Everything about chronic sinusitis

What is chronic sinusitis?

Chronic sinusitis is an infection or inflammation of the sinus that has lasted over 12 weeks without significant improvement, even with maximum medical management. Chronic sinusitis can be attributed to a variety of health conditions like recurrent rhinitis, allergic rhinitis, smoke inhalation, etc.

There are 4 pairs of healthy sinuses in the skull that help keep it light and perform other auxiliary functions. The maxillary sinuses, which are present in the paranasal area behind the maxillary bone, are most commonly affected by sinusitis. They secrete lubricating fluids that keep the nasal passages wet and prevent the entry of bacteria and viruses through the nasal cavity.

How does chronic sinusitis affect breathing?

Normally, sinuses connect to the nasal passages and aid the airflow and drainage through them. They produce mucus that coats the nasal passages and protects them from infections. When sinuses are infected, they start producing infectious discharge that blocks the nasal passages and prevents the patient from breathing normally. This breathing issue often exacerbates at night, leading to obstructive sleep apnea, i.e., the inability to breathe while sleeping.

Chronic Sinusitis Causes

• Nasal polyps
• Deviated nasal septum
• Medical conditions that affect the immune system, like cystic fibrosis, HIV infection, etc.
• Respiratory tract infections
• Allergic rhinitis, e.g., hay fever

Chronic Sinusitis Symptoms

• Nasal swelling with thick, discolored discharge
• Postnasal drainage
• Nasal congestion
• Pain, tenderness, and inflammation in the eyes, cheeks, nose, and forehead
• Decreased taste and smelling sensations
• Pain in the ear, upper jaw, or teeth
• Sore throat with consistent coughing
• Fatigue and migraines

Chronic Sinusitis Diagnosis

Self-examination

Any diagnostic or treatment procedure begins with a self-diagnosis by the patient. The patient should examine their symptoms closely and determine whether they should seek treatment. Often, acute sinusitis cases can be treated medically, but for chronic sinusitis, the patient often needs surgical treatment, for which proper diagnosis is necessary.

Physical examination and diagnostic tests

The ENT specialist will start the examination with your medical and illness history. Often, a detailed medical history is enough to confirm a chronic sinusitis diagnosis. However, thorough diagnostic tests are necessary for detailed treatment planning. Diagnostic tests for chronic sinusitis include:

• Imaging tests: Imaging tests like CT and MRI scans help pinpoint the exact cause of the infection, like nasal polyps, tumors, fungi, etc.
• Nasal endoscopy: An endoscopy helps see the inside of the nasal passages and sinuses clearly to see the extent and cause of the infection.
• Allergy test: Often, patients who are in constant contact with their allergens exhibit similar symptoms as chronic sinusitis. An allergy test helps decide whether the patient has chronic sinusitis or allergic rhinosinusitis.
• Nasal and throat tissue cultures: Tissue cultures help narrow down the organism behind the sinus infections and help the ENT doctor customize their treatment accordingly.

Risks of untreated chronic sinusitis

Permanently lost or reduced smell sensation

Consistent inflammation of the nasal passages can result in damage to the olfactory nerve, which can result in reduction or loss of smelling sensation (anosmia).

Complications from breathing difficulties

Breathing difficulties over time can result in insomnia, fatigue, haziness, etc., affecting the overall quality of life of the patient.

Laryngitis

Laryngitis is the inflammation and irritation of the voice box (larynx), which can lead to voice abnormalities, dry cough, and hoarseness.

Dacryocystitis

It is the inflammation or infection of the tear sacs/ducts which happens when the sinus infection spreads to the eyes. It can lead to tearing, pain, redness, and swelling of the infected eye.

Orbital cellulitis/abscess

If the infection spreads to the eye, it can also lead to infection and inflammation of the eye socket, which can potentially lead to complete loss of vision if not treated immediately. It also causes fever, eye pain and swelling, redness and bulging of your eyelid, eyebrow, and cheek.

Spread of the infection to the brain

The infection can also spread to the brain and cause potential complications like cavernous sinus thrombosis, brain abscesses, meningitis, subdural abscesses, etc. These conditions are all potentially fatal if not managed immediately.

Frontal bone osteomyelitis

The infection can also spread to and infect the skull bones, particularly the frontal bone, also known as frontal bone osteomyelitis.

Prevention of Chronic Sinusitis

There are several risk factors for chronic sinusitis, which make it more likely to occur and difficult to treat. Common chronic sinusitis risk factors include a deviated nasal septum, history of sinusitis, asthma, dental or fungal infections, immune system disorders, rhinitis allergies, smoking, etc. 

If you identify with one or more of the given risk factors, you should follow the precautionary tips given below to prevent chronic sinusitis:

Avoid contact with people who have upper respiratory infections like common cold, flu, etc. Wear a face mask around them as much as possible.

• Wash your hands frequently, especially before meals. Carry a hand sanitizer with you to maintain hygiene and cleanliness.
• Avoid allergens and other contaminants, like smoke, dust, exhaust fumes, etc., that can inflame your lungs and airway.
• If you live in dry or arid regions, use a humidifier to moisten the air in your surroundings.
• If you get sinus infections even after following these precautions, contact an ENT specialist immediately to avoid chronic sinusitis and its complications.