Chronic Sinusitis

What are sinuses?

The sinuses are air pockets in the skull. They are lined with mucus membranes. The mucus helps to flush germs out of the airway. Sinuses likely exist to make the skull lighter and act as a cushioning layer of “bubble wrap” for the brain during trauma.

What is sinusitis?

Sinusitis occurs when the sinuses become inflamed or infected. Inflammation causes mucus membranes to become swollen and to make extra mucus. The swollen lining can block sinus mucus drainage. When this occurs, the sinus becomes infected.

What is chronic sinusitis?

Chronic rhinosinusitis lasts at least 12 weeks, despite treatment and causes at least two of these symptoms:

• Difficulty breathing through the nose
• Runny nose or mucus that drips down the back of the throat
• Facial pressure, pain, or fullness
• Decreased sense of smell

What are other symptoms of chronic sinusitis?

Young children can have bad breath (chronic halitosis).

Fatigue is common to chronic sinusitis. Fatigue is common to many disorders. Because of this it is not used to diagnose chronic sinusitis.

How is chronic sinusitis diagnosed?

Chronic sinusitis is diagnosed by talking with the patient and performing a physical exam. Determining the subtype of chronic sinusitis and planning for surgery requires endoscopy and x-rays.

Nasal endoscopy is an in-office procedure that uses a camera to look inside the nose. Signs of inflammation, infection, and types of sinus blockages can be seen. The procedure lasts a couple of minutes. It is not typically described as painful. It is generally described as “uncomfortable” from pressure and the need to sneeze.

CT scans is a form of x-ray that shows the 3D/three dimensional anatomy of the sinuses. It takes about 30 seconds and does not require injection of dyes. The CT scanner used at Minor & James Surgical Specialists uses very low radiation dose compared to hospital-based scanners. The radiation dose is comparable to two chest x-rays.

What causes chronic sinusitis?

Chronic sinusitis occurs when the mucus membranes remain inflamed and swollen despite medical treatment. This creates cycles of sinus blockage and infections. The underlying reason for sinusitis is unknown. It is thought to result from the body’s immune system attacking its own mucus membranes. The key point is inflammation is the underlying cause of infection, not the other way around.

What are the different types of chronic sinusitis?

There are different categories of chronic sinusitis. There are different, and largely unknown, reasons why people have different types of sinusitis.

1. Chronic sinusitis without polyps. This is “straightforward” sinusitis.
2. Chronic sinusitis with polyps. Polyps are benign, non-cancerous growths inside the nose. They can become large and numerous. When they do, they can clog the sinuses and worsen sinusitis. Treatment can include medications and/or surgery to get rid of polyps.
3. Allergic fungal sinusitis results from a strong allergic response to fungus in the air. Fungal spores are a normal component of the air. Most people can breathe these sports without a problem. Those who are allergic to the spores produce a thick, sticky mucus. Treatment is similar medications and surgeries to other types of sinusitis.

What are common risk factors for chronic sinusitis?

Allergies to environmental materials such as pollens, dusts, molds, and animal dander. Avoidance and treatment of allergies improves the symptoms of sinusitis.

Tobacco smoke or airborne irritants and toxins

Immune system disorders are rare risk factors for chronic sinusitis. These disorders make it difficult to fight infection. Patients with these conditions often have ear and chest infections. The most common cause is decreased production of antibodies that fight infection (hypogammaglobulinemia). However, there are many more immune disorders.

Deviated septum can result in nasal blockage. The septum is the structure that divides your right and left nostril. It is what gets pierced when people get a “septal nose ring.” Septal deviation can result from trauma from sports and accidents. It can also be the result of microtrauma during childhood. It is an uncommon cause of chronic sinusitis.

NSAIDs like aspirin, ibuprofen, naproxen can worsen some types of chronic sinusitis. People with chronic sinusitis with polyps and asthma should not take NSAIDS because reactions can be severe or life-threatening. Common reactions include wheezing, chest tightness, and cough. Acetaminophen (Tylenol) is usually safe to take.

How is chronic sinusitis treated?

Treatment of chronic sinusitis depends on the subtype. Unfortunately, chronic sinusitis is a lifetime illness. Medications and surgery do not cure chronic sinusitis. Treatments do improve symptoms.

• Avoid environmental irritants, toxins, and allergens. Quitting smoking and avoiding allergic triggers are ways to improve sinusitis.
• Decrease nasal inflammation to improve airflow, breathing, and sinus drainage. The following do not require prescriptions.
• Nasal saline rinses (i.e. Neti-Pot or Nielmed irrigators) can wash off irritants before they trigger allergic reactions. Be sure to irrigate before using nasal sprays. Otherwise the medications will be flushed out.
• Nasal steroid sprays are low-dose, non-prescription nasal steroids. They decrease the response to irritants and inflammation. They must be taken daily for several weeks to reach maximum effectiveness. There are several kinds, each with their own odors. But they are all effective.  
• Antihistamines may be oral or sprayed inside the nose. They also work to decrease the response to irritants and inflammation. Some types that don’t typically cause drowsiness are loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra).
• Less commonly, more intensive medical therapy is needed
• Steroid sinus irrigations
• Steroid pills can significantly alleviate symptoms. However, they can suppress the immune system, result in bone fractures, and increase blood sugars
• Antibiotics are used rarely in treatment of chronic sinusitis. Antibiotics do not address inflammation, the root cause of chronic sinusitis.

When do I need surgery for chronic sinusitis?

Surgery for chronic sinusitis is used when medications do not sufficiently alleviate symptoms. The goal of sinus surgery is to open drainage pathways. This decreases symptoms. It also allows medications to penetrate more deeply into sinuses.