Could it be Chronic sinusitis?
What are the sinuses?
Sinuses are air-filled cavities covered by a mucosal layer and located within the bones of your face and skull.
The nose and sinuses are important for filtering, heating and moistening the air you breathe through your nose, which is an important function that protects your lungs. Sinus cavities may also contribute to voice resonance and can absorb energy to protect the brain from trauma.
Acute or chronic sinusitis?
Sinus diseases can be split into two categories: acute (rapid onset) or chronic (over a long period of time). Acute sinusitis is the most common form, and is characterized by a short infection or inflammation of the sinonasal mucosa, which resolves quickly after 1-2 weeks. On the other hand, chronic sinusitis symptoms last for more than 12 weeks.
Types of chronic sinusitis
Chronic sinusitis (also called chronic rhinosinusitis) is a broad diagnosis that includes different disease subtypes, further classified based on the presence of nasal polyps:
Chronic rhinosinusitis with nasal polyps (CRSwNP)
Chronic rhinosinusitis without nasal polyps (CRSsNP)
Causes of chronic sinusitis
Although not fully understood, chronic rhinosinusitis is usually
caused by a combination of different factors that contribute to
the development of the disease. It occurs due to a malfunction
interaction between individual patient characteristics
(including genes) and environmental factors.
Chronic sinusitis can arise due to:
Immune system disorders
Allergic reaction to airborne antigens or to substances produced by certain bacteria and fungi
Inhalation of small particles like cigarette smoke or pollutants
Symptoms of chronic sinusitis
Chronic sinusitis (or chronic rhinosinusitis) is characterized by the presence of two or more of the following key symptoms for at least 12 consecutive weeks, one of which should be either:
Nasal blockage; to have difficulty breathing through your nose
Runny nose; discoloured and thick discharge from the nose or down into the throat
This can be with or without:
Reduction of smell
Some patients may also experience ear or teeth pain, bad breath, sore throat, irritability, and/or lack of energy.
Diagnosis of chronic sinusitis
Chronic sinusitis is diagnosed based on the presence of the above key symptoms, and confirmed by either:
Nasal endoscopy; looking with a camera inside the nose
CT scan; a computed tomography scan
Chronic sinusitis is a broad diagnosis that includes different subtypes of inflammatory disease, further classified based on the presence of nasal polyps. Other tests might be performed, such as smell test, sinus cultures and/or allergy tests.
Medications for chronic sinusitis
Chronic sinusitis is a broad diagnosis further classified based on the presence of nasal polyps. Depending on the subtype, the underlying cause, and the extent of disease, your doctor may use different therapeutic approaches to treat your chronic rhinosinusitis.
The use of medication represents the first-line treatment, and
Surgery is recommended as second-line treatment when medications fail to control symptoms.
Nasal saline irrigation
Saline rinsing (or douching) provides symptomatic relief by washing the nasal cavities, removing secretions, and rinsing allergens and irritants. The use of nasal rinsing with saline prior to administration of other nasal medications enables the medication to effectively reach the inner lining of the nasal mucosa.
Corticosteroid nasal sprays (or topical steroid) are generally prescribed to reduce the inflammation by altering the actions of cells from your immune system. Common generic names of corticosteroids include fluticasone, mometasone, prednisone and triamcinolone. If polyps are present, corticosteroid treatment may shrink them.
If a nasal corticosteroid is not effective, corticosteroid may be prescribed orally. Because oral corticosteroids can cause important side effects, they are generally taken only for a limited period of time. Side effects may include osteoporosis, hypertension, diabetes, weight gain, and eye disorders, among others.
If allergies cause to worsen your sinusitis symptoms, antihistamines may be prescribed to reduce the inflammation. In addition, it is recommended to avoid allergens to further reduce your sinusitis symptoms.
Oral antibiotics may be prescribed in case of chronic and recurring infection of your sinuses. Certain antibiotics, such as macrolides and tetracyclines, have anti-inflammatory properties and further help reducing the inflammation.
Biologicals drugs are novel molecules which are currently being tested in patients with chronic rhinosinusitis with nasal polyps. Although not available yet, these drugs may be efficient to shrink and eliminate nasal polyps without surgery.
