Chronic Sinusitis: Symptoms, Causes, and Treatments

Chronic sinusitis, an inflammatory condition affecting the sinuses, is a prevalent health issue. This persistent inflammation of the sinuses, can significantly affect an individual's quality of life, causing discomfort and fatigue. In this article we’ll help you to understand chronic sinusitis, its symptoms, causes, potential complications, and effective treatment options.

A note from our Medical Director

Chronic sinusitis is a common condition that goes undiagnosed for long periods of time in a number of people who put their symptoms down to seasonal colds, seasonal allergies, or chronic tension headaches secondary to stress. Don't let chronic symptoms last - take charge of your health and if you’re experiencing symptoms of sinusitis, talk to a doctor and take the first steps in investigating and treating your symptoms.

Chronic sinusitis, often referred to as a long-term sinus infection, is generally characterised by inflammation in the sinuses that persists for 12 weeks or more. This condition can cause a range of symptoms, including nasal obstruction, nasal discharge, facial pain, and frequent or persistent headaches.

Symptoms

The most common symptoms of chronic sinusitis include nasal obstruction, nasal discharge, facial pain, headache, halitosis (bad breath), and anosmia (loss of smell). These symptoms can significantly impact an individual's daily life, causing discomfort and fatigue.

Chronic sinusitis is a common condition that can significantly impact quality of life - American Academy of Family Physicians

Causes

Chronic sinusitis can be caused by various factors, including viruses, bacteria, and allergens. Structural issues, such as nasal polyps or a deviated nasal septum, can also contribute to the development of this condition.

Impact and Complications

If left untreated, chronic sinusitis can lead to complications, including infections that spread from the sinuses to the eyes, bones, brain, or spine. It's important to seek medical attention if symptoms persist for more than 12 weeks.

Diagnosis

The diagnostic work-up for a patient with suspected chronic sinusitis typically involves a series of investigations to confirm the presence of inflammation and to identify any underlying causes. The most important investigations, generally performed in the following order, are:

• Clinical Evaluation: A thorough history and physical examination are essential. The presence of at least two of the four cardinal symptoms (nasal obstruction, facial pressure/pain, discoloured nasal drainage, and hyposmia/anosmia) for at least 12 weeks is indicative of chronic sinusitis.

• Nasal Endoscopy: This procedure involves inserting a thin, flexible tube with a light and camera (endoscope) into the nasal passages. It allows the healthcare provider to directly observe the sinuses and look for signs of inflammation, purulent discharge, oedema, or polyps.

• Imaging Tests: Computed tomography (CT) or magnetic resonance imaging (MRI) scans can provide detailed images of the sinuses and nasal area, helping to pinpoint the cause of chronic sinusitis. CT scans are more commonly used and are considered the imaging study of choice to confirm the diagnosis.

• Allergy Testing: If allergies are suspected to be contributing to chronic sinusitis, an allergy skin test or a blood test may be performed to identify specific allergens.

• Nasal and Sinus Samples: Although not often used in the initial diagnosis, tissue samples from the nose or sinuses may be taken for lab tests if the condition does not improve with treatment or worsens.

These investigations are typically performed in a stepwise manner, starting with the least invasive (clinical evaluation) and progressing to more detailed assessments (imaging and sampling) as needed.

It is important to understand that the diagnostic process is collaborative, and effective communication with healthcare providers is crucial for an accurate diagnosis and appropriate management of chronic sinusitis.

At risk groups

Chronic sinusitis most commonly affects young to middle-aged adults but can also affect children.

Importance of Treatment

Treatment is essential to control the inflammation and prevent complications. Chronic sinusitis treatment focuses on controlling or easing inflammation, and treatments may vary depending on the individual's situation*. *

Chronic sinusitis can lead to serious complications if left untreated - Cleveland Clinic

Treatment Options

The treatment of chronic sinusitis typically involves a stepwise approach, starting with the least invasive options and progressing to more intensive treatments if necessary. Here are the recommended treatments, generally trialled in the following order:

• Self-help Measures: Rest, hydration, and the use of warm compresses can help ease sinusitis symptoms. Keeping the sinuses moist, such as by breathing in the vapour from a bowl of hot water or taking a hot shower, can also help ease pain and promote mucus drainage.

• Nasal Corticosteroids: These nasal sprays help prevent and treat inflammation. They are recommended for all types of chronic sinusitis and are often the first line of treatment.

• Saline Nasal Rinses: These can help clear the nasal passages and are often used in conjunction with nasal corticosteroids.

• Oral or Injected Corticosteroids: If symptoms are severe or do not respond to nasal corticosteroids, a short course of oral or injected corticosteroids may be considered.

• Antibiotics: If a bacterial infection is suspected, a short course of antibiotics may be advised. Prolonged courses of antibiotics (3-4 weeks) are sometimes helpful but are best prescribed after consultation with a doctor.

• Allergy Medicines: If allergies are contributing to chronic sinusitis, antihistamines or other allergy medicines may be recommended. Allergy shots (immunotherapy) might also be considered.

• Medicine to Treat Nasal Polyps: If nasal polyps are present, specialist medicines like dupilumab (Dupixent), omalizumab (Xolair), or mepolizumab (Nucala) might be used to reduce their size and lessen symptoms. These would be started under the care of a specialist.

• Surgery: If the condition does not improve with medical treatments, surgery may be considered. The most common operation is functional endoscopic sinus surgery (FESS), which aims to improve the drainage of the affected sinus.

It's important to note that the best treatment for chronic sinusitis varies from person to person, and the treatment plan should be tailored to the individual's specific symptoms and underlying causes.

Treatment is essential to control the inflammation and prevent complications - Mayo Clinic

Doctors and specialists involved

The management of a patient with suspected chronic sinusitis may involve several healthcare professionals, who are likely to be involved in the patient's care in the following order:

• General Practitioner: This is usually the first point of contact for patients. They can diagnose and manage most cases of chronic sinusitis, and refer to specialists when necessary.

• Ear, Nose, and Throat (ENT) Specialist (Otolaryngologist): They have specialised training in conditions of the ear, nose, and throat, including chronic sinusitis. They can perform detailed examinations, such as nasal endoscopy, and surgical procedures if needed.

• Allergist-Immunologist: If allergies are suspected to be contributing to chronic sinusitis, an allergist-immunologist may be involved in the patient's care. They can perform allergy testing and provide targeted treatment.

• Radiologist: Interpret imaging studies, such as CT or MRI scans, which are often used in the diagnosis of chronic sinusitis.

• Surgeon: If the condition does not improve with medical treatments, a surgeon may be involved to perform sinus surgery.

Related Conditions or Complications

Chronic sinusitis can co-occur with conditions such as allergic rhinitis and nasal polyps.

Outlook and Prognosis

With appropriate treatment, the prognosis for chronic sinusitis is generally good. However, the condition can recur, and some individuals may experience persistent symptoms despite treatment.

Practical Tips & Coping Strategies

• Regularly rinse your nasal passages
• Stay hydrated
• Avoid known allergens and irritants
• Use a humidifier
• Practise good hygiene to prevent infections