Sinuses are air-filled spaces that is located around the nose, between the eyes and behind the forehead. Inflammation of the mucous membrane inside the sinuses is referred to as sinusitis. Sinusitis can be grouped into 2 categories – acute sinusitis and chronic sinusitis. Acute sinusitis lasts for about 7 to 10 days and are usually caused by viral infections. On the other hand, chronic sinusitis is defined as sinusitis lasting more than 12 weeks.
Symptoms of Chronic Sinusitis
Diagnosing chronic sinusitis can be tricky as the symptoms of chronic sinusitis are common and non-specific. Generally, at least 2 of the following symptoms need to be present as sinus infection guide in order to make a diagnosis of chronic sinusitis.
- Postnasal drip, which refers to thick discharge that flows from the nose down the back of the throat
- Nasal congestion or nasal obstruction, which can lead to breathing difficulties and snoring at night
- Pain or tenderness around the nose, around or between the eyes and behind the forehead and the cheeks
- Reduced sense of smell and taste in adults
- Cough in children
Chronic sinusitis can also cause other non-specific signs and symptoms such as:
- Cough which often worsens at night
- Sore throat
- Earache
- Bad breath
- Aching in the upper jaw
- Toothache
- Nausea
- Headache
- Fatigue
Fever is a common symptom of acute sinusitis but it rarely occurs in chronic sinusitis.
Causes of Chronic Sinusitis
There are many factors which can cause chronic sinusitis. Medical experts think that chronic sinusitis is a multifactorial inflammatory disorder and it is unlikely to be caused by persistent bacterial infections alone. Factors that can increase the risks of chronic sinusitis include:
- Nasal polyps – This condition is very common. Nasal polyps are benign growths in the nose. They can block the airway, causing accumulation of mucus and encouraging the multiplication of germs.
- Deviated nasal septum – This is also a common condition. A deviated nasal septum can block one or both nasal passages.
- Respiratory tract infections – Persistent respiratory tract infections can cause inflammation and thickening of the mucous membranes inside the sinus. This will lead to blockage of the airways and impede mucus drainage.
- Allergies – Allergies such as hay fever can cause inflammation of mucous membranes in the sinuses.
- Certain medical conditions like cystic fibrosis, gastroesophageal reflux disease (GERD), HIV infection and other disorders related to the immune system may increase the risk of chronic sinusitis.
- Asthma – Asthma increases the risk of persistent inflammation of the airways, leading to a higher chance of getting chronic sinusitis.
- Smoking – Both active and passive smoking increases the risk of chronic sinusitis.
Diagnosis of Chronic Sinusitis
If a person experiences persistent symptoms of chronic sinusitis, he or she should seek medical help as soon as possible because untreated chronic sinusitis can lead to complications such as meningitis or osteomyelitis. A good doctor will take a detailed history and perform a focused physical examination to find the cause for the patient’s condition. A number of tests can be done to help a doctor find the underlying cause.
- Nasal endoscopy or rhinoscopy – The doctor will insert a thin, flexible tube with a camera at its end into the patient’s nasal passages to visualize any abnormalities such as nasal polyps or a deviated nasal septum.
- Imaging – An X-ray, CT or MRI scan of the facial structures can be done to show the details of the patient’s sinuses and nasal region. These images may help the doctor to find out any abnormalities or obstructions which cannot be visualized with nasal endoscopy.
- Cultures of samples from the sinuses and nasal passages – These tests are usually reserved for patients who have persistent symptoms despite adequate treatment. They will help to identify any underlying infections which are causing chronic sinusitis.
- Skin allergy test – This test is done if the doctor suspects the patient has an underlying allergic condition. This test can be used to identify the allergens which cause persistent sinusitis.
Treatment of Chronic Sinusitis
The treatment for chronic sinusitis depends on the underlying cause of the condition. The objectives of treatment are to reduce allergic reactions and inflammation, improve the mucus drainage of the nasal passages and to reduce the frequency of flare-ups.
While waiting for a definitive cause to be found, the patient can be started on symptomatic treatments. Nasal irrigation with saline solution or sprays can be used to clear mucus and remove persistent allergens and irritants in the nasal passages. Antihistamines and decongestants are used to reduce nasal discharge and improve nasal congestion. Analgesics like paracetamol can be used for pain relief.
There are various non-pharmacological treatments which the patient can use to improve their symptoms at home. Rest is important to help the body fight off inflammation and allow the body to heal. Increasing fluid intake is also vital to help dilute mucus secretions and promote nasal drainage. Caffeine and alcoholic beverages should be avoided as they may worse the inflammation. Breathing in warm vapour or taking hot showers will help thin the thick mucus and reduce nasal congestion. If the patient experiences pressure on pain on the face or forehead, place warm, damp towels on the face to ease the pain.
There are various definitive treatments for chronic sinusitis. One of the most commonly used treatments is nasal corticosteroid sprays. These nasal sprays contain steroid medications such as fluticasone or budesonide. The medications will reduce inflammation in the nasal passages and reduce the frequency of flare-ups. If the symptoms are severe and they interfere with the patient’s daily life, short term treatment with oral corticosteroids or steroid injections may be used. Antibiotics may be used if the patient is found to have an underlying sinus infection. In some patients who have underlying allergies, they can undergo immunotherapy to help reduce the body’s response towards harmless allergens and alleviate the symptoms of chronic sinusitis.
If the patient does not respond well to conservative treatment, the patient may be referred for endoscopic sinus surgery. Using an endoscope, the doctor will identify any abnormal structures causing blockages of the airways such as nasal polyps or a deviated nasal septum. Using the endoscope, nasal polyps can be removed and deviated nasal septa can be corrected. A narrow sinus opening can also be enlarged to improve nasal drainage and improve the patient’s condition.
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