Symptoms
It can be recurring acute or chronic –symptoms may be severe or subtle. Some patients simply have post nasal drip and throat clearing. For others, nasal congestion and poor sense of smell may be the problem. Symptoms seen in chronic sinusitis include:
- Pressure-like pain on your forehead, temples, cheeks, nose, or around or behind your eyes
- Difficulty breathing through your nose
- Thick, yellow or greenish discharge that drains into your nose or down the back of your throat
- Reduced sense of smell
What causes chronic sinusitis?
- Anatomy
- Nasal Polyps
- Allergies
- Immune deficiency
Every patients is different but whatever started the by problem– inflammation, fluid, mucous and usually infection are present. What we try to do is contain the problem when it is flaring then try to work our way backwards to find the underlying cause.
ANATOMY
Tight nasal passages that restrict drainage may easily lead to sinusitis following colds or allergies. The result usually is recurring infection and inflammation in one particular area. A deviated septum may impinge on a sinus drainage pathway such as seen in the images below.
Nasal Polyps
Nasal polyps are soft, jelly-like overgrowths of the lining of the sinuses. They may be diffuse and fill the sinus cavities or localized to one area. A more severe form of chronic sinusitis occurs in patients with nasal polyps, asthma & aspirin allergy and is termed the Aspirin Triad.
Diagram (above) of polyps (red teardrops) in the nasal cavity where they can block sinus drainage leading to infection.
Sinus cat scan showing polyps (P) within the sinus cavities. This polyp appears to be blocking the sinus outflow tract potentially causing both recurrent infection and pain.
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Immune deficiency
Immune deficiency sometimes leads to repeated sinus infections which then become chronic. Absent serum IgA is the most common immune deficiency.
Allergy skin testing:
Testing and treatment for immediate sensitivity to environmental allergens may help chronic sinus patients.
Nasal Endoscopy:
With an anesthetic nasal spray this is a well-tolerated procedure. For the initial evaluation, a direct look in the nose identifies many things such as anatomic causes of sinusitis, sinus drainage or nasal polyps.
Sinus CAT Scan:
This test is the gold standard for the diagnosis of sinusitis. If the CAT scan does not show swelling within the sinus passages then chronic sinusitis is not the diagnosis. However, this does not rule out a nasal source of sinus pain.
Antibiotics
Oral Antibiotics are almost always given at some point in chronic sinusitis care but this is rarely a long term solution.
Steroids
Nasal steroid and sometimes short term oral steroids are helpful in milder cases. Steroids in a sinus rinse work even better, especially when the sinus cavity openings have been widened surgically.
Treatment
Antibiotics
Oral Antibiotics are almost always given at some point in chronic sinusitis care but this is rarely a long term solution.
