Chronic Sinusitis

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Introduction

What is chronic sinusitis?

Sinusitis, commonly called a sinus infection, is inflammation (with or without infection) of the air-filled spaces that are located within the bones in and around the nose (paranasal sinuses). This results in swelling of the mucus membranes that line the sinuses, pain and pressure in and around the eyes and cheekbones, and a thick green discharge from the nose.

Generally, chronic sinusitis is diagnosed when symptoms of sinusitis persist for longer than 12 weeks despite treatment. In chronic sinusitis, also called chronic rhinosinusitis, the mucous membranes in the nose and paranasal sinuses are constantly inflamed and become thickened. The inflamed membranes can be seen upon examination of the inside of your nose by your health care provider.

According to the American Academy of Allergy, Asthma and Immunology, chronic sinusitis is one of the most common chronic illnesses in people younger than 45 years of age in the United States (Source: AAAAI).

In contrast to acute sinusitis, most health experts believe that chronic sinusitis is not an infectious disease. However, if you suffer from frequent episodes of acute sinusitis, you are at risk for developing chronic sinusitis.

Treatment for chronic sinusitis varies depending on the underlying cause and your medical history. Treatment may include a humidifier, medications, or possibly surgery. Surgery should be considered when medical treatment fails or when an injury, structural problem, or obstruction is present. Chronic sinusitis with nasal polyps is a common reason for sinus surgery.

Sometimes, chronic sinusitis may be a sign of a serious underlying disease, disorder or condition. Seek prompt medical care if you have symptoms of sinusitis that are unexplained, do not respond to treatment as expected, last longer than 14 days, or recur.

In some cases, sinusitis can spread from the sinuses to the nervous system and lead to life-threatening infections and complications, such as meningitis or brain abscess. Seek immediate medical care (c all 911) if you, or someone you are with, have symptoms of sinusitis that are accompanied by a change in alertness or consciousness, high fever, seizure, severe headache, or a stiff neck.

Symptoms

What are the symptoms of chronic sinusitis?

Symptoms of chronic sinusitis are similar to those of acute sinusitis. However, chronic sinusitis symptoms tend to be milder and do not include fever. How sinusitis affects people varies. It is possible to confuse symptoms of sinusitis with those of a migraine headache. Common symptoms of sinusitis include:

  • Chronic cough (especially in children)

  • Decreased sense of smell

  • Fatigue

  • Headache, which may be worse when bending over or lying down

  • Pain around the upper jaw (similar to a toothache)

  • Pain or pressure in the face or area in and around the eyes, which may be worse when bending over or lying down

  • Stuffy nose and difficulty breathing through the nose

  • Swelling around the nose, eyes and eyelids

  • Thick nasal mucus or postnasal drainage

Symptoms that might indicate a serious or life-threatening condition
In some cases, chronic sinusitis can result in serious complications, such as meningitis or brain abscess. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms:

Causes

What causes chronic sinusitis?

Currently, most health experts believe that chronic sinusitis is a group of diseases that cause similar symptoms, rather than one disease that accounts for all cases of chronic sinusitis. Chronic sinusitis is not an infectious disease, which makes it different from acute sinusitis caused by an infection. However, frequent or recurrent episodes of acute sinusitis put you at risk for developing chronic sinusitis.

Chronic sinusitis is due to ongoing obstruction of the sinuses due to inflammation, difficulties with the normal flow of mucus, or a weakened immune system.

What are the risk factors for chronic sinusitis?

A number of factors contribute to or increase your risk of developing chronic sinusitis. Risk factors include:

  • Allergies, such as hay fever or allergic rhinitis

  • Anatomic abnormalities of the nasal passages and sinuses

  • Asthma

  • Deviated septum

  • Immune disorders or having a weakened immune system

  • Nasal polyps or cysts

  • Nose injury or trauma

  • Prior dental infections

  • Recurrent acute sinusitis

  • Smoking

Reducing your risk of chronic sinusitis

Not all people with risk factors will get chronic sinusitis, but you can lower your risk of chronic sinusitis by:

  • Avoiding known allergens

  • Avoiding nasal trauma by wearing recommended protective equipment for dangerous activities or contact sports

  • Avoiding touching your eyes, nose and mouth, which can transmit bacteria, viruses and fungi from your hands into your nose and sinuses, causing acute sinusitis

  • Drinking plenty of water or other fluids to keep mucus thin

  • Seeking regular medical care and treatment for asthma, hay fever, and allergic rhinitis

  • Washing your hands frequently with soap and water for at least 15 seconds, especially after contact with a person who has an infectious illness

Treatments

How is chronic sinusitis treated?

