What is Chronic Sinusitis?

If the sinus infection (sinusitis) lasts for three months or more, it is classified as Chronic Sinusitis. An estimated 30 to 40 million cases of chronic sinusitis are reported annually in America alone.

What Causes Chronic Sinusitis?

Sinusitis usually results from diminished ciliary action, impaired flow of mucus through the sinus ostia, or due to thickening of mucosal secretions. Any obstruction of the sinus ostia almost always adversly affects the drainage of the sinues, resulting in exessive build-up of mucosal secretions inside the sinuses. Stagnantion of mucus inside the dark, moist and warm sinuses promotes bacterial growth, leading to inflammation of the mucosa, and sinusitis. If this kind of sinus infection persists for three months or more, the patient is considered to have developed chronic sinusitis.

Signs and Symptoms of Chronic Sinusitis:

Nasal congestion, obstruction of the nasal passages, postnasal drip, sinus pressure, postnasal discharge, yellowish/greenish thick nasal discharge, and sinus pressure symptoms are almost always present. Children suffering form chronic sinusitis may also exhibit signs of cough, purulent rhinorrhea, and in most cases, also postnasal discharge/postnasal drip.

As indicated below, the symptoms of chronic sinusitis sinus disease vary depending upon the sinuses involved:

Chronic Ethmoid Sinusitis: Chronic sore throat, Chronic nasal drip, Nasal congestion, Bad breath, Dificulty in breathing through nose, Sensitivity and discomfort of the nasal bridge, Worsening of sinus symptoms during the morning hours.

Chronic Frontal Sinusitis: Chronic frontal sinusitis causes a dull headache that would not go away. Patients suffering from frequent/repeated episodes of frontal sinusitis also show signs of excessive accumulation of mucus within the frontal sinuses. It could also result in extensive polyposis within the frontal sinuses, often requiring a fronto-ethmoidectomy, or a frontal osteoplastic flap surgery. Other symptoms include the usual sinus pressure, sinus pain/discomfort, and persistent aches and pain in the forehead.

Chronic Maxillary Sinusitis: Often involves frontal sinuses (frontal sinusitis), Discomfort and sinus symptoms prevailing throughout the day, Excessive coughing at night, and Persistent pain and headache in the forehead.

Chronic Sphenoid Sinusitis: Typical symptoms include low-grade headache, and the usual sinus infection symptoms lasting longer than three months.

Chronic Sinusitis Diagnosis:

Diagnosis of chronic sinusitis may require: CT scans, Endoscopic middle meatus aspiration culture, Nasal swab and culture, and Transillumination.

Chronic Sinusitis Treatment and Remedies:

Chronic sinusitis treatment often involves: Steroids via nasal spray, Saline (salt water) nasal irrigation, and an entire course (often lasting at least six weeks or more) of antibiotic therapy as may be deemed appropriate.

If it is necessory to open up the passage between the nose and the frontal sinuses and the ethmoid sinuses, or if it is necessary to enlarge the drainage-opening to the maxillary sinus, an endoscopic surgical procedure may be considered. Some times a surgery is required to surgically remove the infected sinuses and to parmanently close their drainage openings. Sometimes fat obliteration of sinuses is also necessary. While Osteoplastic Flap (OPF) surgery is a highly invasive but very effective surgical procedure for the treatment of chronic frontal sinusitis, the Endoscopic Modified Lothrop Procedure (EMLP) is a less-invasive procedure that also helps widen-up the drainage passages of the frontal sinuses. EMLP involves insertion of an endoscope through the nose to the frontal sinus area for the removal of the parts of the septum and the bones surrounding the frontal sinuses.

Chronic Sinusitis Prognosis:

Chronic sinusitis is not considered to be a life-threatening disease. However, considering that the frontal sinuses are located in such a close proximity of the brain, there is a possibility (between 5 to 10%) of intracranial complications to occur.

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