HOW DO YOU TREAT CHRONIC SINUSITIS?

Chronic sinusitis occurs when the spaces inside your nose and head (sinuses) are swollen and inflamed for three months or longer, despite treatment.

This common condition interferes with the way mucus normally drains, and makes your nose stuffy. Breathing through your nose may be difficult, and the area around your eyes might feel swollen or tender.

Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or swelling of the lining of your sinuses. Also called chronic rhinosinusitis, the condition can affect both adults and children.

Symptoms

Common signs and symptoms of chronic sinusitis include:

  • Nasal inflammation
  • Thick, discolored discharge from the nose
  • Drainage down the back of the throat (postnasal drainage)
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
  • Reduced sense of smell and taste

Other signs and symptoms can include:

  • Ear pain
  • Aching in your upper jaw and teeth
  • Cough or throat clearing
  • Sore throat
  • Bad breath
  • Fatigue

Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last at least 12 weeks, but you may have several episodes of acute sinusitis before developing chronic sinusitis. Fever isn’t a common sign of chronic sinusitis, but you might have one with acute sinusitis.

Causes

  • Nasal polyps

Common causes of chronic sinusitis include:

  • Nasal polyps. These tissue growths can block the nasal passages or sinuses.
  • Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages, making the symptoms of sinusitis worse.
  • Other medical conditions. The complications of conditions such as cystic fibrosis, HIV and other immune system-related diseases can lead to nasal blockage.
  • Respiratory tract infections. Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
  • Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.

Risk factors

You’re at increased risk of getting chronic sinusitis if you have:

  • A deviated septum
  • Nasal polyps
  • Asthma
  • Aspirin sensitivity
  • A dental infection
  • An immune system disorder such as HIV/AIDS or cystic fibrosis
  • Hay fever or another allergic condition
  • Regular exposure to pollutants such as cigarette smoke

When to see a doctor

Schedule an appointment with your doctor if:

  • You have had sinusitis a number of times, and the condition doesn’t respond to treatment
  • You have sinusitis symptoms that last more than 10 days
  • Your symptoms don’t improve after you see your doctor

See a doctor immediately if you have the following signs or symptoms, which could indicate a serious infection:

  • Fever
  • Swelling or redness around your eyes
  • Severe headache
  • Forehead swelling
  • Confusion
  • Double vision or other vision changes
  • Stiff neck

Diagnosis

Your doctor will feel for tenderness in your nose and face and look inside your nose.

Methods for diagnosing chronic sinusitis include:

  • Imaging tests. Images taken using CT or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical obstruction that’s difficult to detect using an endoscope.
  • Looking into your sinuses. A thin, flexible tube with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses.
  • An allergy test. If your doctor suspects that allergies might be triggering your chronic sinusitis, he or she might recommend an allergy skin test. A skin test is safe and quick and can help detect what allergen is responsible for your nasal flare-ups.
  • Samples from your nasal and sinus discharge (cultures). Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, your doctor may swab inside your nose to collect samples that might help determine the cause, such as bacteria or fungi.

Treatment

Treatments for chronic sinusitis include:

  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone and beclomethasone. If the sprays aren’t effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide or using a nasal mist of the solution.
  • Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
  • Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long term, so they’re used only to treat severe symptoms.
  • Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis. Under medical supervision, you’re gradually given larger doses of aspirin to increase your tolerance.

Antibiotics

Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. If your doctor can’t rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body’s reaction to specific allergens might improve the condition.

Surgery

  • Endoscopic sinus surgery

In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.

Depending on the source of obstruction, the doctor might use various instruments to remove tissue or shave away a polyp that’s causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.

Prevention

Take these steps to reduce your risk of getting chronic sinusitis:

  • Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before meals.
  • Manage your allergies. Work with your doctor to keep symptoms under control. Avoid exposure to things you’re allergic to whenever possible.
  • Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.
  • Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.

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