are progressively given higher dosages of aspirin while under medical supervision.

• Antifungal medication. You could receive antifungal medication if fungi are the cause of your infection.

• Medication for the treatment of chronic sinusitis and nasal polyps. Your doctor could provide an injection of dupilumab or omalizumab to treat your persistent sinusitis and nasal polyps. These drugs might relieve nasal congestion and shrink nasal polyps.

Chronic Sinusitis: Prevention

One may take the following preventive measures to avoid getting chronic sinusitis −

• Keep your upper respiratory illnesses at bay. Avoid coming into touch with those who are sick with the flu or other viruses. Regularly wash your hands with soap and water, especially before eating.

• Take care of your allergies. To keep your symptoms under control, work with your doctor. Wherever feasible, try to limit your exposure to substances you are allergic to.

• Avoid breathing dirty air or smoking. Your lungs and nasal passages may become irritated and inflamed by tobacco smoke and airborne pollutants.

• Apply a humidifier. Adding moisture to the air in your house may help avoid sinusitis if the air there is dry, as it is if you have forced hot air heating. Be careful to regularly and thoroughly clean the humidifier to maintain it pristine and mold-free.

Conclusion

An interprofessional team of healthcare professionals, including general care physicians, infectious disease specialists, otolaryngologists, radiologists, and specialty-trained nurses, is the best option for managing chronic sinusitis. The patient should be taught how to reduce trigger factors, such as quitting smoking, which can worsen the symptoms of chronic sinusitis, by otolaryngology nurses.

The patient should receive information from the pharmacist on antiallergy treatments that can help manage the symptoms. Being a known trigger of chronic sinusitis, gastroesophageal reflux illness should also be managed by the patients. The patients should also be informed about the potential side effects of chronic sinusitis and when to seek medical attention.