What Is Chronic Sinusitis?
Healthcare providers define chronic
sinusitis as an inflammatory condition involving the paranasal sinuses that lasts 12 weeks or longer, despite treatment. The condition can affect anyone, regardless of age or gender. It is more common in young or middle-aged adults, although children can also be affected.
Because the nasal passages are usually also affected, you might hear healthcare providers use the terms "chronic sinusitis" and "chronic rhinosinusitis" interchangeably.
Inflammation Versus Infection
Healthcare providers used to believe that an infection was the main cause of chronic sinusitis. Therefore, treatment would involve long periods of antibiotics. However, further research has shown that, in most cases, chronic sinusitis is caused by inflammation.
Thus, treatment is focused on controlling the inflammation and swelling in the long-term. Antibiotics are used to control any infections that might occur along with the inflammation.
Types of Chronic Sinusitis
Healthcare providers have defined three types of chronic sinusitis:
- Chronic rhinosinusitis without nasal polyposis (polyps)
- Chronic rhinosinusitis with nasal polyposis (polyps)
- Allergic fungal chronic rhinosinusitis.
Chronic rhinosinusitis without nasal polyposis is the most common form. About two in every three people have this type of chronic sinusitis. Each of these different types has different risk factors, along with different treatment plans.
(Click Sinusitis Types for more information on the different types and who is at risk for each type.)
What Causes It and Who Is At Risk?
Healthcare providers once believed that bacteria were the main cause of a
chronic sinus infection. What they have come to learn, however, is that it is a lot more complex than just a simple infection. Researchers continue to look for the exact cause or causes of chronic
sinusitis.
Researchers do know that certain things increase the likelihood for long-term inflammation and swelling of the sinus and nasal passages, and the inability for the sinuses to drain properly.
People at risk for chronic sinusitis include those with:
- Allergies (more common in people with perennial or year-round allergies)
- Asthma
- A sensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
- Non-allergic rhinitis
- A weakened immune system, such as in people with:
- HIV or AIDS
- Diabetes
- Low blood counts because of chemotherapy
- An organ transplant
Those people who have had more than one sinus surgery or who actively smoke are also at increased risk for developing chronic sinusitis.
Symptoms of Chronic Sinusitis
The four classic signs and symptoms of chronic sinusitis include:
- Mucus- or pus-like nasal drainage and/or postnasal drip
- Pain, pressure, or fullness in the face or head
- Nasal congestion
- Decreased ability to smell.
Most people diagnosed with chronic sinusitis have at least two out of these four symptoms.
Diagnosing Chronic Sinusitis
In order to diagnose chronic
sinusitis, a healthcare provider will begin by asking a number of questions and performing a physical exam. He or she will also recommend tests in order to help make a diagnosis. This can include x-rays, a computed tomography (CT) scan, and/or a magnetic resonance image (MRI) of the sinuses.
It may also include a procedure that uses a camera to look inside of the sinuses. A small piece of tissue (biopsy) may also be taken to help in diagnosing the type of chronic sinusitis
(see Sinusitis Types).
What Are the Treatment Options?
Most cases of chronic sinusitis cannot be cured. Instead, healthcare providers focus on decreasing symptoms and improving quality of life.
The specific treatment recommended will depend on a number of factors, including:
- The type of chronic sinusitis
- Whether medicines have been tried in the past
- Other medical conditions present (such as allergies)
- Symptoms that are present.
Current treatment options for chronic sinusitis include
nasal irrigation, medications, and/or surgery.
Medicines prescribed may include steroids (nasal spray and/or oral steroids), antibiotics, leukotriene modifiers (medicines approved to treat allergies and
asthma), and/or antifungals.
Research scientists continue to study what the best treatment options are for this type of sinusitis.
As was mentioned earlier, most cases of chronic sinusitis cannot be cured. Also, it is not uncommon for people with this condition to have acute sinus attacks. This can happen for a variety of reasons, including:
- Stopping or decreasing medicines
- An upper respiratory infection
- Exposure to heavy allergens or inhalants
- A bacterial sinus infection.
