Chronic sinusitis is an inflammatory condition of the sinuses, analogous to “asthma of the sinuses”. It is diagnosed when patients have at least 12 weeks of symptoms, such as nasal blockage, nasal drainage, facial pain or smell loss.
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Our physicians are recognized among the world’s experts in chronic sinusitis. We are on expert panels setting medical treatment and endoscopic sinus surgery strategies for chronic sinusitis used by otolaryngologists around the world.
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Chronic sinusitis (also referred to as chronic rhinosinusitis) is an inflammatory condition of the sinuses. Sometimes chronic sinusitis may be due to chronic bacterial infections. If symptoms, such as nasal obstruction, nasal drainage, facial pressure and/or decreased sense of smell, last for more than 12 weeks, this is indicative of chronic sinusitis. Sinuses are air-filled spaces in the skull behind the face. They are kept moist and clean by a lining of mucosa. Things such as pollen, smoke and chemical fumes can irritate the mucosa. Constant exposure to irritants can cause ongoing inflammation of this lining. It can also damage tiny hair-like cilia that cover the mucosa. Cilia helps carry mucus toward the opening of the sinus. Damage to cilia keeps mucus from draining from the sinuses. In some cases, the inflammation in the sinuses causes patients to develop growths in the nose called nasal polyps, which can further cause more nasal blockage.
Research performed by our physicians at the University of Cincinnati College of Medicine and UC Health has shown that chronic sinusitis has a significant impact on patients’ quality of life and may also lead to significant morbidity by causing lung problems (such as asthma) if not properly treated. Our experts have shown that beyond the nasal symptoms of chronic sinusitis, many patients experience poor sleep quality and craniofacial pain, which significantly reduces quality of life and decreased productivity. Our research has also shown that the more severe the chronic sinusitis becomes, the more likely that patients are to experience severe lung problems.
For most patients, it is not known what causes chronic sinusitis and much of the research in this field is directed at understanding this process. Research being performed by our physicians is in the process identifying the inflammatory mechanisms of chronic sinusitis. While the causes of chronic sinusitis are currently unknown, there are factors that are known to be associated with chronic sinusitis.
The following are common signs and symptoms of chronic sinusitis:
Nasal blockage.
Congestion of the nasal passages.
Thick, colored drainage from the nose.
Thick mucus draining down the back of the throat (postnasal drainage).
Facial pain and pressure.
Headache and sinus pain.
Loss of smell.
Cough.
Sore throat.
Our physicians are ear, nose and throat doctors with sub-specialty and fellowship training in rhinology with maximal expertise to diagnose and treat chronic sinusitis. Diagnosis of chronic sinusitis begins with our doctors asking about your symptoms and health history. The next step is a comprehensive examination of your nose and face. You may have imaging studies, such as a CT scan of the sinuses. You may also have a nasal endoscopy. During this test, the doctor puts a small camera in your nose to carefully examine the nasal cavity and sinuses. If there is evidence of an acute sinus infection, your doctor may also take a sample of the nasal drainage to check for bacteria.
The first line of treatment for chronic sinusitis is medical management which our physicians have helped to write and which are based in part on our physicians’ research, have recommended that chronic sinusitis patients be aggressively treated with appropriate medical management prior to considering endoscopic surgery. Our physicians focus on providing evidence-based treatments that are tailored to patients’ needs and preferences. Our treatments are aimed at maximizing how well our patients feel using only medications. However, for those patients whose symptoms are not controlled with medications, our physicians use the latest research to identify the patients who could benefit from surgical treatments.
Our evidence-based, patient-centric treatment philosophy is grounded in a belief that physicians should be able to provide patients with the evidence and rationale for any treatment recommendation.
Medicines for sinusitis may include:
Inhaled corticosteroid medicine. Nasal sprays, drops or irrigations with steroids are often prescribed. These medications may be recommended for long-term usage, in which case your doctor will discuss the possibility of side effects (although intranasal corticosteroids are generally very well tolerated).
Saline rinses for the nose.
Sometimes antibiotic medicines are given if there is evidence of infection.
Sometimes steroids are given by mouth if the swelling in the nose and sinuses is severe.
Allergy medications. Antihistamines and allergy shots (immunotherapy) may be recommended if your doctor feels that allergies are contributing to your chronic sinusitis.
Biologic medications. Recently FDA approved medications directly target the inflammatory chemicals that lead to the development of nasal polyps in chronic sinusitis.
Other medicines. There are many other adjunctive medications that exist for chronic sinusitis.
The application and utilization of such medications is performed in a personalized, case-by-case manner.
If medical treatments are not enough to control your symptoms of chronic sinusitis, you may be a good candidate for endoscopic sinus surgery. Previous studies have established parameters for patients who may most benefit from endoscopic sinus surgery, and our providers can discuss these with you. The extent of surgery depends on the severity of the chronic sinusitis and which sinuses are involved. Your doctor will tell you more about your options. 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. This surgery is minimally invasive and is done without incisions on the face.
We have found that:
It’s important to treat the factors that may contribute to exacerbation or worsening of chronic sinusitis. If you have allergies, talk with your doctor about treatment. Our physicians are also experts in allergies and can help. If you are exposed to nasal irritants such as sawdust, use a filter mask. If you smoke, ask your doctor for help with quitting. Smoke irritates the sinuses and can make your sinus problems worse. If you live with smokers, ask them to consider quitting or only smoking outdoors.
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