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Chronic Sinusitis Overview

Chronic sinusitis (CRS) occurs when your sinuses (empty cavities in nose and around it) are swollen and inflamed for more than 3 months as diagnosed by a qualified physician, an ear, nose, and throat (ENT) doctor. Chronic and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold.

CRS is a very common chronic inflammatory condition that interferes with the way mucus normally drains and makes your nose continually stuffy. Breathing through the nose may be difficult, you may feel pressure on and off inside your nose. Mucus may appear thick and/or yellowish. You may keep blowing your nose in a kleenex. In the morning, you may experience more thick yellow mucus and perhaps dried.

CRS can be brought on by allergies, chronic infection, growths in the sinuses (nasal polyps) and swelling of the lining of your sinuses. CRS is also referred to as chronic rhinosinusitis, allergic rhinitis or allergic sinusitis. CRS can affect both adults and children. But for the most part, adults over 40 years of age are affected when otherwise free of asthma or cystic fibrosis.

Symptoms

Common signs and symptoms of chronic sinusitis include:

  • Nasal inflammation, swelling, redness on the nasal sinus lining
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Thick, discolored or yellow discharge from the nose
  • Dried yellow mucus in the morning
  • Breathing through the mouth consequent to nasal obstruction
  • Drainage down the back of the throat
  • Blowing you nose frequently
  • Feelings of pressure around your nose, eyes, cheeks or forehead
  • Absent or reduced sense of smell
  • Exacerbated CRS symptoms when drinking alcohol and red wine

Other possible signs and symptoms can include:

  • Ear pain
  • Aching in your upper jaw and teeth
  • Cough or throat clearing
  • Sore throat
  • Bad breath
  • Fatigue

Causes and risk factors

CRS is said to be a multifactorial disease. The exact root cause of CRS remains to be identified.

  • Nasal polyps. These tissue growths can block the nasal passages or sinuses.
  • Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages, making the symptoms of sinusitis worse.
  • Respiratory tract infections. Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
  • Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.
  • Asthma
  • Other medical conditions. The complications of conditions such as cystic fibrosis, HIV and other immune system-related diseases can lead to nasal blockage.
  • Aspirin sensitivity
  • A dental infection
  • An immune system disorder such as HIV/AIDS or cystic fibrosis
  • A history of allergies: pollen, dust, dust mites and/or hay fever, etc.
  • Regular exposure to pollutants and vitiated air, such as cigarette smoke

Complications

Serious complications of chronic sinusitis complications are rare, but may include:

  • Infections. Uncommonly, people with chronic sinusitis may develop inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis), an infection in the bones, or a serious skin infection.
  • Vision problems. If your sinus infection spreads to your eye socket, it can cause reduced vision or possibly blindness that can be permanent.
  • Anosmia. Complete loss of smell.

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 meals.
  • Manage your allergies. Work with your doctor to keep symptoms under control. Avoid exposure to things you’re allergic to whenever possible. Antihistamines typically have no effect on CRS.
  • Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.

CRS with Nasal Polyps (CRSwNP) and without Nasal Polyps (CRSsNP) Subtypes

Nasal polyps are outgrowth inside sinuses. They are discussed in further detail here.

The most frequent complaints in cases of CRSwNP are nasal obstruction in 96.5% of people, disturbed smelling/tasting in 90.3% and the necessity of blowing the nose in 79.8%. Furthermore, a runny nose (69.6%), viscous nasal secretion (66.6%), and otalgia (17.1%) were major complaints.

In cases of CRSsNP, nasal obstruction is also the key symptom. More rarely, smelling/tasting disorders (75.5%), fatigue after waking up (69.7%), facial pains (69.7%), and posterior rhinorrhea (67.8%) were observed. Otalgia (35.3%) was reported more frequently than in CRSwNP.

Eosinophilic or Non-Eosinophilic CRS

Refer to nasal polyps.

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