Chronic Sinusitis

Chronic sinusitis-a long-term inflammation or blockage of the sinus passages-is one of the most common chronic conditions. It affects more than 30 million Americans, and leads to more than 12 million doctor’s office visits each year, according to the National Center for Health Statistics.

Unlike acute sinusitis, which usually improves within a few weeks, chronic sinusitis typically lingers for three months or more. This condition can be very uncomfortable, to the point that it can interfere with your normal activities. However, you do not have to suffer in pain when there are several effective treatments available to relieve the discomfort of chronic sinusitis.

Causes
The sinuses are small, air-filled spaces in the head. They are found on the sides of the nose, behind and in between the eyes, in the forehead, and behind the nasal cavity. They’re lined with mucus membranes, which produce thick, sticky mucus. Mucus captures dirt, allergens, and dust to keep them out of the body. Tiny hairs called cilia wave back and forth to push the mucus to the back of the nose, where it is drained into the throat.

Chronic sinusitis often occurs after a cold or other upper respiratory infection that causes the sinus membranes to become inflamed. The sinuses drain through narrow openings that can easily become blocked if the tissues surrounding them become inflamed. When the openings are blocked, the mucus becomes trapped inside the sinus and is at risk for infection. Viral, bacterial, and fungal infections as well as allergies can all cause chronic sinusitis.

Other causes of chronic sinusitis include:

• An anatomical problem, such as a deviated septum (an abnormality of the wall that divides the two sides of the nose), or polyp (growth from the mucus membranes in the nose) can reduce the size of the opening to the sinus passages.
• Allergies-a reaction to pollen, mold, fungi, or other allergens can cause congestion in the nose, which can block the sinus passages. Research has found that people with chronic sinusitis have an increased immune response to common fungi in the air.

Risk Factors
Risk factors for chronic sinusitis include:

• Colds and other upper respiratory infections
• Pollution
• Fungi
• Pollen
• Dry and cold air
• Fumes (such as paint and chemical solvents)
• Dental infection
• Gastroesophageal reflux (GERD)
• Physical abnormalities (deviated septum, polyps, cysts)

People with a weakened immune system are more likely to develop chronic sinusitis, especially when exposed to these risk factors.

Symptoms and Signs
Chronic sinusitis can be very uncomfortable, and can significantly affect your quality of life. Inflammation causes fluid to build up in the sinus cavity, blocking the normal drainage of mucus.

As a result, you may experience:

• Stuffy nose
• Difficulty breathing through the nose
• Yellowish or greenish discharge from the nose or down the back of the throat
• Loss of sense of smell
• Headaches
• Pain or tenderness in the nose, cheeks, forehead, jaw, teeth, ear, or behind the eye
• Bad breath (halitosis)
• Fatigue
• Sore throat
• Cough

In chronic sinusitis, these symptoms last for more than three months.

When to Seek Medical Advice
Call the doctor if you’ve had symptoms of sinusitis that don’t go away, don’t respond to treatment, or keep returning. An infection that lasts for more than three months may be chronic sinusitis.

Diagnosis
The doctor will take a medical history and will look for any polyps or anatomical problems (such as a deviated septum) that might be causing the sinusitis.

Methods to screen for chronic sinusitis include:

• Fiberoptic nasal endoscopy - a thin, lighted tube called an endoscope is threaded up your nasal passages to allow the doctor to look for any blockages.
• A computed tomography (CT) scan creates an image of your sinuses, so that the doctor can see the extent of any blockages.
• Allergy tests - If the doctor suspects that an allergy is causing your symptoms, a simple skin test can help identify the culprit.
• Culture - The doctor may remove a small amount of fluid from your sinuses and culture it to determine which type of bacteria or another organism is causing the sinusitis.

Complications
When sinusitis is caused by an infection, complications can include:

• Meningitis (an infection in the brain lining) or brain abscess (infection in the brain) – both of which are emergency medical conditions
• Aneurysm (a potentially life threatening bulge in a blood vessel) or blood clots
• Vision problems (if the infection spreads to the eye socket)
• Flare-ups in people who have asthma
• Loss of smell and taste

Treatment
A number of treatment options are available for people with chronic sinusitis, ranging from medications to surgical procedures to open up blocked sinus blockages.

Medications include:

• Nasal irrigations. Flushing the nasal cavity with saline (salt water) can help to remove dried mucus and improve nasal drainage. This may be particularly important in dry climates.
• Antibiotics. If the cause of the problem is a bacterial infection, a four-to-six week course of antibiotics (amoxicillin, penicillin, erythromycin) should help clear up the infection. People whose infections don’t clear up with oral antibiotics may need to receive antibiotics through a vein (intravenously).
• Corticosteroids. Steroid medications can reduce inflammation in the nasal passages to clear breathing. These medications can be taken orally (prednisone), or through the nose (Flonase, Nasacort). Steroid medications taken through the nose have far fewer side effects than those taken orally.
• Antihistamines and decongestants. Over-the-counter antihistamines and decongestants (Claritin, Afrin, and Sudafed) can help dry up mucus and drain the sinuses.

If these treatments aren’t effective, the doctor may recommend surgery. Surgical treatments include:

• The permanent “breathe-right” strip. This implanted version of the “breathe right” nasal strip helps keep the sinus passages open.
• Nasal valve repair. This surgery corrects a deformity in the nasal valve (the outer portion of the nose) to open up the passageway for air to enter the nose.
• Endoscopic surgery. Using a thin, lighted tube called an endoscope as a guide, the doctor carefully removes the tissues or polyps (growths) that are blocking the sinus passages to improve drainage. This surgery is minimally invasive, with the procedure done completely from within the nose and producing no visible scars.
• Balloon sinuplasty. In this procedure, the doctor inserts a balloon into the sinus passages and inflates it to restore enlarge the sinus openings and promote normal drainage. This procedure is also minimally invasive and produces no visible scaring.

Self-Care
When you’re suffering the pain and pressure of chronic sinusitis, several home-care measures can provide relief:

• Use a saline nasal spray a couple of times a day to relieve congestion and discomfort.
• Irrigate sinuses using saline
• Apply hot, wet compresses to your face-especially around your sinuses - to relieve discomfort.
• Breathe in the steam from a steam inhaler two or three times a day.
• Drink liquids frequently-especially hot liquids-to loosen nasal secretions.

Here are a few steps you can take to prevent sinus infections and sinusitis:

• Use a humidifier to keep the air in your home moist.
• Wash your hands with soap and water throughout the day to avoid catching a respiratory infection.
• Use an air filter in your home to remove some of the pollutants and allergens that can trigger sinusitis.

Prognosis
Chronic sinus infections can be cured with the appropriate therapy, but treatment may take several months to be effective. It is possible for the condition to come back if the blockages are not treated correctly.

Sources:
National Center for Health Statistics. Chronic Sinusitis.
http://www.cdc.gov/nchs/fastats/sinuses.htm
National Institutes of Health. Chronic Sinusitis Sufferers have Enhanced Immune Responses to Fungi. http://www3.niaid.nih.gov/news/newsreleases/2004/chronicsinusitis.htm
Merk Manual. Sinusitis.
http://www.merck.com/mmpe/sec08/ch091/ch091h.html
Ivker RS. Chronic Sinusitis. In: Rakel D. Rakel, Integrative Medicine. 2nd ed. Philadelphia, PA:Saunders Elsevier; 2007:chap 19.
Leung RS, Katial R. The diagnosis and management of acute and chronic sinusitis. Primary Care: Clinics in Office Practice. 2008;35: