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Health Tip: Sinus Infections, Part 2 - Chronic
sinusitis
Two weeks ago we learned about the causes and treatment
of acute sinusitis. When sinusitis lasts longer than 12 consecutive weeks, it’s
called chronic sinusitis. While most acute sinusitis tends to be due to infectious
causes, a greater proportion of chronic sinusitis is related to non-infectious causes
such as allergies and structural problems that obstruct the openings that drain
the sinuses.
Chronic sinusitis affects anywhere from 30 million to 40 million Americans each
year. As with acute sinusitis, chronic sinusitis begins
 with
inflammation of the mucous membranes in the sinuses. This eventually causes fluid
to accumulate with plugging of the passages that normally allow the sinuses to drain.
The primary symptoms associated with chronic sinusitis are facial pain, congestion,
difficulty breathing through the nose, drainage of a thick, yellow or greenish discharge
from the nose or down the back of the throat, headache, bad breath, nausea and sore
throat. While many of these symptoms are seen in acute sinusitis also, two major
differences are that chronic sinusitis typically causes more severe fatigue and
is less likely to produce fever.
What causes chronic sinusitis? Basically,
anything that can plug the openings that drain the sinuses can cause chronic sinusitis.
Allergies do  it by causing swelling of the mucous membranes. Infections, most commonly
viruses, impede drainage when the mucous membranes become inflamed and thickened.
Nasal polyps, small, benign growths in the nasal cavity, can obstruct the sinuses
as can a deviated nasal septum. Molds and fungus are far more likely to be involved
in the development of chronic sinusitis than in acute sinusitis. In the case of
these organisms, some experts believe they trigger an inflammatory response which
then leads to swelling and blockage of sinus drainage.
How is chronic sinusitis diagnosed?
The diagnosis of acute sinusitis is primarily clinical, meaning the doctor relies
primarily on the history and physical to determine if sinusitis is present. In confirming
the presence of
 chronic sinusitis, however, special testing is usually necessary.
Nasal endoscopy is a procedure in which a thin, flexible tube with fiber optic lighting
is directed into the sinus to directly visualize the mucous membranes within the
sinus. Imaging studies such as a CT or MRI scans may reveal "impaction", or complete
blockage, with fluid buildup within the sinus. When an infectious cause is suspected,
cultures to determine the organism responsible may be done. Skin testing may reveal
the responsible allergen when sinusitis develops on an allergic basis.
How is chronic sinusitis treated?
The treatment of chronic sinusitis hinges on the underlying cause. Since allergies
are frequently implicated, taking oral antihistamines or using intranasal corticosteroids
(Flonase, Beconase or Nasacort), usually helps. Allergy desensitization when there
is a known allergic trigger may be beneficial also. One of the safest and most
effective treatments for allergy-related chronic sinusitis is
nasal irrigation. This involves the use of a bulb syringe or
neti pot to wash out the nasal cavity which helps to enhance drainage
of mucous from the sinuses. When a bacterial infection is causing the sinusitis,
taking an antibiotic may be necessary. Surgery may be required when there is a physical
blockage such as a nasal polyp or a deviated nasal septum. Surgery may also be necessary
to open up the drainage passages in cases of severe blockage, particularly if the
sinusitis has not responded to simpler measures.
What else can I do for my sinusitis?
First and foremost, don't smoke or expose yourself to smoke-filled environments.
Drink plenty of fluids to help dilute your nasal secretions. Install a humidifier
to keep the air in your home moist and clean. If environmental allergies are causing
problems consider getting an indoor air filter, at least for the bedroom.
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