A stuffy nose, post nasal drainage, loads of congestion – and it’s not even flu season. What’s going on? If you experience these symptoms, along with pain and tenderness in the face, ear pain, an achy jaw and sore throat, you might have sinusitis. If you have these symptoms for more than three months and no treatment is helping, you may be experiencing what we call chronic sinusitis. Let’s take a look at what causes sinusitis and how your ENT physician can help you treat your chronic sinusitis.
Sinusitis, by definition, is an inflammation of the sinuses. It can be viral or bacterial, but the type of sinusitis often discussed is bacterial in nature. Sinusitis is classified as either acute or chronic. Acute sinusitis happens every so often, is treated, and goes away. Sinusitis that persists or recurs frequently is chronic sinusitis.
There are many common causes of sinusitis, whether it be chronic or acute. These include:
The anatomy of the sinus can also contribute to instances of chronic sinusitis in that certain anatomical conditions cause people who catch colds to end up with sinusitis. If a sinus opening is particularly narrow, the patient is more at risk. A deviated septum can also increase risk, as the septum pushes on the middle turbinate and enables obstruction. Another condition is enlargement of the middle turbinate, a disorder called concha bullosa. People who experience many sinus infections can have chronic thickening of the lining of the sinuses, making them forever susceptible.
All forms of respiratory illness that cause thickening of the mucosal lining can lead to sinusitis. A condition like cystic fibrosis, when patients cannot clear the mucus in the lungs and sinus, makes the patient more vulnerable to chronic sinusitis.
In order to properly treat chronic sinusitis, it is important to discover the underlying cause. If the patient complains that they experience sinusitis every time they have a cold, we can look inside their sinuses to see if there is a structural abnormality or change that is causing the problem. If a person claims they are chronically congested or have a runny nose all the time, allergies are likely the culprit. If the patient complains of pain, this might mean that the repeated condition has created a condition that will require aggressive medical management, including surgery.
An endoscopy or CT scan can help your ENT physician find out what’s going on in your sinuses and then develop a plan for overall treatment and future medication.
When treating sinusitis, a doctor’s goal is to decrease inflammation of the nose. Through this process, a physician can also narrow down the specific cause of sinusitis. The first line of treatment is a salt water wash combined with a topical nasal steroid spray to promote mucus drainage and to reduce nasal inflammation. If this gets the patient down to 1-2 sinusitis events per year, it’s unlikely that any further or more invasive involvement is necessary. The irrigation wash can help keep out pollen and fungus.
If this doesn’t work, allergy testing might be necessary. Avoidance of certain allergens can tell the doctor if an environmental irritant is at work, or if additional allergy medication is needed.
If both of these things fail, there are surgical options. A deviated septum or other anatomical abnormalities will require a surgery like a septoplasty. There are two procedures designed to open up the sinuses to make them function better. One is a balloon sinuplasty – a procedure done in-office to stretch the sinus cavity. Another, more aggressive option is functional endoscopic sinus surgery. This is performed in a hospital and has a longer recovery time, but may be required in certain cases.
In order to avoid surgery, the doctor might prescribe systemic steroids to decrease inflammation to get back to baseline sinus activity.