Chronic Sinusitis

Overview

Chronic Sinusitis has significant impacts on a patient’s quality of life. Chronic Sinusitis can become occluded from pre-existing anatomic abnormalities or mucosal edema from inflammation.

Causes

Anterior rhinoscopy can sometimes reveal pus or polyps as a source of chronic sinusitis. Nasal endoscopy can help determine where the location of drainage may be coming from. Additionally, a culture of the fluid within the sinus is made easier with endoscopic assistance. The gold standard for evaluating the sinuses is a non-contrast CT scan because it reveals the anatomical subtleties that may be contributing to the problems.

Symptoms

  • Initial symptoms of acute (less than four weeks duration) sinusitis include facial pain and pressure, nasal congestion, anosmia or hyposmia.
  • If symptoms are present for longer periods of time (more than 12 weeks), patients may have headache, halitosis, fatigue and chronic cough.

Treatments

Diagnosing sinus infections can sometimes be quite difficult as nasal congestion can be mistaken for a sinus infection. 

If symptoms persist for more than ten days, then antibiotic treatment is recommended. It is important to take a course of antibiotics as prescribed to maximize penetration into the sinus tissues (many doctors recommend at least 14 days of treatment). The simultaneous use of oral steroids is also critical in helping to opening the sinuses and promoting normal sinus drainage.

If patients continue to have problems, sinus surgery has been shown to be beneficial in resolving the symptoms; published success rates of 90% are common, making the endeavor worthwhile to the patient. Typically, sinus surgery is an outpatient procedure done under general anesthesia that is well tolerated. Surgery facilitates post-operative application of medicines, in-office endoscopic monitoring of disease, and the ability to irrigate the sinuses at home with a saline wash.

Ultimately, control of mucosal disease is an important portion of controlling sinus disease. Seasonal allergies can be controlled with oral antihistamines and topical nasal steroid sprays and continued sinus washings can help maintain mucosal health. Often, long-term medical management of allergic rhinitis and other mucosal disease is necessary in preventing recurrent sinus infections. While patients can still have sinus infections postoperatively, endoscopic examination and retreatment with antibiotics and steroids may be necessary.