Chronic sinusitis is the presence of constant nasal and sinus symptoms for three months or longer.
There are four pairs of sinuses.
The ethmoid sinus is a matchbox-sized area filled with 7 to 10 interconnected bubbles made of very thin-walled bone. These bony bubbles are lined with a mucous membrane similar to that found in the nose. Each bubble has its own opening to drain into the nasal, or nose, cavity. The front part of the ethmoid is the most crucial of all the sinuses because the forehead and maxillary sinuses must drain through it into the nose. The back part of the ethmoid drains through a separate opening.
The sinuses are normally air-filled. The lining of the sinuses are covered with microscopic fingers known as cilia that direct the mucus to the drainage openings.
The function of the sinuses is not clearly understood. In the average healthy person, the lining of the sinuses and nose makes about 1 to 1 1/2 pints of mucus each day. One of the functions of the sinuses is to moisten, cleanse and warm the air as it goes through the nose before it enters the lungs. The healthy nose is a wonderful filter removing eighty percent (80%) of all tiny particles as they are breathed in. Since the sinuses are air-filled, another function is thought to be making the skull lighter in weight
Chronic sinus disease affects thirteen percent (13%) of the US population. or about 30-40 million people, according to the National Center for Health Statistics. In cases of chronic sinus disease, the natural drainage pathways of the sinuses do not always work properly.
Conditions in the environment like dry air, pollutants, dust and dirt can damage the microscopic "fingers" so that mucus is not cleared, and bacteria overgrow.
People with chronic sinusitis, regardless of the cause, are more likely to develop episodes of acute sinusitis, as well.
The classic symptoms of chronic sinusitis are:
Chronic cough and loss of smell may occur.
In children, symptoms are slightly different. Symptoms in children include:
The impact of chronic sinus symptoms on the overall well being of a person is frequently underestimated. Several studies show that these symptoms significantly impact one's sense of wellness, health and productivity.
The most important part of diagnosis is the history of the illness. The healthcare provider will pay particular attention to symptoms, environmental reactions and responses to medications. Since other diseases can act like chronic sinusitis, a complete medical history is crucial.
Physical exam using a rigid nasal endoscope not only accurately diagnoses chronic sinusitis, but also is used to follow the medical management of this disorder.
Computed tomography, or CT scan, of the sinuses is the standard means of X-ray diagnosis. However, a CT scan should be obtained only after all other medical treatment has been tried. CT scan is used to assess the extent of the disease or to identify any structural problems. However, the scans must be interpreted with caution since other conditions can look like chronic sinusitis on CT scan. Also, CT scans may not identify chronic sinusitis when it does exist. Diagnosis and treatment should not be based on X-ray alone, but instead should be based on symptoms.
Persons who have allergic diseases need to avoid their trigger allergens and use aggressive treatment to limit the damage to the nasal lining and the sinuses. For environmentally caused disease, avoiding exposure to cold air, keeping the air humidified and minimizing exposure to pollutants all help. Aggressive treatment of symptoms will help minimize damage.
For people with structural problems of the nose and sinuses, topical corticosteroids, such as
Long-term effects depend on the underlying causes and the effects of sinus opening obstruction. Left untreated, chronic sinusitis can cause significant problems because the infection erodes the bony walls. In the frontal sinus, this can lead to pressure on the eyeball and double vision, forehead swelling, or brain abscesses and meningitis. In the ethmoid sinus, this can lead to abscess around the eye. In the maxillary sinus, this can lead to blockage of the nose. In the sphenoid sinus, this can lead to double vision and decreased movement of the eyeball, or brain abscesses and meningitis.
Treatment for chronic sinusitis caused by allergies includes:
Treatment for chronic bacterial sinusitis includes appropriate antibiotics such as
For people who do not respond to these treatments and who have structural problems, surgery is the next step in management. The goal of surgery is to reestablish the normal routes of drainage and remove all areas of infection. After surgery:
Side effects depend on the different treatments used. With surgery, complications are infrequent. There is a very rare occurrence of tear duct injury, a disturbance in vision, or leak of spinal fluid.
With successful medical and surgical treatment, symptoms are usually controllable and infections can be reduced.
Monitoring depends on the symptoms. However, any person with progressively worsening symptoms or eye involvement needs to seek immediate medical care.
Author:William Stevens, MD
Editor:Keefe, Sandy, RN, MSN
Reviewer:H. William Kelly, PharmD