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Chronic sinusitis

Chronic sinusitis is inflammation of the linings of the sinuses that surround the nose that lasts a long time or keeps coming back. It's caused by anything that constantly or regularly irritates the lining of the nose.

  • About sinusitis
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • Prevention
  • Special considerations
  • Further information
  • Sources
  • Related topics

About sinusitis

What are the sinuses?

The sinuses are air-filled spaces behind the bones of your face that open up into the nose cavity. They are lined with the same membrane as your nose. This is called the mucous membrane and it produces a slimy secretion called mucus to keep the nasal passageways moist and to trap dirt particles and bacteria.

You have four main sets of sinuses.

  • The maxillary sinuses are in each cheekbone.
  • The frontal sinuses are on either side of your forehead, above your eyes.
  • The smaller ethmoid sinuses are behind the bridge of your nose, between your eyes.
  • The sphenoid sinuses are between the upper part of your nose and behind your eyes.

The maxillary sinuses are the largest of the sinuses and the ones most commonly affected by sinusitis.

What is sinusitis?

Sinusitis is inflammation of the mucous membranes of one or more of your sinuses.

Sinusitis lasting anything from a few days up to a month is called acute sinusitis (see Related topics). When it lasts three months or more it's known as chronic sinusitis. The medical terms acute and chronic refer to how long the condition lasts for, rather than how severe it is.

Symptoms

If you have chronic sinusitis, your symptoms may include:

  • pain and pressure in your face, which is worse when you lean forwards
  • a blocked or runny nose with green or yellow mucus, which can drain down the back of your nose into your throat and cause a sore throat and cough
  • a headache when you wake in the morning
  • a reduced sense of smell
  • bad breath (halitosis)

Any pain you may experience will depend on which of your sinuses are affected.

  • Frontal sinusitis can cause pain just above your eyebrows, and your forehead may be tender to touch.
  • Maxillary sinusitis can cause your upper jaw, teeth and cheeks to ache and may be mistaken for toothache.
  • Ethmoid sinusitis can cause pain around your eyes and the sides of your nose.
  • Sphenoid sinusitis can cause pain around your eyes, at the top of your head or in your temples. You may also have earache and neck pain.

Causes

The mucus that is produced by the mucous membranes in your sinuses normally drains into your nose through small holes called ostia. The ostia can become narrow or even blocked if the sinuses get infected and inflamed so the mucus cannot drain properly.

Chronic sinusitis can be caused by anything that constantly or regularly irritates the lining of the nose and so results in inflammation of the mucous membranes. Examples of irritants include:

  • infection from viruses, bacteria or fungi
  • airborne allergens such as grass and tree pollen
  • smoke and air pollution
  • sprays containing chemicals (eg household detergents)
  • nasal decongestants, if overused
  • chronic drug misuse (snorting substances such as cocaine)

People who have allergy-based asthma often have chronic sinusitis as well. There are a number of medical conditions such as cystic fibrosis that can also cause sinusitis.

Any problem with the nose that blocks the drainage holes can cause chronic sinusitis such as a structural blockage resulting from a growth from the membrane (polyp).

Diagnosis

Your GP will ask you about your symptoms and will examine you. He or she may also ask about your medical history.

If you have chronic sinusitis, your GP may refer you to a doctor who specialises in ear, nose and throat conditions for further tests. These may include a nasendoscopy, where your doctor will insert a small, flexible tube with a light and a camera lens at the end (endoscope) into your nostril to examine the inside of the sinuses. He or she will look through this and the image will usually be projected onto a video screen. A nasendoscopy is performed under local anaesthesia. This completely blocks feeling from the sinus area and you will stay awake during the operation.

You may need to have a computerised tomography (CT) scan. A CT scan uses X-rays to build up a three-dimensional picture of your sinuses.

Treatment

Self-help

Home remedies may provide some relief for your symptoms. It may be helpful to gently flush out your nose, using a syringe and a glass of warm water with a teaspoon of salt added. This can dislodge some of the mucus in your nose and sinuses, and bring some relief. An alternative is to use pre-filled squeeze bottles, which are available from a pharmacy.

Some people find that breathing in steam from a bowl of hot (but not boiling) water containing a few drops of menthol oil (eg Olbas oil or Karvol) may provide some relief from the symptoms. However, this is not scientifically proven. Another method is to sit in the bathroom with the hot shower running and inhale steam this way. Some people find that applying a warm compress on the areas of the face that are painful and sleeping with their head and shoulders propped up with pillows provides relief, but there is no scientific evidence that this works.

Medicines

Nasal sprays containing mild steroids such as beclometasone (eg Beconase) are available over-the-counter and on prescription from your GP. This is usually one of the first treatments to try if you have chronic sinusitis. Your GP may also prescribe antibiotics if you have a bacterial infection. Antifungal medicines may be prescribed if chronic sinusitis is caused by a fungus.

If you have chronic sinusitis and an allergy then you may find that controlling your allergy helps to reduce the symptoms of your sinusitis. Antihistamine tablets such as loratadine (eg Clarityn) may help to do this.

If your sinusitis does not get better with these medicines, your GP may prescribe some steroid tablets.

Always read the patient information leaflet that comes with your medicine and ask your pharmacist or doctor for advice.

Surgery

If your chronic sinusitis doesn't get better with home or medical (drug) treatments, you may need surgery.

In functional endoscopic sinus surgery (FESS) the surgeon washes out the sinuses sinuses and widens the drainage holes using an endoscope. This can be done under a local or a general anaesthesia. A general anaesthetic means that you will be asleep throughout the operation.

Other types of surgery can remove nasal polyps or correct an obstruction in the nose that may be the cause of your sinusitis. Ask your doctor for more information about the different types of surgery.

Prevention

There are a number of things you can do to help prevent sinusitis developing such as:

  • taking a short course (usually no longer than seven days) of decongestant medicine when you have a cold
  • keeping your allergy symptoms under control - ask your doctor or pharmacist for advice
  • having a flu vaccination
  • maintaining good general health by eating healthily and taking regular exercise
  • staying well hydrated by drinking plenty of fluids
  • not smoking
  • staying away from smoky environments

Special considerations

If you are flying or diving, the changes in pressure can make the air trapped in your sinuses expand or contract. Usually this just causes increased discomfort, but if you are diving to depth you may be at risk of serious damage. If you are considering going diving, you should always consult your doctor first if you have sinusitis.

Further information

The British Association of Otorhinolaryngologists (ENT-UK)

Sources

  • ENT UK. www.entuk.org, accessed 24 May 2007
  • Clinical Knowledge Summaries. www.cks.library.nhs.uk, February 2006
  • Ah-See K, Evans AS. Sinusitis and its management. BMJ 2007; 334:358-36
  • National Institute of Allergy and Infectious Diseases, National Institute of Health, US department of health and human services. www.niaid.nih.gov, accessed 23 May 2007
  • Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th ed. Oxford: Oxford University Press, 2003
  • Simon C, Everitt H, Kendrick, T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005 (pg 918)
  • Psychostimulant Working Group Report. Scottish Executive, Substance Misuse Division, 2002. www.scotland.gov.uk, accessed 08 June 2007

Related topics

Acute sinusitis

Sinusitis in children