What is chronic sinusitis?

By Dr. Inell Rosario, MD

Chronic sinusitis is inflammation of the lining of the sinus cavities for three months or longer. The sinuses are paired, air-filled cavities that are surrounded by the eyes, brain, maxilla and upper teeth, and back of throat. Names of the paranasal sinuses are the frontal, ethmoid, maxillary and sphenoid sinuses. Their natural drainage pattern is aided by tiny cilia that beat secretions to the back of the throat.

When the sinuses are infected, they can cause headaches, eye and teeth pain or pressure and nasal congestion. Sinus infections can be caused by viruses or bacteria and are exacerbated by allergies, foreign bodies, or structural abnormalities.

Why should I care about sinusitis?

Sinusitis is very common, and in any year most people will suffer from at least one episode of acute infection. An acute sinus infection lasts less than three months but otherwise has the same symptoms and causes as a chronic sinus infection but responds to therapy or spontaneously resolves.

Because sinus infections are so common, knowing about them will allow you to recognize the symptoms in yourself or others and therefore be able to seek treatment sooner. The sinuses do surround vital structures, so their infections can cause life-threatening problems such as periorbital (around the eye) or brain abscess or pus, loss of vision or meningitis.

What causes chronic  sinusitis?

Bacteria are often the culprit in ongoing sinusitis even if the infection began with a viral infection. Nasal obstruction caused by a deviated septum or large turbinates increase the risk for nasal obstruction or difficult nasal breathing and slow the clearance of the sinus infection.

Molds or fungal elements can also cause sinusitis but thankfully occur quite infrequently even in the diabetic or immunosuppressed patient. Gastroesophageal reflux is often considered as a cause of sinusitis, especially in children or in any age group if the sphenoid sinuses are involved

How is a sinus  infection diagnosed?

A sinus infection is diagnosed based on symptoms of pain and/or pressure over the sinuses or upper teeth, nasal discharge anteriorly and or posteriorly, decreased sense of smell and or taste, fatigue, halitosis, nausea, and at times a fever. Nasal endoscopy is where the ENT (ear, nose and throat) specialist takes a small camera and inspects the areas in the nose near the opening of the sinuses. A CT scan of the sinuses is also used to diagnose a sinus infection. These are used especially if symptoms are only present on one side of the face, not responding to therapy, warranting surgical intervention.

How do I prevent  a sinus infection?

It is no mystery that getting good rest or sleep rejuvenates the body and immune system. Proper hygiene and diet with aid of multivitamins are helpful. Saline rinses are a must, as they simply rinse away and reduce the amount of bacteria and viruses the body then has to defend against. Avoiding cigarette smoke, molds, and dusty environments is also crucial.

How do I treat a sinus infection?

If you are in good health, start off with the simple interventions such as rest, multivitamins, saline nasal rinses, nasal steroid or antihistamine sprays. If you are not improving after five days or if symptoms are progressing rapidly or show signs of a complication of sinus infection such as eye swelling, then see your doctor for intervention.

A sinus culture may be taken to see what bacteria may be causing your infection, especially if you have already been treated with a few different antibiotics. Sinus surgery in the operating room, or now more readily Balloon Sinuplasty, may be performed in the office to treat your chronic sinus infection.

Balloon Sinuplasty is a minimally invasive surgery that often can be done comfortably in the ENT doctor’s office with local anesthesia. The patient can return to their usual activities shortly after the procedure.

A lighted guide wire, then a balloon is inserted into the sinus cavities to dilate their natural opening, and if desired, washing out or rinsing the sinuses is often done at the same time. By just dilating the sinus opening, the natural anatomy is maintained. In the past, studies have shown that this leads to continued function of the sinus and nasal cilia to clear sinus infections.

Action steps 

Always start with a thorough evaluation by your primary care physician or provider, and they will direct you to an ENT specialist or allergist if needed. If you read or see information in the news, bring it in with you to your visit so that questions or concerns you may have about what is in the news may be addressed. Don’t be afraid to get a second opinion if you are not satisfied with the answers you are receiving.

Dr. Rosario is a board certified otolaryngologist (ENT physician) and Sleep Medicine specialist that has been in private practice since July 1997. She treats a wide range of ENT problems including sinusitis and tonsil issues in both adults and pediatric patients, manages patients with difficult nasal breathing, ear lobe deformities, facial scars, thyroid tumors, insomnia, seasonal affective disorder, snoring and sleep apnea, and hearing loss. Contact or visit her at her new office: Andros ENT & Sleep Center, PA, 5565 Blaine Ave., Suite 225, Inver Grove Heights, MN 55076, 651-888-7800, Fax: 651-888-7899, www.androsent.sleep.com.