Chronic Sinusitis

Chronic Sinusitis (Rhino-Sinusitis)

Sinusitis is an inflammation of the lining of one or more of the sinus cavities in the facial bones around your nose. Sinusitis can make life miserable, causing tenderness in your face, aching behind your eyes and difficulty breathing through your nose.

Most cases of sinusitis are acute infectious sinusitis, which generally lasts less than four weeks. If the signs and symptoms of sinusitis last more than 12 weeks, or if you have frequent bouts of sinusitis, you may have chronic sinusitis.

Chronic sinusitis is one of the most common chronic diseases in the United States, affecting an estimated 33 million people each year. Treatment may be with medications or, in some cases, surgery.

Signs & Symptoms

Chronic sinusitis is not typically accompanied by fever. You may have chronic sinusitis if you have two or more of these major signs and symptoms:

• Pressure-like pain on your forehead, temples, cheeks, nose, or around or behind your eyes
  
  
• Difficulty Breathing Through your Nose
  
  
• Thick, yellow or greenish discharge that drains into your nose or down the back of your throat
  
  
• Reduced Sense of Smell

You may also have chronic sinusitis if you have one major sign or symptom and at least two of these minor signs and symptoms:

• Aching in your upper Jaw and Teeth
  
  
• Headache
  
  
• Bad Breath
  
  
• Ear Pain
  
  
• Fatigue
  
  
• Cough
  
  
  

Causes

Your sinuses are hollow spaces within the bones of your face, behind and above your nose. They humidify and warm the air you breathe, aid your sense of smell, and improve the sound of your voice. They also make mucus, which cleans and moisturizes your nasal passages.

Inside your sinuses are tiny hairs, called cilia (SIL-e-uh), which constantly sweep mucus out of your sinuses and into your nose and throat. Your sinuses drain into your nose through small openings called ostia (OS-te-uh). When the ostia become blocked, mucus backs up in your sinuses.

When your sinuses can't drain, microorganisms such as viruses, bacteria or fungi can multiply and cause infection. Infection causes swelling, which makes it even harder for your sinuses to drain.

Common causes of sinus blockage, which can lead to chronic or recurrent sinus infections, are:

• Respiratory Tract Infections. Bacterial and viral infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, impeding mucus drainage and creating conditions ripe for bacteria growth.
  
  
• Allergy. Your immune system may mistake harmless elements such as pollen, pet dander or dust mites as violent attackers and fight back. The results of this battle mimic signs and symptoms of a cold — stuffy nose, itchy eyes, cough — and may cause congested sinuses. Seasonal allergies may increase your risk during distinct times of the year. If you have allergies to dust mites or pets, your symptoms could appear and reappear at seemingly more random times.
  
  
• Fungi. Fungi can cause a specific type of chronic sinusitis called allergic fungal sinusitis.
  
  
• Nasal or Sinus Obstructions. Nasal polyps, small growths that resemble grapes, can obstruct the passages from your sinuses to your nose, making proper drainage difficult. The size and shape of the opening between your sinuses and nasal cavity also may obstruct sinus drainage.
  

Other causes of chronic sinusitis include:

• Immune deficiency disorders, such as HIV/AIDS, which make you more susceptible to chronic sinusitis
  
  
• Cystic fibrosis, which causes your body's secretions to become thick and sticky in your sinuses as well as in your lungs
  
  
• Trauma, such as a fractured facial bone, which may obstruct one or more of your sinus cavities
  

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When to seek Medical Advice

Typically, people have several episodes of acute sinusitis before developing chronic sinusitis. If you've had sinusitis a number of times and the condition doesn't respond to treatment, or if your infection has lasted more than three months, ask your doctor if you might have chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist.

Chronic sinusitis may make asthma symptoms worse in people with asthma and in people who have asthma-like reactions to aspirin and related medications such as ibuprofen. If you experience wheezing or shortness of breath, or if you're concerned about possible aspirin allergy, see your doctor.

Screening & Diagnosis

Chronic sinusitis can be difficult to diagnose because the symptoms may be similar to colds or allergies. Provide your doctor with as much detail about the type and duration of your symptoms as possible.

Your doctor may recommend allergy skin tests to determine whether allergies are causing your sinusitis. Allergy skin tests are safe, involve little if any discomfort and usually can be done in a short time.

These procedures help in diagnosing chronic sinusitis:

• Nasal Endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
  
  
• Imaging. Images taken using a computerized tomography (CT) scan or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area, including a deep inflammation or infection that may be difficult to detect using an endoscope.

