Symptoms
Chronic sinusitis sufferers have at least 2 of the following symptoms for longer than 3 months:
- Cloudy or colored nasal or post-nasal discharge
- Difficulty breathing through the nose
- Facial pain or pressure
- Loss or change of sense of smell
Causes
Chronic sinusitis is typically divided into two categories: those with nasal polyps and those without.
Those with nasal polyps may have the following causes:
- Inhalant allergies: Such as trees, grasses, weeds, animals.
- Allergic fungal sinusitis: Caused by allergy to a fungi.
- Aspirin-exacerbated respiratory disease: Triad of aspirin sensitivity, asthma, and nasal polyps.
- Kartagener’s Syndrome (primary ciliary dyskinesia): Caused by a gene mutation resulting in the inability to clear mucous from the sinuses.
- Churg-Strauss Syndrome (eosinophilic granulomatosis with polyangiitis): Has various degrees of severity, but typically consists of asthma, nasal polyposis, and elevated eosinophils in the blood.
- Cystic Fibrosis: Caused by a gene mutation leading to overly thick sinus secretions.
- Generalized inflammatory process: Some patients with nasal polyps do not have an identifiable cause of their disease, but rather have an underlying inflammatory process.
Chronic sinusitis without nasal polyps has the following causes:
- Infection: Typically a bacterial infection of the sinus itself, but could also be secondary to a dental infection that has spread to the sinus. Patients with a compromised immune system are prone to chronic infections.
- Anatomic blockage/abnormalities: Such as a deviated septum or large middle turbinate can block the drainage pathway of the sinuses leading to a chronic infection.
- Inhalant allergens: Cause inflammation of the sinus cavity, blocking the drainage pathway of the sinuses.
- Smoking
Symptoms
Chronic sinusitis sufferers have at least 2 of the following symptoms for longer than 3 months:
- Cloudy or colored nasal or post-nasal discharge
- Difficulty breathing through the nose
- Facial pain or pressure
- Loss or change of sense of smell
..Causes
Chronic sinusitis is typically divided into two categories: those with nasal polyps and those without.
Those with nasal polyps may have the following causes:
- Inhalant allergies: Such as trees, grasses, weeds, animals.
- Allergic fungal sinusitis: Caused by allergy to a fungi.
- Aspirin-exacerbated respiratory disease: Triad of aspirin sensitivity, asthma, and nasal polyps.
- Kartagener’s Syndrome (primary ciliary dyskinesia): Caused by a gene mutation resulting in the inability to clear mucous from the sinuses.
- Churg-Strauss Syndrome (eosinophilic granulomatosis with polyangiitis): Has various degrees of severity, but typically consists of asthma, nasal polyposis, and elevated eosinophils in the blood.
- Cystic Fibrosis: Caused by a gene mutation leading to overly thick sinus secretions.
- Generalized inflammatory process: Some patients with nasal polyps do not have an identifiable cause of their disease, but rather have an underlying inflammatory process.
Chronic sinusitis without nasal polyps has the following causes:
- Infection: Typically a bacterial infection of the sinus itself, but could also be secondary to a dental infection that has spread to the sinus. Patients with a compromised immune system are prone to chronic infections.
- Anatomic blockage/abnormalities: Such as a deviated septum or large middle turbinate can block the drainage pathway of the sinuses leading to a chronic infection.
- Inhalant allergens: Cause inflammation of the sinus cavity, blocking the drainage pathway of the sinuses.
- Smoking
Diagnosis
Diagnosis of chronic sinusitis includes two of the four symptoms listed in the section above AND evidence of sinusitis seen on either nasal endoscopy or CT scan.
Nasal Endoscopy
Performed by placing a small camera inside the nose. Signs of nasal polyposis or cloudy/colored sinus drainage is consistent with chronic sinusitis.
CT scan
This is a detailed X-ray of the sinuses that can be performed in the office and discussed with our patients on the same visit. Inflammation of the sinuses is consistent with chronic sinusitis.
Allergy Testing
Patients that have chronic sinus infections, along with allergy symptoms, are often allergy tested to identify the type of environmental allergens that may be triggering their symptoms. Allergens cause inflammation of the nasal passageways that can lead to sinus infections.
Nasal Culture
Patients with persistent sinusitis that is not responding to treatment may have a culture taken from the nose. This allows for the identification of the type of bacteria causing the infection and which antibiotics would be most effective in treating the infection.
Lab Work
Occasionally blood work is performed to evaluate for certain diseases/conditions. Lung function testing may also be performed due to the prevalence of asthma in chronic sinusitis patients.
Diagnosis
Diagnosis of chronic sinusitis includes two of the four symptoms listed in the section above AND evidence of sinusitis seen on either nasal endoscopy or CT scan.
Nasal Endoscopy
Performed by placing a small camera inside the nose. Signs of nasal polyposis or cloudy/colored sinus drainage is consistent with chronic sinusitis.
CT scan
This is a detailed X-ray of the sinuses that can be performed in the office and discussed with our patients on the same visit. Inflammation of the sinuses is consistent with chronic sinusitis.
Allergy Testing
Patients that have chronic sinus infections, along with allergy symptoms, are often allergy tested to identify the type of environmental allergens that may be triggering their symptoms. Allergens cause inflammation of the nasal passageways that can lead to sinus infections.
