Chronic sinusitis is a condition in which the cavities around the nasal passages (sinuses) become persistently inflamed and swollen. Also known as chronic rhinosinusitis, the condition can affect individuals of all ages, race and socioeconomic background. A diagnosis of chronic sinusitis is made when the symptoms of inflammation of the sinuses remain unresolved for at least three months. These symptoms include nasal congestion, nasal drainage, diminished sense of smell, and facial pressure. The sinuses are moist air spaces behind the bones of the upper face — between the eyes and behind the forehead, nose and cheeks. Normally, the sinuses produce mucous which drains through small openings into the inside of the nasal cavity. Anything that obstructs that flow can cause a buildup of mucus, and sometimes pus, in the sinuses. Drainage from the sinuses can be obstructed by structural abnormalities of the nose or by tissue swollen by infection, by allergies and other environmental irritants. Polyps and benign and cancerous tumors are also possible but less common causes of sinus blockage. The buildup of stagnant mucus leads to inflammation and subsequent congestion, diminished sense of smell, and sometimes-facial pain or pressure.
In adults, chronic sinusitis most often is linked to nasal swelling caused by allergies, especially allergies to inhaled dust, mold, pollen, or the spores of fungi. These allergies trigger the release of histamine and other molecules that cause the inner lining of the nose to swell and block sinus drainage.
Your doctor will conduct a physical examination and may order tests such as: Nasal endoscopy: A thin tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses.
Imaging studies: X-rays aren't proven useful in cases of chronic sinusitis. However, images taken using a CT scan 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. CT scan has proven to be the best study to evaluate chronic or recurrent acute sinus symptoms.
Nasal and sinus cultures: Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment, or is worsening, cultures of the infected mucous might help determine the cause, such as bacteria or fungi.
An allergy test: If your doctor suspects that the condition might be triggered by allergies, he or she might recommend an allergy skin test. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.
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. Most patients who undergo sinus surgery will still need medical treatment to prevent the return of chronic sinusitis.
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.
Surgery should always be viewed as a last resort in children and should always be chosen in consultation with a specialist who treats pediatric sinusitis.
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