Chronic sinusitis

Chronic sinusitis occurs when the spaces inside your nose and head (sinuses) are swollen and inflamed for three months or longer, despite treatment.

This common condition interferes with the way mucus normally drains, and makes your nose stuffy. Breathing through your nose may be difficult, and the area around your eyes might feel swollen or tender.

Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or by swelling of the lining of your sinuses. Also called chronic rhinosinusitis, the condition can affect both adults and children.

Symptoms

Common signs and symptoms of chronic sinusitis include:

• Nasal inflammation
• Thick, discolored discharge from the nose (runny nose)
• Drainage down the back of the throat (postnasal drainage)
• Blocked or stuffy (congested) nose causing difficulty breathing through your nose
• Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
• Reduced sense of smell and taste

Other signs and symptoms can include:

• Ear pain
• Headache
• Aching in your upper jaw and teeth
• Cough or throat clearing
• Sore throat
• Bad breath
• Fatigue

Chronic sinusitis and acute sinusitis have similar signs and symptoms. But acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last at least 12 weeks, but you may have several episodes of acute sinusitis before developing chronic sinusitis. Fever isn't a common sign of chronic sinusitis, but you might have one with acute sinusitis.

When to see a doctor

Schedule an appointment with your doctor if:

• You've had sinusitis a number of times, and the condition doesn't respond to treatment
• You have sinusitis symptoms that last more than 10 days
• Your symptoms don't improve after you see your doctor

See a doctor immediately if you have the following signs or symptoms, which could indicate a serious infection:

• Fever
• Swelling or redness around your eyes
• Severe headache
• Forehead swelling
• Confusion
• Double vision or other vision changes
• Stiff neck

Causes

Common causes of chronic sinusitis include:

• Nasal polyps. These tissue growths can block the nasal passages or sinuses.
• Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages, making the symptoms of sinusitis worse.
• Other medical conditions. The complications of conditions such as cystic fibrosis, HIV and other immune system-related diseases can lead to nasal blockage.
• Respiratory tract infections. Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be caused by viruses or bacteria.
• Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.

Risk factors

You're at increased risk of getting chronic sinusitis if you have:

• A deviated nasal septum
• Nasal polyps
• Asthma
• Aspirin sensitivity
• A dental infection
• A fungal infection
• Tumors
• An immune system disorder such as HIV/AIDS or cystic fibrosis
• Hay fever or another allergic condition
• Regular exposure to pollutants such as cigarette smoke

Complications

Serious complications of chronic sinusitis complications are rare, but may include:

• Vision problems. If your sinus infection spreads to your eye socket, it can cause reduced vision or possibly blindness that can be permanent.
• Infections. Uncommonly, people with chronic sinusitis may develop inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis), an infection in the bones, or a serious skin infection.

Prevention

Take these steps to reduce your risk of getting chronic sinusitis:

• Avoid upper respiratory infections. Avoid contact with people who have colds or who are sick with other infections. Wash your hands frequently with soap and water, especially before meals.
• Manage your allergies. Work with your doctor to keep symptoms under control. Avoid exposure to things you're allergic to whenever possible.
• 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.

Diagnosis

Your doctor may ask about your symptoms. He or she may feel for tenderness in your nose and face and look inside your nose in a physical exam.

Methods for diagnosing chronic sinusitis include:

• Imaging tests. Images taken using CT or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical blockage, such as polyps, tumors or fungi, that's difficult to detect using an endoscope.
• Looking into your sinuses. A thin, flexible tube with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses. This can help your doctor see a deviated nasal septum, polyps or tumors.
• An allergy test. If your doctor suspects that allergies might be triggering your chronic sinusitis, he or she might recommend an allergy skin test. A skin test is safe and quick and can help detect what allergen is responsible for your nasal flare-ups.
• Samples from your nasal and sinus discharge (cultures). Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, your doctor may swab inside your nose to collect samples that might help determine the cause, such as bacteria or fungi.

Treatment

Treatments for chronic sinusitis include:

• Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone and beclomethasone. If the sprays aren't effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide or using a nasal mist of the solution.
• Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
• Oral or injected corticosteroids. These medications are used to relieve 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.
• Allergy medications. If allergies are causing sinusitis, your doctor may recommend allergy medications.
• Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis and nasal polyps. Under medical supervision, you're gradually given larger doses of aspirin to increase your tolerance.
• Antifungal treatment. If your infection is due to fungi, you may have antifungal treatment.
• Medication to treat nasal polyps and chronic sinusitis. If you have nasal polyps and chronic sinusitis, your doctor may give you an injection of dupilumab or omalizumab to treat your condition. These medications may reduce the size of the nasal polyps and lessen congestion.

Antibiotics

Antibiotics are sometimes necessary for sinusitis if your infection is caused by bacteria. If your doctor can't rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens might improve the condition.

Surgery

In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.

Depending on the source of the blockage, the doctor might use various instruments to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.

Lifestyle and home remedies

These self-help steps can help relieve sinusitis symptoms:

• Rest. This can help your body fight inflammation and speed recovery.
• Moisturize your sinuses. Drape a towel over your head as you breathe in the vapor from a bowl of medium-hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air to help ease pain and help mucus drain.
• Warm compress. A warm compress on your nose and forehead may help relieve the pressure in your sinuses.
• Rinse out your nasal passages. Use a specially designed squeeze bottle, saline canister or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses.

Preparing for an appointment

You'll likely see your primary care doctor first for symptoms of sinusitis. If you've had several episodes of acute sinusitis or appear to have chronic sinusitis, your doctor may refer you to an allergist or an ear, nose and throat specialist for evaluation and treatment.

When you see your doctor, expect a thorough examination of your sinuses. Here's information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment
• Key personal information, including whether you have allergies or asthma, and family medical history
• All medications, vitamins or other supplements you've recently been taking, including the doses
• Questions to ask your doctor

For chronic sinusitis, questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What treatments are available and which do you recommend for me?
• I have these other health conditions. How can I best manage these conditions together?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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