What is chronic sinusitis?
Chronic sinusitis, also referred to as chronic rhinosinusitis, is a type of rhinosinusitis. Chronic sinusitis is a condition which refers to an inflammation of the nose and paranasal sinuses. Chronic sinusitis is more inflammatory than infectious and has the symptoms appeared between 8 and 12 weeks. Subtypes of chronic rhinosinusitis include chronic sinusitis without nasal polyposis, chronic sinusitis with nasal polyposis, and allergic fungal sinusitis.
To make the diagnosis of chronic sinusitis, two or more of major chronic sinusitis symptoms must be present. These major symptoms of chronic sinusitis are:
- Anterior, posterior, or both mucopurulent drainage
- Nasal blockage
- Facial pain, and headache
- Decreased sense of smell and taste
Other signs and symptoms of chronic sinusitis may include cough, sore throat, smelly breath, aching in the upper jaw and teeth, fatigue, ear pain and sickness in the stomach.
Causes and risk factors
Common causes of chronic sinusitis include nasal polyps, deviated nasal septum (the wall between the nostrils), respiratory tract infections, allergies such as hay fever or allergic rhinitis, and other medical conditions, namely cystic fibrosis, gastroesophageal reflux or acid reflux, and infection of human immunodeficiency virus (HIV).
The likelihood of developing chronic sinusitis is increased with the presence of such medical conditions as a nasal passage abnormality, asthma, aspirin sensitivity, disorder of immune system and hay fever, as well as regular exposure to pollutants like tobacco smoke.
Chronic sinusitis treatment include the following medications:
- Topical corticosteroid nasal sprays are used to control inflammation and prevent recurrence of nasal polyps. A brief course of oral corticosteroids can also shrink nasal polyps. However, the use of oral corticosteroids in children are not recommended because of their impacts on growth limitation.
- Antihistamines are beneficial for chronic sinusitis patients with underlying allergic rhinitis or hay fever. Regular use of antihistamines can manage pervasive symptoms. To treat the symptoms in a child patient under 6 months old, cetirizine is proven to have a good safety and therefore recommended. A nebulizer can be used to deliver antihistamines to treat the inflamed areas.
- Use of nasal saline and saline irrigations is an option for treating chronic sinusitis. As shown by research, high-volume saline irrigations can efficaciously improve the overall symptoms of chronic sinusitis. Nasal saline can be taken by the use of a nebulizer.
- Antibiotics have not been officially approved for use in chronic rhinosinusitis, but they may be used to treat an infection indicated by nasal discharge.
- Sinus surgery might be necessary for patients with severe polyposis. It removes inspissated mucus and restores sinus patency.
- Antileukotriene agents, such as zafirlukast, montelukast, and zileuton, are recommended as the treatment of nasal polyps.
- Aspirin desensitization and daily aspirin therapy can be used to treat patients with an aspirin-exacerbated respiratory disease, only if they have no contraindications to aspirin therapy.
- Antifungals, including oral terbinafine and topical amphotericin B, have failed to show efficacy in treating chronic rhinosinusitis patients, so they are not recommended.