What is chronic rhinosinusitis (CRS)? It is defined as 12 weeks of ongoing inflammation of the nose and sinuses. Symptomatic patients will present with nasal discharge or drainage, facial pain and pressure, nasal congestion or obstruction on examination or with a CT scan. CRS is not an infectious disease although acute sinusitis may be. Different causes of CRS have been investigated over the years. Despite much research, the jury is still out on what causes CRS. CRS is likely caused by a combination of contributing factors such as:
- Allergy- There is a common relationship between allergies and sinusitis but allergies alone do not cause CRS.
- Biofilms-One theory about CRS says that biofilms which are like bacteria with scaffolding around them could be the cause. While this may be the case for some patients there is not any good evidence that this is always the cause.
- Fungus in the nose was once thought to be a possible cause. This has been disproven.
- Acid Reflux- Patients with acid reflux do seem to have sinusitis at an increased rate but there is no evidence that one causes the other.
- Anatomy- Variation from person to person of the anatomy of the sinuses likely play a large role in why some patients develop CRS and others do not. The same may be true of septal deviation.
Many patients with chronic rhinosinusitis describe it as having a brain fog. They seem to have a harder time paying attention, are more distractible, and show longer reaction times. The good news is that, with treatment, many patients will have improvement with their symptoms and the feeling of brain fog.
Treatment of Sinusitis
Treatment is focused on controlling the inflammation in the nose and sinuses regardless of the cause of the sinusitis and the symptoms. Broadly speaking there are two types of treatment, medical and surgical.
- Medical Therapy- These are medications that are aimed at decreasing inflammation. The most commonly used medications are topical nasal steroids. These include Flonase and Nasonex. This is sometimes coupled with sinus irrigations which serve to remove some of the mucus from the sinuses.
- Surgical Therapy- If a patient cannot find relief with medical therapy alone we turn to surgery. The goal of surgical therapy is to make the openings to the sinuses larger so that medications can be delivered topically in a more effective way. Some patients are good candidates for doing this with a balloon while others need more traditional surgery.
One important point to remember when discussing the treatment for sinusitis is that the focus is on quality of life. This is to say that we are less concerned with what CT scans show and more concerned with how a patient feels. The patient and the surgeon must work together to develop a treatment plan that fits into a patient’s lifestyle and goals.