Generality
Chronic sinusitis, or rhinosinusitis, is the persistent and slowly progressive inflammation of the paranasal sinuses.
To consider it chronic, a sinusitis must have a minimum duration of 12 weeks.
The main causes include: nasal polyps, deviations of the nasal septum, facial trauma and allergies.
The most appropriate treatment planning takes place only after an accurate diagnosis and identification of the triggering causes.
Brief reminder of what paranasal sinuses are
The paranasal sinuses are 4 pairs of cavities filled with air, with seat inside the cheeks and forehead and resulting from the particular arrangement of the ethmoid cranial bones (ethmoid sinuses), sphenoid (sphenoid sinuses), frontal (frontal sinuses) and maxilla (maxillary sinuses).
They perform different functions:
- Improve the perception of odors;
- They amplify the sounds and the voice, acting as a sounding board;
- They make the skull less heavy as a whole;
- They humidify, heat and purify the inspired air. The purification action takes place thanks to a layer of mucus and cilia that resides on the inner surface of the paranasal sinuses.
What is chronic sinusitis?
Chronic sinusitis is the persistent and gradual appearance of one or more of the paranasal sinuses.
Also known as rhinosinusitis, chronic sinusitis generally has a minimum duration of 12 weeks.
Its presence interferes with the drainage of the mucus present inside the paranasal sinuses; the absence of adequate drainage of the paranasal mucus leads to an abnormal accumulation of the latter and is a factor favoring the growth of pathogenic agents, especially of the bacterial type.
Chronic sinusitis is uncommon.
CHRONIC SINUSITIS AND ACUTE SINUSITIS
Chronic sinusitis is opposed to acute sinusitis .
Doctors call the sinusitis acute inflammation of the paranasal sinuses with rapid appearance and canonical duration of 2-3 weeks (rarely exceeding 30 days).
A common condition in the general population, acute sinusitis can evolve and take on the characteristics of chronic sinusitis.
According to several clinical investigations, most patients with chronic sinusitis have a previous history of acute sinusitis.
Causes
The potential causes of chronic sinusitis are numerous.
The possible conditions that can inflam the sinuses include:
- Nasal polyps . They are soft benign, multiple or solitary tumor growths, which can grow along the nasal cavities or inside the paranasal sinuses. Their presence can represent an obstacle for the passage of air;
- Allergic diseases, such as allergic rhinitis or hay fever . The presence of these conditions can cause swelling of the tissues constituting the paranasal sinuses. When inflated, these tissues are an obstacle to the passage of air and represent a factor favoring infectious processes;
- The presence of the deviated nasal septum . The doctors talk about a deviated nasal septum, when the osteo-cartilaginous lamina interposed between the two nasal cavities undergoes a deviation to the right or to the left. In several people, this deviation restricts the channel of the affected nostril, reducing the flow of air through it;
- The facial traumas that involve the rupture of one or more of the bony elements that make up the paranasal sinuses;
- Respiratory tract infections . The most common respiratory tract infections that can cause chronic sinusitis are colds, flu and flu-like syndromes. These infections are responsible for an inflammatory process that affects the mucous layer of the paranasal sinuses, and represent ideal conditions for the growth of bacterial agents;
- Medical conditions of some clinical relevance, such as cystic fibrosis, gastroesophageal reflux, AIDS, asthma or autoimmune diseases that obstruct the paranasal cavities (eg: Wegener's granulomatosis or sarcoidosis);
- Dental infections, which have spread to the maxillary bones of the skull and have induced an inflammatory process on the maxillary sinuses;
- A lowering of the immune system . It is a circumstance that can take place, for example, in old age or during a chemotherapy treatment for the treatment of a neoplasm.
RISK FACTORS
People with congenital deformations of the nasal septum, smokers, citizens of highly polluted city centers, diabetics, those who sniff narcotics such as cocaine, individuals suffering from so-called primitive ciliary dyskinesia (or syndrome of Kartagener), as well as all the carriers of one of the aforementioned causes of chronic sinusitis (therefore, subjects with nasal polyps, cystic fibrosis, AIDS, etc.).
Symptoms and Complications
The classic symptoms and signs of chronic sinusitis consist of:
- Nasal obstruction and / or congestion. These two conditions cause breathing difficulties, as the air struggles to pass through the nasal cavities;
- Reduced sense of smell and taste;
- Pain, soreness and swelling around the eyes, at the level of the cheeks, in correspondence of the nose or of the forehead;
- Discharges of thick, yellow mucus or tending to green, from the nose or towards the throat.