Surgery will be suggested by your doctor when maximal medical treatment has failed. By maximal medical treatment, we refer to different and adequate types of therapy, with medications that have proved their efficacy during large clinical trials.
The standard surgical procedure for chronic rhinosinusitis is Functional Endoscopic Sinus Surgery. The aim for every patient who gets operated for chronic rhinosinusitis is to remove the disease in key areas, to restore adequate aeration and drainage of the sinuses, to remove nasal polyps if present, and overall to protect normal nasal functioning.
When should sinus surgery be considered?
If the medical treatments prescribed by your doctor fail to control your symptoms, sinus surgery may be suggested.
How does sinus surgery work?
The standard procedure for chronic rhinosinusitis is Functional Endoscopic Sinus Surgery (FESS). The goal for every patient undergoing sinus surgery is to remove the disease in key areas, to restore adequate aeration and drainage of the sinuses, to remove nasal polyps if present, and to restore normal nasal functioning.
The surgeon will insert a small tube with a tiny camera into the nostrils and guide it into the sinus cavities. The diseased tissues will be removed using additional instruments. During the operation, the surgeon may also remove the disease in key areas in order to restore adequate aeration and drainage of the sinuses. Endoscopic surgery is usually performed as an outpatient procedure.
Benefits of surgery
Sinus surgery offers a significant improvement of patient's quality of life. In particular, sinus surgery will relieve most of the symptoms that are attributable to chronic sinusitis such as nose obstruction, runny nose, nasal secretions in the throat, and facial pain. The effects of surgery on reduced smell vary strongly between patients and depend on the extent of the disease. Surgery is also expected to improve patient's sleep quality, work performance and daytime fatigue.
Risks & complications of surgery
Sinus surgery is a challenging procedure and despite the availability of new instrumentation, complications during surgery may still occur. The major complications include bleeding, intracranial injury (inside the skull), and visual disturbances. Examples of minor complications include effusion of blood around the eye ('blue eye') or redness of the skin around the eye, watery eyes, scar formation inside the nose and persistence of the disease.
Symptoms recurrence after sinus surgery
In approximately 20% of patients undergoing surgery, symptoms will recur. Poorer surgical outcomes were shown in patients with:
Sinusitis where the upper (frontal) sinuses are affected
Aspirin-exacerbated respiratory disease (AERD)
Exposure to occupational agents
Best post-operative care
The best post-operative care after a sinus surgery is intensive and frequent rinsing of the nose and sinuses with large amounts of saline water and (re-)starting your nasal medication, for instance nasal corticosteroid sprays. You will also see your ENT doctor more frequently during the first weeks to months after sinus surgery. These extra visits are used for cleaning your nose and sinuses for example of blood crusts and giving extra care if necessary.
What to expect and when to visit...
the general practitioner
A "common cold" should resolve within one to maximum two weeks. Chronic symptoms of the nose and sinuses last longer than that and if the symptoms do not resolve completely after 1-2 weeks or if there is an transient improvement and subsequent worsening the patient is advised to see a general practitioner.
the ENT (ear-nose-throat) doctor
Chronic sinusitis is primarily treated by the primary care physician who usually advices nasal rinsing with saline and prescribes a nasal corticosteroid spray. If the disease is not controlled the patient can be referred to an ear-nose-throat (ENT)-doctor. Not controlled means that with the applied treatment the patients still has symptoms and impairment of quality of life. In unclear cases and thus unclear diagnosis of chronic sinusitis by the primary care physician the patient can also be referred to an ENT doctor.
Pharmacists are also members of the multidisciplinary team that can offer help in treating chronic sinusitis. They have knowledge about different drugs and can give useful advices on how to use nasal sprays. Some pharmacists can also advice you on how to perform nasal rinsing with salt water. The pharmacist will also stress the fact that a consequent use of nasal sprays with corticosteroids is essential to achieve the maximal benefit from this drug.
Additionally, counselling about the temporal effects of nasal sprays with corticosteroids can also be giving by the pharmacist. Patients should know that it might take some days before they start to notice the beneficial effects of nasal sprays with corticosteroids and that the effect is not instantly like for example with decongestive sprays. However, to make a proper diagnosis and to get the follow-up needed, you must also see a doctor and ideally an ear-nose-throat (ENT)-doctor.