Chronic Sinusitis

• Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat
• Nasal obstruction or congestion, causing difficulty breathing through your nose
• Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
• Aching in your upper jaw and teeth
• Reduced sense of smell and taste
• Cough, which may be worse at night

Other signs and symptoms can include:

• Ear pain
• Sore throat
• Bad breath (halitosis)
• Fatigue or irritability
• Nausea

The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except they last longer and often cause more significant fatigue. Chronic sinusitis is sinusitis that lasts more than eight weeks or keeps coming back. Unlike with acute sinusitis, fever isn't a common sign of chronic sinusitis.

Causes

When you have sinusitis, the mucous membranes of your nose, sinuses and throat (upper respiratory tract) become swollen. This swelling blocks the sinus openings and prevents mucus from draining normally.

Blocked sinuses create a moist environment that makes it easier for infection to take hold. Sinuses that become infected and can't drain become pus-filled, leading to symptoms such as thick, yellowish or greenish discharge and other symptoms of infection.

Common causes of chronic sinusitis include:

• Nasal polyps or tumors. These tissue growths may block the nasal passages or sinuses.
• Allergic reactions. Allergic triggers include fungal infection of the sinuses.
• Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
• Trauma to the face. A fractured or broken facial bone may cause obstruction of the sinus passages.
• Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system diseases may result in nasal blockage.
• Respiratory tract infections. Infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, blocking mucus drainage and creating conditions ripe for growth of bacteria. These infections can be viral, bacterial or fungal in nature.
• Allergies such as hay fever. Inflammation that occurs with allergies may block your sinuses.
• Immune system cells. With certain health conditions, immune cells called eosinophils can cause sinus inflammation.

Risk factors

You're at increased risk of getting chronic or recurrent sinusitis if you have:

• A nasal passage abnormality, such as a deviated nasal septum, or nasal polyps
• Aspirin sensitivity that causes respiratory symptoms
• A medical condition such as cystic fibrosis or gastroesophageal reflux (GERD)
• An immune system disorder such as HIV/AIDS or cystic fibrosis
• Hay fever or another allergic condition that affects your sinuses
• Asthma — about one in 5 people with chronic sinusitis have asthma
• Regular exposure to pollutants such as cigarette smoke

Complications

Chronic sinusitis complications include:

• Asthma flare ups. Chronic sinusitis can trigger an asthma attack.
• Meningitis, an infection that causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
• Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.
• Aneurysms or blood clots. Infection can cause problems in the veins surrounding the sinuses, interfering with blood supply to your brain putting you at risk of a stroke.

Diagnosis

To look for the cause of your symptoms, your doctor will feel for tenderness in your nose or throat. Your doctor may use a tool to hold your nose open and apply medication that constricts blood vessels in your nasal passages. This makes it easier to see inside your nasal passages. Your doctor will then shine a light into your nasal passages to look for inflammation or fluid. This visual inspection will also help rule out physical conditions that trigger sinusitis, such as nasal polyps or other abnormalities.

Your doctor may use several methods to help screen for chronic sinusitis:

• Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
• Imaging studies. Images taken using computerized tomography (CT) or magnetic resonance imaging (MRI) can show details of your sinuses and nasal area. These may identify a deep inflammation or physical obstruction that's difficult to detect using an endoscope.
• Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing chronic sinusitis. However, in cases in which the condition fails to respond to treatment or is progressing, tissue cultures may help pinpoint the cause, such as identifying a bacterial pathogen.
• An allergy test. If your doctor suspects that the condition may be brought on by allergies, an allergy skin test may be recommended. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.

Treatments and drugs

The goal of treating chronic sinusitis is to:

• Reduce sinus inflammation
• Keep your nasal passages draining
• Eliminate the underlying cause
• Reduce the number of sinusitis flare-ups you have

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms. These include:

• Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
• Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flixonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and beclomethasone (Beconase AQ).
• Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Examples include prednisone and methylprednisolone. Oral corticosteroids can cause serious side effects when used long term, so they're used only to treat severe asthma symptoms.
• Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Examples of OTC oral decongestants include Sudafed and Actifed. An example of an OTC nasal spray is otrivine. These medications are generally taken for a few days at most; otherwise they can cause the return of more severe congestion (rebound congestion).
• Over-the-counter pain relievers such as aspirin, paracetamol or ibuprofen. Because of the risk of Reye's syndrome — a potentially life-threatening illness — never give aspirin to anyone younger than age 18.
• Aspirin desensitization treatment if you have reactions to aspirin that cause sinusitis. However, this treatment can have serious complications such as intestinal bleeding or severe asthma attacks.

Antibiotics

Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. However, chronic sinusitis is usually caused by something other than bacteria, so antibiotics usually won't help.

Antibiotics used to treat chronic sinusitis caused by a bacterial infection include amoxicillin (Amoxil, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the infection doesn't subside or if the sinusitis comes back, your doctor may try a different antibiotic.

If your doctor does prescribe antibiotics, it's critical to take the entire course of medication. Generally, this means you'll need to take them for 10 to 14 days or even longer — even after your symptoms get better. If you stop taking them early, your symptoms may come back.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat the condition.

Surgery

In cases that continue to resist treatment or medication, endoscopic sinus surgery may be an option. For this procedure, the doctor uses an endoscope, a thin, flexible tube with an attached light, to explore your sinus passages. Then, depending on the source of obstruction, the doctor may use various instruments to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage. 

Lifestyle remedies

These self-help steps can help relieve sinusitis symptoms:

• Rest. This will help your body fight inflammation and speed recovery.
• Drink fluids, such as water or juice. This will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, as they can be dehydrating. Drinking alcohol can also worsen the swelling of the lining of the sinuses and nose.
• Moisturize your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of medium-hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
• Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
• Rinse out your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others), bulb syringe or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses.
• Sleep with your head elevated. This will help your sinuses drain, reducing congestion.

Prevention

Take these steps to reduce your risk of getting chronic sinusitis:

• Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals.
• Carefully manage your allergies. Work with your doctor to keep symptoms under control.
• Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.
• Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

References:

http://www.health.com/health/gallery/0,,20472158,00.html

http://patient.info/health/chronic-sinusitis

http://www.nytimes.com/ref/health/healthguide/esn-sinusitis-ess.html

http://www.richmondent.com/sinus-allergy/sinusitis/chronic-sinusitis/

http://www.medicinenet.com/sinusitis/article.htm