What is Chronic Sinusitis?

Chronic sinusitis is a chronic inflammation characterized by the failure to drain mucus from the paranasal sinuses (cavities located on the sides, above, and behind the nose) due to an obstruction that causes mucus accumulation and the formation of bacterial agents.

What are the causes of chronic sinusitis?

Sinusitis can be caused by infectious agents, such as bacteria, fungi, and viruses, as well as allergic factors. Dust, temperature changes, and strong odors are listed as triggers for allergic rhinitis.

Exposure to certain chemical agents and alterations in the nasal anatomy or sinuses are other contributing factors. Rarely, conditions such as tumors can also lead to sinusitis.

Among the main causes of chronic sinusitis, we find:

• Nasal polyps;
• Deviated nasal septum;
• Facial trauma;
• Allergies;
• Respiratory infections;
• Dental infections;

Symptoms of Sinusitis

The signs and symptoms of chronic sinusitis differ from those of acute sinusitis. In chronic sinusitis, cough is a frequent symptom, while fever is rare. Acute sinusitis, in contrast, is a temporary sinus infection often associated with a common cold.

Chronic rhinosinusitis, however, is a long-lasting inflammatory process (more than 12 weeks) and can be classified into chronic rhinosinusitis with polyposis and chronic rhinosinusitis without polyposis. To diagnose chronic rhinosinusitis, at least two of the following signs must be present:

• Nasal obstruction or nasal discharge associated with at least one of the following symptoms:
  • Facial pressure or pain;
  • Reduced or loss of sense of smell;
  • Evidence of tomographic changes or nasal fibroscopy findings;
  • Duration exceeding 12 weeks;

• Other signs and symptoms may include:
  • Ear pain;
  • Upper jaw and tooth pain;
  • Cough, which may worsen at night;
  • Sore throat;
  • Bad breath (halitosis);
  • Fatigue or irritability;
  • Nausea;

How is chronic sinusitis diagnosed?

Nasal Endoscopy

A thin, flexible tube (endoscope) with a fiber optic light is inserted through the nose, allowing the doctor to visually examine the nasal cavities.

Medical Imaging Exams

Computed tomography (CT) scans provide detailed images of the sinuses and nasal region. They can identify deep inflammation or physical obstructions that are difficult to detect with an endoscope. These scans also assess sinus anatomy and may indicate the need for surgery. Sinus X-rays are inadequate for evaluating rhinosinusitis. CT scans are not routinely used, but only in specific situations.

Allergy Tests

If allergies are suspected, skin allergy tests may be recommended to identify the responsible allergen.

Other Tests

Blood tests to detect immune disorders and sweat chloride tests to detect cystic fibrosis may also be ordered.

Difference between rhinitis and sinusitis

Many people confuse sinusitis and rhinitis. While distinct, rhinitis can trigger sinusitis. The difference can be confusing for most people.

Simply put, rhinitis affects only the nose, while sinusitis involves the sinuses (air-filled cavities in the face located in the cheekbones, behind the eyes, and in the forehead). Rhinitis typically presents with a runny nose, sneezing, nasal itching, and congestion. Sinusitis, on the other hand, may include colored nasal discharge, congestion, cough, and facial pressure.

What is the goal of endoscopic surgery in the treatment of sinusitis?

In chronic sinusitis, functional endoscopic sinus surgery restores the natural function of the sinuses by improving drainage of nasal secretions.

This is the most common surgical procedure for chronic paranasal sinus infections. The surgery aims to eliminate obstructions preventing sinus drainage by removing thin membranes of bone and mucosa. An endoscope allows detailed visualization of the nasal cavities.

What are the pre- and postoperative phases of the procedure?

Pre-operatively, patients must follow a prescribed medication regimen and, if smokers, abstain from tobacco for at least 20 days before surgery to minimize scar formation and ensure successful surgery.

Post-operatively, patients may experience fatigue for about 2 weeks and pain in the treated area, which is managed with medication.

Follow-up appointments with nasal endoscopy will monitor the healing process.

When to see a doctor?

Consult a doctor if symptoms persist for more than 5 days. An ENT doctor can assess, treat, and determine if surgery is necessary. Delaying treatment and self-medicating can complicate treatment and potentially lead to serious consequences.