Treatments

Treatments for chronic sinusitis include:

Corticosteroids. If you have intense inflammation of your sinuses, your doctor may prescribe a corticosteroid. Doctors commonly prescribe nasal corticosteroid sprays, but severe inflammatory sinusitis may require oral corticosteroids. Your doctor may prescribe corticosteroid pills to try to shrink the inflamed sinus membranes, then recommend a corticosteroid nasal spray to prevent them from swelling again.

Antibiotics. Chronic sinusitis may require a long period of antibiotic treatment. You may need to take antibiotics for a minimum of four weeks, and for as long as 12 weeks.

If your condition doesn't improve with medications, your doctor may recommend surgery. Surgically enlarging a narrow sinus passage or removing a bone or polyp that's blocking a passage will allow better drainage, making an infection less likely. Your doctor may perform surgery using a thin, flexible tube called an endoscope.

Newer treatments are continually being studied. For example, some studies have examined the role of nasal antifungal medications in treating chronic sinusitis. Initial results looked promising, with as many as 75 percent of people experiencing some relief from their symptoms. More study is needed, however, because another study found no effect from the treatment.

Rhino-Sinusitis

Rhino-sinusitis is an inflammatory process involving one or more of the paranasal sinuses that usually follows an allergic reaction or viral upper respiratory infection. In some cases, rhino-sinusitis may occur due to increased production of bacteria on the surface of the sinus cavities.

Technically there is no difference between Rhino-sinusitis and nasal polyps; though a slight distinction is made, in that nasal polyps are a worst case scenario of the condition of rhino-sinusitis. Rhino-sinusitis refers to the inflammation of the tissues of the nose (rhino-) and sinuses. Nasal Polyps (tissue swellings) can form within the nose and sinuses; these are responsible for many symptoms described by patients with chronic rhino-sinusitis.

Rhino-sinusitis can be divided into four subtypes and causes may vary due to the type of condition:

Acute Rhino-Sinusitis

Acute rhino-sinusitis is an inflammatory condition of one or more of the para-nasal cavities that usually lasts up to four weeks. Acute rhino-sinusitis can range from acute viral rhinitis (the common cold) to acute bacterial rhino-sinusitis.

Acute rhino-sinusitis usually begins with a cold, which obstructs the sinuses and causes mucosal swelling which is usually followed by a bacterial sinus infection... Then mucus glands start to secrete large amounts of mucus which fills this cavity.

Patients should also be aware about common environmental irritants that may aggravate their rhino-sinusitis such as:

• Cigarette Smoke
  
  
• Dust Mites
  
  
• Pollen
  
  
• Molds
  

Allergen avoidance is still the best way to manage an allergy problem.

A combination of two or all of the following conditions is a common symptom of acute rhino-sinusitis:

• Sneezing
  
  
• Running Nose
  
  
• Stuffy Nose
  
  
• Fever
  
  
  

Chronic Rhino-Sinusitis

Chronic rhino-sinusitis is the inflammatory and infection that concurrently affects the nose and para-nasal sinuses. Chronic Rhino-sinusitis is a debilitating form of sinusitis that can lead to significant physical symptoms as well as substantial functional and emotional impairment.

Chronic Rhino-sinusitis may become extensively painful and tissues of nose (rhino) may swell since this condition lasts for longer than 12 weeks. In chronic rhino-sinusitis, a long duration of the following symptoms is typical and may be present:

• Nasal Polyps
  
  
• Cystic Fibrosis
  
  
• Nasal Obstruction
  
  

Chronic Rhino-sinusitis may be caused by a variety of underlying conditions such as:

• Viral Growth
  
  
• Bacterial Growth (Bacterial rhino-sinusitis results when the inflammatory process allows for an increased production of bacteria, which in turn causes more inflammation)
  
  
• Fungal Growth
  

Recurrent Acute Rhino-Sinusitis

Recurrent acute rhino-sinusitis is defined as about four or more recurrences of acute disease within a 12-month period, with resolution of symptoms between each episode. In most cases, each episode of recurrence lasts for at least seven days period.

Sub Acute Rhino-Sinusitis

Sub acute rhino-sinusitis is basically a low-grade condition of acute infection that lasts for more than four weeks, but less than 12 weeks period. Sub-acute rhino-sinusitis usually involves one or two pairs of paranasal cavities.

Though acute rhino-sinusitis is regarded as a low grade condition, it may cause a great deal of low productivity and discomfort.

Symptoms of Rhino-Sinusitis

These are the general signs and symptoms of Rhino-sinusitis:

• Facial Pain
  
  
• Facial Pressure
  
  
• Nasal Blockage
  
  
• Discharge
  
  
• Fever
  
  
• Headaches
  
  
• Halitosis
  
  
• Fatigue
  
  
• Cough
  
  
• Ear Pain/ Pressure/ Fullness
  
  
• Mailaise
  
  
• Sore Throat

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