Chronic Sinsitis

What is chronic sinusitis?

Although chronic sinusitis is not a life-threatening disease, it has a significant impact on a individual’s quality of life. Studies that have compared chronic sinusitis to other chronic conditions such as asthma, back pain, congestive heart failure, and arthritis have demonstrated that chronic sinusitis has a more severe impact on quality of life than the other conditions. It is also one of the leading causes of absenteeism from work and expenditures for medications.

Chronic sinusitis is a different disease than acute sinusitis. The symptoms are different as are the treatments. The exact cause of chronic sinusitis is unknown. There are factors that are thought to contribute to the problem, such as anatomic factors within the nose and sinuses, allergies, and scarring of the nose and sinuses following trauma or surgery. However, in the vast majority of individuals, the exact cause and time of development of chronic sinusitis may be difficult to determine. Chronic sinusitis is not a result of an acute sinusitis that has not resolved. It is a disease whereby an inflammation in the lining of the nose and sinus cavities has been present for a long period (over 3 months).

This chronic inflammation sometimes gives rise to the development of polyps, which are fleshy and watery outpouchings of the lining of the nose and sinuses. These polyps are present in approximately 20-25% of patients suffering from chronic sinusitis, and contribute to the symptoms associated with the disease.

What are the symptoms?

The symptoms of chronic sinusitis are usually prolonged. Occasionally, the inflammation may be present for years before symptoms manifest themselves. Symptoms include facial pain or pressure in the areas of the sinuses, (the cheeks, around the eyes, the forehead and behind the nose or the top of the head), congestion, blocked nose and decreased sense of smell, and clear or colored drainage from the nose or to the back of the throat. These symptoms are often longstanding, giving the sensation of a cold that will not resolve.

In addition to the above symptoms, individuals with chronic sinusitis may suffer from frequent “exacerbations”. That is, episodes when the symptoms are more severe and slower to resolve despite antibiotic treatment.

It is unusual for chronic sinusitis to cause fever or dizziness. In addition, severe headaches, even if localized to the area of the sinuses, are often not due to sinusitis but rather one of the many other causes of headaches, which include migraines, tension headaches, neuralgias, and cluster headaches. It is unusual for chronic sinusitis to cause fever or dizziness. In addition, severe headaches, even if localized to the area of the sinuses, are often not due to sinusitis but rather one of the many other causes of headaches, which include migraines, tension headaches, neuralgias, and cluster headaches.

How is the diagnosis of chronic sinusitis made?

The diagnosis of chronic sinusitis is based on the symptoms, the physical examination, where findings may include nasal drainage or pus, polyps, or other signs of sinus obstruction. As part of this physical examination, an “endoscopy” is often performed. This consists of inserting a flexible or rigid tube, which has at its tip a lens for visualization and a light for illumination. This tube is usually inserted for a few millimeters into the nose. This is not a painful examination and occasionally a topical anesthetic is sprayed to freeze the nose prior to this examination.

A CT (Computed Tomography) scan – or CAT scan – of the sinuses is often performed during the course of diagnosis or treatment of chronic sinusitis. A CT is a sophisticated form of x-ray which provides more precise detail and a more accurate image of the sinuses than a simple x-ray can. This CT may be requested by the otolaryngologist at the initial visit or at a later time after medical treatment has been initiated.

What is the initial treatment for chronic sinusitis?

The initial treatment for chronic sinusitis is medical. The different types of medications used for the treatment of chronic sinusitis include corticosteroid nasal sprays (contain a weak dose of cortisone), oral prednisone (cortisone), antibiotics, salt-water irrigation of the nose, and other medications for symptom relief such as expectorants (to loosen secretions). The type of medication prescribed, the dosage used and the duration of use are dependent on the physician’s evaluation.

Should initial treatment with medications fail and the patient’s symptoms persist or worsen, surgery may be indicated. A few years ago, this surgery involved making facial incisions leaving facial scars, took longer, involved several days in hospital after surgery, and required a longer recovery period. With the progress made in technique, instrumentation, and training, sinus surgery is now performed in a minimally invasive manner through the nostrils without any incisions for the majority of cases, is minimally uncomfortable, and is often performed on an outpatient basis with a shorter recovery period at home. The goal of surgery is not necessarily to cure the disease, but relieve symptoms, and open the nose and sinuses, making the use of medications, such as nasal sprays, more effective. These sprays may need to be continued for extended periods after surgery to maintain the disease in a quiescent state.