Chronic Sinusitis

Chronic sinusitis is recurrent or persistent infection of the paranasal sinuses. The sinuses are air cells contained within the facial skeleton. The sinuses function to moisturized and warm the nasal airflow. The average person has approximately one liter of secretions from the sinus mucosa during one day. This is usually not noticeable, unless it becomes thick, infected, or voluminous. The sinuses open directly into the nasal cavities through small openings. It is when these openings become obstructed that sinusitis develops. The most common causes of sinus obstruction are the common cold, allergic rhinitis, non-allergic rhinitis, and anatomic causes of blockage, such as nasal septal deviation or concha bullosa (see below). Acute infections are characterized by purulent runny nose and post-nasal drip, mid-facial pain, nasal congestion, and fever. They are usually treated with an antibiotic and a decongestant. Amoxicillin is the first choice in non-allergic individuals, with Bactrim reserved for Penicillin allergic individuals. Sudafed is a good decongestant. Topical decongestants such as Neo-synephrine may also be used, but only for three to five days. Usually the acute infection will resolve, although if the underlying problem (i.e. allergic rhinitis or nasal septal deviation) is not treated, the sinusitis may become recurrent or chronic.

Recurrent or chronic infections are characterized by yellow to green nasal and post-nasal discharge, dull mid-facial pain, and nasal congestion. Fever is usually not present. The difference between recurrent and chronic infections is whether or not the infection gets better between episodes. Should recurrent or chronic sinusitis develop, it should be treated with a broad spectrum antibiotic such as Augmentin, Zithromax or Biaxin. In addition, a nasal steroid spray such as Nasonex, Flonase or Nasacort should be used. An antihistamine and decongestant such as Claritin D, Allegra D or Zyrtec with Sudafed may also be added. It is important to treat recurrent or chronic infections for at least four weeks, in order to allow the medications to penetrate the chronically inflammed sinus mucosa and fully eradicate the infection.

Should the symptoms of chronic sinusitis persist despite medical therapy, a CT scan of the paranasal sinuses should be obtained. If this is normal, chronic sinusitis is not present. In these cases, the sinus symptoms are due to recurrent obstruction, but the sinus mucosa is not chronically inflammed. The key to treating this problem is to treat the underlying disorder (i.e. allergic rhinitis with allergy shots, nasal septal deviation with septoplasty). If the CT scan shows chronic inflammation of the sinus mucosa, nasal or sinus polyps, obstruction of the ostiomeatal unit (the ethmoid sinus and the opening to the maxillary sinus) or concha bullosa (middle turbinate enlargement due to an ethmoid air cell), then endoscopic sinus surgery is necessary to correct the problem. It is imperative that the underlying disorder also be treated (i.e. allergic rhinitis with allergy shots, nasal septal deviation with septoplasty), or the risk of recurrent sinus disease requiring revision surgery is high.