What is Chronic Sinusitis?

wheat AllergyChronic sinusitis

affects more than 40 million people in the United States annually. It accounts for 20% of the visits to the allergist office. It is an inflammatory condition affecting the paranormal sinuses. This particular condition is termed chronic as it persists for more than 12 weeks. It is almost always accompanied by inflammation of the nasal airways. It generally begins with rhinitis symptom and this condition is also known as Chronic rhinosinusitis.

 

There are four cavities or hollow sinuses around the nasal passage. Normally air should pass through these four sinuses and mucous should drain into the nose. The sinuses are equipped to defend themselves against bacteria and germs. A chronic inflammation makes them vulnerable and bacteria present in nasal passages enter the sinuses and affect the mucous lining causing a sinus infection. It affects mostly middle aged adults but it could also affect children.

 

Causes of Chronic Sinusitis:

  • It is mostly non infectious and related to allergy.
  • It could be because of an upper respiratory tract infection. These infections could be caused by virus, bacteria or fungus.
  • It could be because of a chronic gastroesophageal reflux.
  • Exposure to environmental pollutants like smoke and industrial toxins could also lead to it.
  • Anatomic blockage in the ostiomeatal complex or a crooked nasal septum results in fluid accumulation and blocks the sinuses acusing the said condition.
  • A medical condition like cystic fibrosis or chronic obstructive pulmonary disease.
  • An infected dental abscess could also lead to it.
  • Sinus infection caused by molds in the airways or a fungal infection caused by aspergillus can result in it.
  • Abnormal tissue growths in the sinuses (nasal polyps or tumors)can cause blockage and infection.
  • A face injury or trauma can damage the sinuses and cause the discussed condition.
  • Immunological diseases or HIV can cause it.
  • Aspirin sensitivity causing respiratory problems could cause it.

 

 

Symptoms of the condition:

  • Headache with throbbing pain around the forehead and eyes.
  • Pain around the region of the sinuses.
  • Nasal obstruction and congestion making it difficult to breathe through the nose.
  • Drainage of a thick, greenish yellow mucous or discharge from the nose or down the back of the throat.
  • Tenderness and inflammation around the eyes.
  • Anosmia or impaired sense of smell when the olfactory receptors of the nose are affected by the inflammation.
  • Development of an ear ache and bad breath (halitosis).
  • Pain in jaws and tooth ache.
  • Cough which is more intense at night.
  • Sore throat.
  • Nausea.
  • Tiredness and irritable disposition.

Diagnostic Tests to detect the condition:

Apart from the physical examination revealing the obvious signs of the discussed condition the following tests are usually conducted to detect the condition.

  • Nasal endoscopy:

    An endoscope (a thin wire with a fiber-optic camera) is inserted through the nose to detect any inflammation in the sinuses.

  • Imaging:

    A CT Scan or MRI can detect deep rooted inflammation which are not revealed by the endocopy.

  • Allergy Test:

    An allergy skin prick test, patch test may be conducted to single out the allergen causing the symptoms.

  • Nasal and Sinus Cultures:

    Tissue cultures from the sinuses become necessary where the disease is unresponsive to treatment and caused by bacterial, viral or fungal infection.

Treatment of Chronic Sinusitis:

  • The first step would be to treat the underlying cause of the condition.
  • Saline nasal sprays are used to help rinse and drain the nasal passages.
  • Nasal corticosteroid sprays are used to treat inflammation of the sinuses. Fluticasone (Flonase), Budesonide (Rhinocort Aqua), Mometasone (Nasonex) are commonly used.
  • Corticosteroids are also taken orally to relieve symptoms of severe sinusitis caused from inflammation and nasal polyps. These are especially used to relieve asthma symptoms. 1 out of 5 patients having the said condition develop asthma. However, they are not suitable for long term use.
  • Oral decongestants like Sudafed, Actifed can be used temporarily to seek relief. Decongestants nasal sprays (oxymetazoline or Afrin) can also provide quick relief. However, these cannot be used for long term as they may cause the return of the congestion.
  • Bacterial infection causing the said condition has to be treated with antibiotics. Amoxicillin, Doxycycline are some of the common antibiotics used.
  • In case of anatomical defects like a crooked septum, or internal growths like nasal polyps or tumors surgery is the only option. Endoscopic surgeries to remove polyps and widen a narrowed sinus opening are quite common.
  • In case of an allergy causing the problem, the first step would involve removing the irritant. Allergy shots or immunotherapy where the allergen is introduced in small doses in the body to promote immunological tolerance could also be a viable option.

Complications of the condition:

  • Asthma attacks:

    Prolonged suffering from this condition can increase the risks of asthma attacks.

  • Vision problems:

    Sinus infection can spread to eye sockets. The results could be impaired vision or even blindness.

  • Meningitis:

    The infection in the sinuses could spread to the membranes and the fluid in the cavities surrounding the brain and the spinal cord. This could lead to a life threatening condition.

  • Aneurysms and blood clots:

    The inflamed sinuses can exert pressure on the surrounding veins leading to the brain causing an interference with the blood supply to the brain increasing the chances of a stroke.

Prevention of the condition:

  • Do not let a common cold and cough persist. If it is caused by any infection it is important to see the doctor and be treated with antibiotics.
  • Personal hygiene is extremely important to prevent cross contamination from bacteria, virus and fungus.
  • Random usage of nasal sprays, be it antihistamine, decongestant or corticosteroids increase the risks of a relapse of the infection.
  • If it is caused by air borne allergens, then it is important to take steps to remove it from the immediate environment. Indoor allergens can be removed by installing a HEPA enabled air filter. If it is caused by a seasonal allergen, it would be wise to go outdoors wearing a pollen mask.
  • Install a humidifier to moisten the ambient air. This might help with nasal drainage.
  • Stay away from cigarette smoke, vehicle exhausts and industrial smoke, fume and toxins.