Chronic sinusitis (in adults)

What is chronic sinusitis?

Chronic sinusitis is a long-term inflammation of the sinuses. The sinuses are moist air spaces behind the bones of the upper face — between the eyes and behind the forehead, nose and cheeks. Normally, the sinuses drain through small openings into the inside of the nose.

Anything that obstructs that flow can cause a buildup of mucus, and sometimes pus, in the sinuses. Drainage from the sinuses can be obstructed by structural abnormalities of the nose, infection, or tissue swelling caused by allergies. The buildup of mucus leads to increased sinus pressure and facial pain. In adults, chronic sinusitis most often is linked to nasal swelling caused by allergies, especially allergies to inhaled dust, mold, pollen, or the spores of fungi. These allergies trigger the release of histamine and other chemicals that cause the inner lining of the nose to swell and block sinus drainage.

Polyps, nasal tumors and nasal fractures can obstruct the sinus drainage leading to chronic sinusitis. Chronic sinusitis also can be seen in people whose sinuses and nasal passages are structurally abnormally narrow. People with asthma, cystic fibrosis, or immune system problems develop chronic sinusitis more often than others.

Symptoms of chronic sinusitis

The most common symptom is painful pressure in upper parts of the face, especially in the forehead, behind the nose, between or behind the eyes, or in the cheek. Sometimes, sinus pain can feel like a toothache. Other symptoms include nasal congestion, postnasal drip that is worse at night, and bad-smelling breath that is unrelated to dental problems. Fever and a thick, discolored nasal discharge are signs of acute sinusitis, a short-term sinus infection usually caused by viruses or bacteria. The same symptoms can be present in chronic sinusitis.

Diagnosing chronic sinusitis

Your doctor will ask about your symptoms, how long you have had them, and what you may be allergic to in your environment. He or she will examine you, paying special attention to your nose and throat. During this examination, your doctor will check for:

• Fever
• Tenderness in the areas of your face overlying your sinuses
• Inflammation and mucus in your nose and throat
• Nasal polyps or a deviated septum
• Enlarged lymph nodes.

Your doctor usually can diagnose chronic sinusitis and start treatment based on your symptoms and the physical examination. Further tests usually are not necessary. If the diagnosis is not clear, or if your doctor suspects you may have a structural blockage, he or she may order tests to look at the sinuses — usually computed tomography (CT) or magnetic resonance imaging (MRI) of your sinuses. You also may be referred to a specialist for further tests. An ear, nose and throat specialist can take a closer look inside your nose and throat with a tiny scope that has a camera lens at the end. An allergy specialist can perform skin-prick or blood (RAST) tests to find out what you are allergic to.

Expected duration of chronic sinusitis

Symptoms of chronic sinusitis can last for months or years. Some doctors consider sinusitis to be chronic rather than acute when it lasts at least three months.

Preventing chronic sinusitis

If you have chronic sinusitis, avoid cigarette smoking and exposure to secondhand smoke. You also should avoid spending long periods of time outdoors when there are high levels of airborne allergens or pollutants. Indoors, using air conditioners and humidifiers can sometimes help prevent symptoms of chronic sinusitis. If you have allergies, you can help to prevent episodes of sinusitis by identifying and avoiding triggers and by taking appropriate medications as directed. Several measures can be taken at home to remove many indoor airborne allergens that trigger sinus problems. Here are some things you can do:

• Keep windows closed, especially bedroom windows. You can cut down your exposure to indoor contamination by using a HEPA filter (high-efficiency particulate air filter) on your air conditioner.
• While traveling in your car, drive with your external vents closed and air conditioning on. Some newer vehicles can be equipped with a high-efficiency, air-filtration system.
• Take a shower or wash your hair before going to bed at night to remove pollutants or airborne allergens that accumulated during the day.
• Dry clothes inside, either in a dryer or on a line. Clothing drying on an outside line can gather allergens.
• Minimize activities with heavy exposure to pollens, such as lawn mowing and leaf blowing.
• Inhaling steam and rinsing your nose with a saline solution regularly also can help to avoid symptoms.
• Make sure you drink enough fluids.

Treating chronic sinusitis

If you think you have sinusitis, you can try some things at home first to help reduce swelling and open blocked sinuses. Inhaling steam and using nasal saline spray washes often helps. Decongestants, by mouth or nasal spray, are available without a prescription and can help to relieve the pressure. To control the pain, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others).

Because chronic sinusitis often is caused by inflammation related to allergies, identifying, treating and preventing your allergies helps to relieve the sinusitis. Allergy medications include antihistamines, decongestants, leukotriene inhibitors and anti-inflammatory medications.

Corticosteroid nasal sprays also can relieve nasal swelling and sinus inflammation. If these sprays don't help, you may need a trial of oral steroids, such as prednisone. If there is evidence of active bacterial infection ,you may need to take a course of antibiotics. If your allergies are difficult to control, an allergy specialist can test you for specific allergies and administer desensitizing shots (immunotherapy) to treat your symptoms.

If symptoms are difficult to control with medications alone, you may need to see an ear, nose and throat specialist, who can determine if you need your sinuses drained or if you need endoscopic surgery to widen the sinus openings. Endoscopic surgery uses small scopes and instruments to see and operate through the nasal passages to get to the sinuses. If the blockage of the sinus opening is limited, balloon dilatation of the area may resolve the problem and avoid more involved surgery.

Nasal polyps and other structural blockages also can be removed with endoscopic sinus surgery. Even a deviated septum can be corrected with endoscopic surgery.

People with chronic sinusitis and nasal polyps not responding to other therapies may be candidates for treatment with one of the FDA approved monoclonal antibodies.

When to call a professional

If your symptoms are not getting better after several days, or if you develop a fever or a brown or green discharge, you should see your doctor. If you develop a severe headache, you should call your doctor for a more urgent evaluation.

Prognosis

The prognosis for chronic sinusitis depends on its cause. Often medication or surgery is needed to reduce the inflammation or correct the blockage. In many cases, the inflammation has to be managed with medications for a long time to prevent recurrence.

Additional info

National Institute of Allergy and Infectious Diseases (NIAID)
https://www.niaid.nih.gov/

American Academy of Allergy, Asthma & Immunology (AAAAI)
https://www.aaaai.org/

American Academy of Otolaryngology — Head and Neck Surgery
https://www.entnet.org/