Sometimes, the presence of: can complete the symptomatological picture of chronic sinusitis:
- Ear pain;
- Discomfort in the upper jaw or dental arch;
- Cough, especially during the night (nocturnal cough);
- Sore throat;
- Halitosis;
- Fatigue;
- Irritability;
- Nausea.
The symptomatology of chronic sinusitis is very similar to the symptomatology of acute sinusitis. The only difference lies in the duration and in the fact that acute sinusitis is often also associated with a feverish state.
COMPLICATIONS
Chronic sinusitis can give rise to several complications.
The most significant complications from the clinical point of view consist of asthma attacks and development of infectious states, from which the appearance of meningitis, vision problems and blood clots or aneurysms may depend, inside the blood vessels that supply the breasts paranasal.
WHEN TO REFER TO THE DOCTOR?
It is good for an individual to contact a doctor who specializes in treating ear, nasal cavity, throat problems etc. (otolaryngologist), when the symptoms defined as typical of chronic sinusitis last for more than 4 weeks.
Important note: Chronic sinusitis deserves an immediate medical consultation when it is responsible for a symptomatic picture that includes: pain around the eyes, cheeks and / or forehead, severe headache, confusion, double vision, changes in vision, rigidity of neck and / or respiratory problems. The symptoms mentioned above are characteristic of the complications of chronic sinusitis.
Diagnosis
An accurate physical examination and a careful medical history are often sufficient for a diagnosis of chronic sinusitis.
However, in some circumstances and to better understand the triggering causes, doctors may consider it essential to subject the patient to more specific diagnostic tests, including: a nasal endoscopy, a CT scan or a nuclear magnetic resonance (NMR) of the nasal area, culture tests on the mucus of the nasal cavities and paranasal sinuses and an allergy test.
OBJECTIVE AND ANAMNESIS EXAMINATION
The physical examination is the set of diagnostic maneuvers, carried out by the doctor, to verify the presence or absence, in the patient, of signs indicative of an abnormal condition.
In the specific case, when faced with a suspected condition of chronic sinusitis, the doctor observes the nasal cavities (using an instrument suitable for the purpose), to see if they show signs of inflammation, obstructive elements, etc.
The anamnesis is the collection and critical study of symptoms and facts of medical interest, reported by the patient or his family members (NB: family members are involved, above all, when the patient is very small).
NASAL ENDOSCOPY
Nasal endoscopy, or rhinoscopy, consists in the introduction, in the nasal cavities, of an instrument equipped with a camera and light, and in the detailed observation, through the aforementioned instrument, of the paranasal sinuses.
TAC AND NUCLEAR MAGNETIC RESONANCE
The CT and the NMR of the nasal area make it possible to identify any areas of obstruction and inflammation.
They are very precise tests, as they provide very detailed images of the organs placed under observation.
They are both painless, but, while the MRI does not expose the patient to any substance or radiation harmful to health, the TAC involves the exposure of the person under examination to a certain dose of harmful ionizing radiation.
Treatment
In general, the treatment of chronic sinusitis involves a therapy aimed at treating the causes ( causal therapy ), an anti-inflammatory therapy aimed at mitigating the symptoms and preventing complications ( symptomatic therapy ) and a therapy aimed at improving mucus drainage from the paranasal sinuses.
If the drainage therapy is ineffective or does not give the desired results, the conditions exist for practicing a specific surgical procedure, whose purpose is to favor the passage (and therefore also the elimination) of the mucus through the nasal cavities and the paranasal sinuses.
The administration of antibiotics ( antibiotic therapy ) is reserved only for patients with a demonstrated bacterial infection in the paranasal sinuses. Bacterial infections, following chronic sinusitis, are less frequent than believed; therefore the use of antibiotic therapy is also rare.
Finally, it is important to remember the benefits that can derive from some natural remedies and other precautions (such as sleeping with the head raised): these solutions increase the efficiency of the aforementioned therapies and can positively influence healing times.
SYMPTOMATIC THERAPY
The symptomatic treatments, applied in the case of chronic sinusitis, consist of:
- Decongestants . They are medicines indicated in the presence of nasal obstruction or congestion; therefore, they favor the release of the nose and the passage of air through the nasal and paranasal cavities.
