Chronic Sinusitis

DISCLAIMER: This information is provided to be a summary of information for those looking into medication for sinusitis treatment and is not to be taken as medical advice. If you think you have sinusitis make sure you contact your doctor as they will be best equipped to diagnose and treat you. Never ignore your doctor’s advice because of this information. 

Overview

Chronic sinusitis is a condition which occurs when the spaces inside the head and nose are swollen and inflamed for longer than 3 months despite treatment. 

This common condition can interfere with the way mucus drains and makes your nose stuffy. It may be difficult to breath through your nose and the area around your eyes may feel tender or swollen. 

Chronic sinusitis may be brought on by swelling of the lining of your sinuses, or growths in the sinuses (nasal polyps). It is also called chronic rhinosinusitis and this condition can affect adults or children. 

Symptoms

Common signs of chronic sinusitis include: 

  • Thick, discoloured discharge from the nose
  • Pain, tenderness and swelling around your eyes, forehead, nose, or cheeks. 
  • Nasal inflammation
  • Postnasal drainage
  • Reduced sense of smell and taste
  • Nasal congestion or obstruction causing difficulty breathing through your nose. 

Other symptoms may include: 

  • Cough or clearing your throat
  • Fatigue
  • Aching in the upper teeth and jaw
  • Bad breath
  • Ear pain
  • Sore throat

Chronic and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses that is usually associated with a cold. Signs and symptoms of chronic sinusitis will last at least 12 weeks. You may have several bouts of acute sinusitis before developing chronic sinusitis. You may have a fever with acute sinusitis but it is not a symptom of chronic sinusitis. 

Causes

Some common causes of chronic sinusitis include: 

  • Respiratory tract infections. Infections in the respiratory tract (usually colds) can inflame and thicken the membranes of your sinuses and block the drainage of mucus. These infections can be fungal, viral, or bacterial.
  •  Deviated nasal septum. The septum is the wall between your nasal passages. When this is crooked it can block or restrict sinus passages which makes regular sinusitis symptoms worse. 
  • Nasal polyps. These are tissue growths that can block the sinuses or nasal passages. 
  • Allergies such as hay fever. Inflammation that occurs with allergy flareups may block your sinuses. 
  • Other medical conditions. Complications due to conditions such as HIV, cystic fibrosis, and other immune system-related diseases can contribute to nasal blockage. 

Diagnosis

Your doctor will feel for tenderness in the face and nose and also look inside your nose. 

Methods to diagnose chronic sinusitis include: 

  • Looking into your sinuses. A thin, flexible tube with a fiber-optic light will be inserted through your nose to let your doctor see the inside of your sinuses. 
  • Imaging tests. Images taken with an MRI or CT scan can show the details of your nasal area and sinuses. These can pinpoint a physical obstruction or deep inflammation that is hard to detect with an endoscope. 
  • Samples from your nasal and sinus discharge. Cultures are usually not required to diagnose chronic sinusitis. However, if your chronic sinusitis doesn’t respond to treatment or is getting worse, your doctor may swab inside your nose to collect samples that can assist in determining the cause such as fungi or bacteria. 
  • An allergy test. If your doctor thinks allergies might be triggering your chronic sinusitis they may recommend an allergy skin test. A skin test is quick and safe and can help figure out what allergen is responsible for nasal flare-ups.  

Treatment

Medications

Sinusitis treatments may include: 

  • Nasal corticosteroids. These nasal sprays will help treat and prevent inflammation. Examples of nasal corticosteroids for sinusitis treatment include: budesonide, triamcinolone, beclomethasone, fluticasone, and mometasone. If the sprays don’t work well enough for your sinusitis treatment, your doctor might recommend rinsing with a solution of saline mixed with a few drops of budesonide, or using a nasal mist of the solution. 
  • Oral or injected corticosteroids. These medications are used for sinusitis treatment and relief of inflammation, especially if you have nasal polyps. Oral corticosteroids are associated with serious side effects during long term usage so they are only used for sinusitis treatment when there are severe symptom. 
  • Aspirin desensitization treatment. This is used as a sinusitis treatment if you have reactions to aspirin that cause sinusitis. Under medical supervision you will be given larger and larger doses of aspirin to increase your tolerance. 
  • Saline nasal irrigation. Sinusitis treatment with nasal irrigation involves using nasal sprays or solutions. They rinse away irritants and allergies and reduce drainage. 

Antibiotics

If you have a bacterial infection causing sinusitis, antibiotics may be used as a part of your sinusitis treatment. If your doctor can’t rule out underlying infection, they may recommend an antibiotic, sometimes in combination with other medications. 

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots that help to reduce the body’s reaction to specific allergins can be a good sinusitis treatment. 

Surgery

In cases with resistance to medication or treatment, endoscopic sinus surgery could be an option. In this procedure, your doctor will use a thin, flexible tube with a light to explore your sinus passages. 

Depending on the source of the obstruction, your doctor can use different tools to remove tissue or shave away a polyp causing blockage. Enlarging a narrow sinus opening can also be an option to promote drainage.