• Posted February 27, 2024

What Is Chronic Sinusitis, and How Is it Treated?

Stuffy, sneezing, miserable: folks plagued by chronic sinusitis know the feeling all too well.

Experts at University of Cincinnati Health say it's also an all-too-common affliction, affecting an estimated 14.6% of Americans.

What is chronic sinusitis?

The sinuses are air-filled spaces in the skull at the back of the face, and they rely on mucus to stay moist and clean. However, bacterial infections, exposure to irritants (smoke, pollen, chemical fumes), asthma, a deviated septum, allergies and immunological disorders can all irritate and inflame the mucosa and also harm the tiny hair-like cilia that cover it.

When cilia are severely damaged, they can no longer do their job of draining mucus from the sinus, resulting in mucosal buildup.

In worse-case scenarios, chronic irritation can trigger the growth of nasal polyps, which cause even more blockages.

Chronic sinusitis (also known as chronic rhinosinusitis) is defined as "nasal obstruction, nasal drainage, facial pressure and/or decreased sense of smell, [lasting] for more than 12 weeks," according to the UC Health experts.

Chronic sinusitis isn't only about feeling stuffed up: It can trigger craniofacial pain and impede sleep and productivity.

How is chronic sinusitis diagnosed?

According to doctors at UC Health, folks who complain of sinus issues will first be asked about specific symptoms and their personal health histories.

"The next step is a comprehensive examination of your nose and face," according to UC Health. "You may have imaging studies, such as a CT scan of the sinuses."

A nasal endoscopy might also be performed, where a doctor uses a tiny camera to inspect the nasal cavity and sinuses. If evidence of a sinus infection is discovered, the endoscopy might also take a sample of the nasal drainage for testing.

Is it an allergy or is it chronic sinusitis?

In a recent study, experts at UC Health, led by Dr. Ahmad Sedaghat, tracked 219 patients plagued by sinus issues who'd been diagnosed with a nasal allergy. They found that while most did have some form of allergy, almost half (45.2%) also tested positive for chronic sinusitis.

Many would've have benefited from testing that spotted the sinusitis earlier, the study authors noted.

"We have seen so many patients suffer for so long due to the confusion between allergies and chronic rhinosinusitis [CRS],"Sedaghat said in a UC Health news release. "I've had patients who tell me that they have been treated with allergy shots for 10, 20 or more years without relief of their symptoms but who after we discovered they had CRS and we started them on appropriate treatment, achieved relief within a few months."

How is chronic sinusitis treated?

Typically, there's a "medications first, surgery second" approach to managing sinusitis.

Medications for chronic sinusitis:

• Inhaled corticosteroids, often given as nasal sprays, drops or nasal irrigations. They might be prescribed for long-term use. Steroids are sometimes given by mouth if inflammation is severe

• Saline rinses for the nose

• Allergy meds are given only if your doctor believes an allergy is playing a role in your sinusitis

• Biologics. The U.S. Food and Drug Administration has recently approved some biologic drugs that target inflammatory chemicals that are linked to the development of polyps

• Other medicines, prescribed in a "case-by-case" manner, as needed

Surgery for chronic sinusitis:

When medications fail to ease your symptoms, endoscopic sinus surgery could be the next step, the UC Health experts said.

"During endoscopic sinus surgery, the doctor uses a small camera [endoscope] to navigate inside the nose and sinuses, and to open the sinuses while removing diseased tissue [like polyps] and eradicating infection," UC Health explained.

Patients typically report an average pain level of 5 out of 10 during the "worst" part of the surgery, the UC health team said, and post-surgical pain is typically eased using a nonprescription painkiller such as acetaminophen.

Keeping chronic sinusitis from returning:

The best way to keep the condition at bay is to rid your environment of possible triggers, such as allergies (use your allergy medications), smoke (another great reason to quit smoking) and dust and sawdust (if needed, wear a protective mask).

SOURCE: UC Health, conditions/chronic sinusitis