Nasal Culture
Patients with persistent sinusitis that is not responding to treatment may have a culture taken from the nose. This allows for the identification of the type of bacteria causing the infection and which antibiotics would be most effective in treating the infection.
Lab Work
Occasionally blood work is performed to evaluate for certain diseases/conditions. Lung function testing may also be performed due to the prevalence of asthma in chronic sinusitis patients
Available Treatments
Treatment options can be divided into medical and surgical therapies. Part of the purpose of surgical treatment is to allow for better access of topical medications in the nasal cavity.
Medical
- Nasal saline: Saltwater nose spray that can rinse the nasal cavity of allergens, bacteria, debri, and mucus.
- Intranasal steroids: Fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort), triamcinolone (Nasacort), beclomethasone (QNasl) are several examples. Intranasal steroid sprays have been shown to help reduce facial pain and nasal congestion.
- Oral steroids: Typically prescribed for only short periods of time in order to reduce long term side effects.
- Allergy immunotherapy (allergy shots): Patients with perennial and non-perennial inhalant allergies may benefit from allergy immunotherapy. Patients injected with allergens, just under the skin, at a small dose that is gradually increased to a higher dose. This allows the patient to develop tolerance to these allergens.
- Aspirin desensitization: For patients with aspirin-exacerbated respiratory disease.
- Steroid eluting stent: A dissolvable stent impregnated with a steroid that is placed into the nasal cavity. The steroid is released from the stent daily, providing targeted treatment of nasal polyps.
- Antibiotics: Used when there are signs of an infection. Antibiotic use may be for 20 days or longer. An antibiotic nasal rinse is another option for treating chronic infection.
- Biologic agents: Omalizumab (Xolair), reslizumab (Cinqair), mepolizumab (Nucala), benralizumab (Fasenra), dupilumab (Dupixent) are examples. These medications inhibit specific components of the inflammatory pathway that leads to the formation of nasal polyps.
Surgical
- Septoplasty: Deviated portions of the septum are removed allowing for better airflow through the nose; in severe septal deviations, correction can also lead to better drainage of the nasal sinuses.
- Balloon Sinuplasty: This is a procedure that enlarges the natural drainage pathway of your sinuses, leading to fewer sinus infections in the future. It is often performed under local anesthesia in the office.
- Functional Endoscopic Sinus Surgery: For patients with nasal polyps or extensive sinus disease, various instruments are used to open up the sinus drainage pathways. This is all done with a camera through the nose.
Treatment
…Medical
- Nasal saline: Saltwater nose spray that can rinse the nasal cavity of allergens, bacteria, debri, and mucus.
- Intranasal steroids: Fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort), triamcinolone (Nasacort), beclomethasone (QNasl) are several examples. Intranasal steroid sprays have been shown to help reduce facial pain and nasal congestion.
- Oral steroids: Typically prescribed for only short periods of time in order to reduce long term side effects.
- Allergy immunotherapy (allergy shots): Patients with perennial and non-perennial inhalant allergies may benefit from allergy immunotherapy. Patients injected with allergens, just under the skin, at a small dose that is gradually increased to a higher dose. This allows the patient to develop tolerance to these allergens.
- Aspirin desensitization: For patients with aspirin-exacerbated respiratory disease.
- Steroid eluting stent: A dissolvable stent impregnated with a steroid that is placed into the nasal cavity. The steroid is released from the stent daily, providing targeted treatment of nasal polyps.
- Antibiotics: Used when there are signs of an infection. Antibiotic use maybe for 20 days or longer. An antibiotic nasal rinse is another option for treating chronic infection.
- Biologic agents: Omalizumab (Xolair), reslizumab (Cinqair), mepolizumab (Nucala), benralizumab (Fasenra), dupilumab (Dupixent) are examples. These medications inhibit specific components of the inflammatory pathway that leads to the formation of nasal polyps.
Surgical
- Septoplasty: Deviated portions of the septum are removed allowing for better airflow through the nose; in severe septal deviations, correction can also lead to better drainage of the nasal sinuses.
- Balloon Sinuplasty: This is a procedure that enlarges the natural drainage pathway of your sinuses, leading to fewer sinus infections in the future. It is often performed under local anesthesia in the office.
- Functional Endoscopic Sinus Surgery: For patients with nasal polyps or extensive sinus disease, various instruments are used to open up the sinus drainage pathways. This is all done with a camera through the nose.
Services We Provide
- Treatment of acute and chronic sinusitis
- Nasal endoscopy
- In-office CT scan
- Allergy testing and treatment
- Nasal culture when indicated
- In-office balloon sinuplasty
- Septoplasty
- Functional endoscopic sinus surgery
- Propel and Sinuva stents
Services We Provide
- Treatment of acute and chronic sinusitis
- Nasal endoscopy
- In-office CT scan
- Allergy testing and treatment
- Nasal culture when indicated
- In-office balloon sinuplasty
- Septoplasty
- Functional endoscopic sinus surgery
- Propel and Sinuva stents
ii Rosenfeld, Richard M., et al. “Clinical Practice Guideline (Update): Adult Sinusitis.” Otolaryngology–Head and Neck Surgery, vol. 152, no. 2_suppl, 2015, doi:10.1177/0194599815572097