They exist in the form of liquids, nasal sprays and tablets.
Examples of decongestants are: pseudoephedrine and oximetazoline.
Generally, the intake of these medicines should not exceed 5-7 consecutive days. A prolonged intake, in fact, has effects opposite to those for which decongestants are used: in these situations, one also speaks of "rebound congestion".
- Anti-inflammatories and painkillers, such as paracetamol, aspirin and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
- Nasal irrigation with saline solutions . Carried out by special syringes or spray bottles, they have the effect of rinsing the nasal and paranasal cavities, limiting the amount of obstructions.
- Corticosteroids for nasal application . Regardless of the mode of administration, all corticosteroids are very effective anti-inflammatory drugs.
Nasal corticosteroids are applied by spray bottles and are intended to mitigate and prevent inflammation of the paranasal sinuses.
Examples of nasal corticosteroids are: fluticasone, budesonide, triamcinolone, mometasone and beclometasone.
- Oral or injectable corticosteroids . Doctors prescribe them when the inflammation, induced by chronic sinusitis, is very severe.
Oral corticosteroids and injectable corticosteroids find particular use in the presence of chronic sinusitis associated with nasal polyps.
Examples of oral or injectable corticosteroids are: prednisone and methylprednisolone.
It is important to warn readers that oral administration corticosteroids have several serious side effects.
SURGICAL THERAPY
Surgical treatment for chronic sinusitis is an operation that is called functional endoscopic surgery of the paranasal sinuses or FESS .
Endoscopic paranasal sinus surgery involves the use of the endoscope, a tubular and flexible instrument, equipped with a light and a camera at one end, and connected to a monitor.
Inserted into the nose, the end of the endoscope equipped with a camera and light allows you to view the inside of the nasal and paranasal cavities and to eliminate what prevents the passage of air.
There are two potential benefits of FESS:
- Restore a normal air flow through the nasal cavities;
- Promote mucus drainage, accumulated due to chronic sinusitis.
FESS is a minimally invasive operation.
Recently, doctors have developed a new surgical technique, an alternative to FESS.
This is the so-called paranasal sinus dilation with a balloon .
Briefly, the expansion of the paranasal sinuses with a balloon consists in the insertion in the nasal and paranasal cavities of an inflatable balloon, the inflation of which allows to widen the aforementioned cavities and eliminate any obstructions.
The balloon is inserted by means of a catheter; once the nasal and paranasal cavities are free, the surgeon deflates the balloon and extracts it.
NATURAL REMEDIES AND OTHER TIPS
To speed healing and make the pharmacological treatments have a better effect, doctors advise the person with chronic sinusitis to:
- Stay at rest . A period of time allows the body to fight the present inflammation better and more quickly. Thus, healing is faster;
- Drink lots of fluids, especially water . Water intake dilutes mucous secretions, favoring drainage from the nasal and paranasal cavities. Caffeinated beverages and alcohol should be avoided; alcohol in particular could worsen the swelling of the paranasal sinuses;
- Hydrate the paranasal sinuses . The most effective method to hydrate the paranasal sinuses is to aspirate the vapors emitted from a bowl filled with hot water. In these circumstances, the best results are obtained by applying a towel to the head.
An alternative to putting your face on a bowl full of water is to take a hot shower for several minutes, so that a fair amount of steam circulates in the room.
The hydration of the paranasal sinuses reduces the painful sensation and promotes mucus drainage;
- Apply warm compresses to the face, in this case around the nose, cheeks and eyes. It helps in reducing the painful sensation;
- Sleep with your head raised . This position of the head favors the drainage of the mucus, reducing the state of congestion / nasal obstruction;
- Stop smoking at least temporarily, if you are obviously a smoker.
Prognosis
In the case of chronic sinusitis, the prognosis depends mainly on two factors: the triggering causes and the time when the therapies begin.
If the triggering causes are clinically very important, recovery times become longer and there are greater chances that complications appear.
As far as the beginning of the therapies is concerned, a timely cure allows to speed up the healing time.
Prevention
Avoid contact with people suffering from any upper respiratory tract infection (so as not to contract the same ailment), adequately control any allergic pathologies, avoid smoking, avoid particularly polluted places and provide for the humidification of the air present in the particularly dry environments are the main preventive measures, which doctors suggest regarding the reduction of the risk of chronic sinusitis.
