Chronic Sinusitis

What is chronic sinusitis?

Chronic sinusitis is one of the two main types of sinusitis. (The other is acute sinusitis). Chronic sinusitis is further sub-classified into either chronic sinusitis with nasal polyps, or chronic sinusitis without nasal polyps. People with chronic sinusitis experience symptoms that last for three months or longer at a time.

Chronic sinusitis is a serious condition that can greatly affect quality of life. If you suffer from this condition, you are not alone. Chronic sinusitis is one the most common health complaints in the United States, affecting over 30 million people every year. It is also one of the most common reasons for outpatient antibiotic prescriptions.

Chronic sinusitis with polyps

Chronic sinusitis with polyps is one form of chronic sinusitis. Sinonasal polyps refer to grape-like swellings of the sinus tissue lining due to severe underlying inflammation. Patients with chronic sinusitis with nasal polyps have a much more aggressive form of chronic sinusitis and their symptoms come back more often. These patients are also more likely to require surgery as time goes on, and multiple surgeries may be necessary as part of treatment.

Polyps in the nose are not like polyps found in the colon, for example, and they are not linked to cancer.

Chronic sinusitis symptoms

The symptoms of chronic sinusitis are similar to acute sinusitis, but differ in how long symptoms last. (Chronic sinusitis lasts three months or more without symptom resolution). Symptoms include:

  • Nasal obstruction (airflow is blocked in either one or both of the nostrils)
  • Thick and/or foul-smelling or tasting nasal discharge or postnasal drip
  • Facial pain (sometimes referred to as sinus headaches) or pressure across the cheeks or forehead, or over the bridge of the nose between the eyes; less commonly, pain may occur at the top center of the head or behind the eyes. Facial pain is more common in acute sinusitis than in chronic sinusitis.
  • Loss of sense of smell
  • Fever (more common in acute sinusitis than in chronic sinusitis)

Patients with chronic sinusitis and nasal polyps are more likely to have more severe nasal obstruction and loss of smell compared to patients with chronic sinusitis without polyps.

Chronic sinusitis treatment options

Depending on the severity the cause of your symptoms, there are treatment options available to help ease or possibly eliminate your symptoms entirely. Treatment options include

  • Oral steroid taper: Steroids such as Prednisone or Medrol are given in pill form over the course of 1-2 weeks. During the treatment, the dosage is gradually reduced.
  • Antibiotics: Oral antibiotics may be used for 2-3 weeks duration, but on a case-by-case basis. Not all patients with chronic sinusitis require oral antibiotics.
  • Nasal steroid sprays: Several brands of nasal steroid sprays exist either as prescription or over-the-counter, all with similar effectiveness in reducing inflammation in the nose.
  • High-volume saline irrigations (240 mL squeeze bottle preferred): Saline solutions are usually prescribed for use 2-3 times per day until symptoms subside.
  • Decongestants: Medications like oral pseudoephedrine and nasal oxymetazoline sprays may help alleviate nasal obstruction by constricting blood vessels in the sinus and nasal tissues, shrinking the swollen tissues. Again, nasal decongestants should only be used for 2-3 days at a time to avoid dependency.Expectorants: Medications such as Mucinex (Guaifenesin) thin the mucus which may help it drain out the nose more easily.
  • Endoscopic sinus surgery: If medical therapies are inadequate at providing relief, sinus surgery is often used to enlarge the natural openings of the sinuses to more effectively distribute medication.

Endoscopic sinus surgery

Your surgeon may recommend sinus surgery when medical therapies fail to provide the results you want. Endoscopic sinus surgery is most often utilized for patients with chronic or recurrent acute sinusitis. The goal of sinus surgery is to enlarge the natural openings of the sinuses to allow for better distribution of topical therapies to the sinus cavities. Additionally, wider holes make it easier for the sinuses to drain, even when swollen from infection or environmental irritants.

Learn more about endoscopic sinus surgery.

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