Chronic sinusitis appears when one or more sinuses get inflamed and swollen for at least 12 weeks, despite treatment. Even though it is less common than the acute sinusitis, chronic sinusitis is beginning to be more common in all age groups. This disease is also known as chronic rhinosinusitis and it interferes with drainage and causes mucus buildup. When you deal with chronic sinusitis, one of the first signs is that breathing through your nose becomes very difficult. The area around your eyes and face might feel swollen, and you might have facial pain or tenderness.
This disease is caused in general by an infection, by growths in the sinuses (nasal polyps) or by a deviated nasal septum. The condition most commonly affects young and middle-aged adults, but it also can affect children.
The sinusitis becomes chronic when the symptoms persist for more than 3 months, despite any attempts of treatment. Two or more of the following symptoms will make a doctor decide if you suffer from chronic sinusitis or not:
- trouble smelling or tasting food and drinks
- yellow or green-colored mucus dripping from your nose
- dry or hardened mucus blocking your nasal passages
- mucus leaking down the back of your throat
- tenderness or discomfort in your face, especially in the area of your eyes, forehead, and cheeks
There are also other common symptoms of chronic sinusitis as follows:
- headaches due to pressure and swelling in your sinuses
- pain in your ears
- throat soreness
- jaw and tooth soreness
- feeling nauseous
- cough that feels worse during the night
- bad breath (halitosis)
The most common causes of chronic sinusitis include:
- Nasal polyps which can block the nasal passages or sinuses.
- Deviated nasal septum may restrict or block sinus passages.
- Other medical conditions such as the complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases.
- Respiratory tract infections — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
- Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.
You’re at increased risk of getting chronic or recurrent sinusitis if you have:
- A nasal passage abnormality, such as a deviated nasal septum or nasal polyps
- Asthma, which is highly connected to chronic sinusitis
- Aspirin sensitivity that causes respiratory symptoms
- An immune system disorder, such as HIV/AIDS or cystic fibrosis
- Hay fever or another allergic condition that affects your sinuses
- Regular exposure to pollutants such as cigarette smoke
Chronic sinusitis can also develop several complications such as:
- Meningitis causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
- Other infections which can spread to the bones (osteomyelitis) or skin (cellulitis).
- Partial or complete loss of sense of smell caused by the nasal obstruction and inflammation of the nerve for smell (olfactory nerve).
- Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.
When to see a doctor
You should schedule an appointment with your doctor if you experience any of the following symptoms:
- You’ve had sinusitis a number of times, and the condition doesn’t respond to treatment
- You have sinusitis symptoms that last more than seven days
- Your symptoms don’t improve after you see your doctor
Moreover, you should see your doctor immediately if you have any of the following, which could indicate a serious infection:
- High fever
- Swelling or redness around your eyes
- Severe headache
- Double vision or other vision changes
- Stiff neck
You can prevent the chronic sinusitis with some of the following actions:
- Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before meals.
- Manage your allergies. Work with your doctor to keep symptoms under control.
- Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.
- Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.
Your doctor will perform the following procedures to determine a correct diagnosis:
- Nasal endoscopy. The doctor will introduce a thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose. This is how he will see the inside of your sinuses.
- Imaging studies. A CT scan or MRI will show details of your sinuses and nasal area. This will help your doctor see if there is a deep inflammation or physical obstruction that’s difficult to detect using an endoscope.
- Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as bacteria or fungi.
- An allergy test will help your doctor understand if an allergen is responsible for your nasal flare-ups.
Your doctor might recommend you the following treatments to reduce the symptoms:
- Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
- Nasal corticosteroids. These nasal sprays help prevent and treat inflammation.
- Oral or injected corticosteroids will relieve the inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long term, so they’re used only to treat severe symptoms.
- Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis. Under medical supervision, you’re gradually given larger doses of aspirin to increase your tolerance.