patient education guide Questions and Answers About Chronic Sinusitis

Dale H. Rice, MD

These sinuses are lined by a membrane. When this membrane becomes inflamed--usually as a result of an infection or obstruction--you can get sinusitis. Sinusitis can be acute, recurrent, or chronic. Acute sinusitis responds well to treatment within a few weeks. Recurrent sinusitis is characterized by episodes that repeat at least 4 times a year. Sinusitis is considered to be chronic when symptoms persist for at least 12 weeks after treatment of acute sinusitis has ended.

What is sinusitis?

You have 4 pairs of sinuses around your nasal cavity:

•Frontal sinuses over the eyes in the brow area.

•Maxillary sinuses inside each cheekbone.

•Ethmoidal sinuses just behind the bridge of the nose and between the eyes.

•Sphenoidal sinuses behind the ethmoidal sinuses in the upper region of the nose and behind the eyes.

These sinuses are lined by a membrane. When this membrane becomes inflamed--usually as a result of an infection or obstruction--you can get sinusitis. Sinusitis can be acute, recurrent, or chronic. Acute sinusitis responds well to treatment within a few weeks. Recurrent sinusitis is characterized by episodes that repeat at least 4 times a year. Sinusitis is considered to be chronic when symptoms persist for at least 12 weeks after treatment of acute sinusitis has ended.

What causes sinusitis?

Normal mucus contains many different types of bacteria. Maintenance of this bacterial environment depends on factors such as humidity, temperature, local nutrients, and the presence of substances that enhance immune function. Any condition that affects these factors, or that otherwise allows bacteria to become overgrown in the nose, nasal passages, or sinuses, can cause sinusitis.

Often, chronic sinusitis develops after an attack of acute sinusitis. Other times, physical abnormalities, such as nasal polyps, or diseases can cause you to have very thick mucus that remains stagnant in the sinuses. This can sometimes contribute to bacterial overgrowth and chronic sinusitis.

What are the signs and symptoms of sinusitis?

Sinusitis typically causes you to feel pain or pressure over the affected area--often, the front of the face. Your teeth may hurt, or you may notice some swelling around your eyes. You may have thick nasal discharge, and headache and fever are possible. Sinusitis can also cause bad breath.

What diagnostic procedures will my physician perform?

Often, the diagnosis of chronic sinusitis can be established based on your symptoms. Sometimes, your physician may need to order imaging studies of your sinuses, especially if you are not responding to treatment. If your physician suspects an obstruction, polyp, or other physical abnormality, he or she may arrange for you to have a nasal endoscopy. This procedure allows the physician to examine the interior of your nose and sinus drainage areas.

How is chronic sinusitis treated?

Your physician may want to prescribe an antibiotic. He or she will probably also prescribe a nasal and/or systemic corticosteroid or decongestant. If you have allergies, an antihistamine can relieve your symptoms. If you do not respond to these treatments, your doctor may arrange for an imaging study of your sinuses to see whether surgery is necessary.

There are nondrug measures that can help you feel more comfortable too. A warm compress held over the affected area may ease discomfort. Breathing in warm vapor from a vaporizer or hot cup of water may clear your nasal passages. Saline nasal sprays, available at your local drugstore, are also helpful.

What happens if the sinusitis is untreated?

Chronic sinusitis is uncomfortable. In rare circumstances, it can lead to serious complications, including brain abscess, meningitis, and infection of the teeth and bones.

How can I prevent getting sinusitis?

There are several things you can do. Avoiding airborne irritants, such as cigarette smoke and other pollutants, can help. If you have known or suspected allergies to mold, pollen, dust, or other irritants, consult an allergist. He or she can recommend treatment to reduce or limit allergy symptoms. Excessive alcohol consumption can cause swelling of nasal or mucous membranes.

Chlorine can irritate the lining of the nose and sinuses, so you might want to avoid swimming in treated pools if possible. If you need to travel by air, taking decongestants before and during the flight may help reduce your discomfort. Environmental controls--humidifiers, air conditioners, and filters--can also help keep air clean and at a stable temperature, which is healthier for the sinuses. For sinus comfort, keep humidity levels above 50% and the air temperature above 18°C (64.4°F).

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