Treatment plans for chronic sinusitis are generally aimed at relieving nasal congestion, improving breathing, reducing pain and pressure, and possibly correcting physical or structural problems of the nose or sinuses.

General treatment of chronic sinusitis

General treatment of sinusitis includes:

  • Avoiding allergic triggers if you have allergies

  • Drinking plenty of fluids to stay hydrated and keep nasal discharge loose

  • Getting plenty of rest

  • Keeping the head elevated while sleeping to reduce pressure on the sinuses

  • Using a cool mist vaporizer to moisten and loosen nasal discharge

Medications used to treat chronic sinusitis

For some people with chronic sinusitis, medication may be recommended or prescribed. It is very important to read and follow the complete directions and warnings on over-the-counter medicines and discuss their use with your health care provider before taking them. Medications that are prescribed to treat infections, such as antifungals and antibiotics, need to be taken exactly as directed to cure the underlying infection. To effectively treat chronic sinusitis due to an underlying infection, these drugs often need to be taken for an extended period of time.

Medications and other recommended treatments may include the following:

  • Antibiotics are prescribed if the sinusitis is caused by a bacterial infection. Antibiotics will not treat sinusitis caused by a viral or fungal infection.

  • Antifungal drugs are prescribed if sinusitis is caused by a fungal infection. Antifungal drugs will not treat sinusitis caused by a viral or bacterial infection.

  • Antihistamines or allergy shots to help control underlying allergies

  • Antileukotrienes to disrupt the inflammatory pathways that produce symptoms

  • Corticosteroid nasal sprays to reduce the inflammation and pain of sinusitis

  • Decongestants to shrink inflamed and swollen sinuses. These medications, such as Sudafed, can have serious side effects that can affect the heart in some people. They should be used only as directed by your health care provider.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve) to control the pain, pressure and inflammation of chronic sinusitis. Discuss the use of NSAIDs with your health care provider because these medications can have potentially serious side effects in some people.

Surgical treatment for chronic sinusitis

Surgery may be an option in some cases of chronic sinusitis to correct structural problems, remove physical obstructions or polyps, repair injuries, or clear out diseased tissue.

What are the potential complications of chronic sinusitis?

Left untreated, chronic sinusitis may cause potentially serious complications and damage to the sinuses that must be surgically repaired. It is important to contact your health care provider for sinusitis symptoms that are persistent or come back after treatment. With proper diagnosis of the underlying cause, chronic sinusitis can be managed and you can help avoid complications including:

  • Brain abscess

  • Damage to the sinuses

  • Loss of taste or smell, which can be permanent

  • Meningitis

  • Orbital cellulitis (invasive infection of the skin and tissues around the eye), abscess, and blindness

  • Osteomyelitis (bone infection)

  • Worsening asthma

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 12
  1. Complications of sinusitis. American Rhinologic Society. http://care.american-rhinologic.org/complications_sinusitis.
  2. Sinusitis Q&A. American Rhinologic Society. http://care.american-rhinologic.org/sinusitis_q_a.
  3. Sinusitis. American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org/conditions-and-treatments/allergies/sinusitis.aspx.Sinusitis. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000647.htm.
  4. Sinusitis: What is the difference between acute and chronic sinusitis? National Institute of Allergy and Infectious Diseases. http://www.niaid.nih.gov/topics/sinusitis/Pages/acuteVsChronic.aspx#Chronic.
  5. Hamilos DL. Approach to the evaluation and medical management of chronic rhinosinusitis. Clin Allergy Immunol 2007; 20:299.
  6. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2012.
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