Chronic Sinusitis: Symptoms and Treatment

A common affliction in the United States, chronic sinusitis (also referred to as chronic rhinosinusitis) is a recurring and ongoing inflammation and swelling of paranasal sinuses persisting for 12 weeks or longer. Paranasal sinuses are 4 spaces filled with air located in bones surrounding the nose-

  • Frontal sinuses (in the forehead)
  • Maxillary sinuses (behind the cheek bones)
  • Ethmoid sinuses (between the eyes)
  • Sphenoid sinuses (behind the eyes)

Although it most generally affects young and middle-aged adults, chronic sinusitis is also known to occur in children. It can be caused by a myriad of diseases that carry paranasal inflammation as a symptom.

Symptoms

The following are the symptoms most commonly associated with chronic rhinosinusitis:

Blockage of the nasal passage

Facial pain and pressure and pain in area surrounding the eyes; may aggravate when the person is bending or lying down

Headaches, dizziness, heavy head

Nighttime coughing

General discomfort and malaise

Thick greenish discharge of mucus from the nose; can include pus and/or blood

Difficulty in breathing through the nose

Can also lead to a reduced sense of smell

Ear Problems

Recurring sore throat and bad breath (Maxillary sinusitis)

Causes

 

Causes of chronic sinusitis broadly include:

  • Blockage in the nose from allergies, caused due to nasal polyps, nasal tumors
  • Structural abnormalities like deviated nasal septum
  • Nasal blockage due to bacterial infection
  • Dental infections like tooth abscess
  • Allergy to the aspergillus species of fungus

Factors that increase the risk of developing chronic rhinosinusitis or predispose an individual to contract it are:

  • Environmental factors such as dust or pollution
  • Smoking as well as passive smoking

Treatment

The treatment goals are mainly to eliminate the infection and mucosal edema. This maybe achieved through antibiotics and nasal irrigation. Pills taken orally may help clear a blocked nose (oral decongestants). Nasal sprays (topical steroids) may relieve symptoms of chronic sinusitis caused due to allergies.

Over-the-counter painkillers (analgesics) may be used to control facial pain.

Surgery to clean and drain the sinuses may be required. Surgical correction of a deviated septum or nasal obstruction may decrease the chances of a relapse of chronic sinusitis.

A comparatively nascent advancement in the treatment of chronic sinusitis is a form of surgery called Functional Endoscopic Sinus Surgery (FESS). This surgery eradicates anatomical and pathological impediments in order to restore natural clearance of the sinuses. This substitutes earlier techniques requiring facial or oral incisions and gives due attention to the natural openings of the sinuses.

Persistent symptoms and disease in patients despite the use of medical and functional endoscopic approaches, older techniques like the Caldwell-Luc radical antrostomy have to be resorted to. It encompasses the surgical removal of the entire diseased maxillary sinus mucosa and drainage is allowed into the nasal orifice by crafting a large opening in the lateral nasal wall.

Complications arising due to chronic sinusitis:

  • Abscesses
  • Meningitis
  • Visual problems

In extreme cases infection of the brain, seizures, coma, and death

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