Rhinosinusitis, more commonly called sinusitis, is inflammation of the sinuses. Sinuses are hollow areas in the bones of the face and head that are connected to the nose through small narrow channels. When they get blocked or filled up with fluid, viruses or bacteria may cause infection.

There are two types: acute sinusitis which lasts for less than four weeks and chronic sinusitis which is present for more than three months.

Chronic sinusitis is different from the more common form of rhinosinusitis (called acute sinusitis), which is a temporary infection of the sinuses that often occurs following colds. Chronic rhinosinusitis is a more persistent problem that requires a specific treatment approach.

If you have been treated for sinusitis with antibiotics multiple times within a single year, or if you have two or more of the symptoms listed below much of the year, talk to your ENT doctor about whether you might have chronic rhinosinusitis

Chronic rhinosinusitis often has more complicated and elusive causes, unlike acute rhinosinusitis, which is usually caused by infection. Infections can certainly contribute to or worsen chronic rhinosinusitis, but people with the chronic condition usually have longstanding inflammation that cannot be explained by infection alone.

Chronic sinusitis is divided into three categories depending on the features present.

Chronic sinusitis without polyps-this is the more common entity and is caused by allergies, air irritants or pollutants and infection.
Chronic sinusitis with polyps-polyps are abnormal growths in the nose and sinuses which may block and clog the sinuses. Treatment involves medication to shrink them or surgery to remove the polyps.
Allergic fungal sinusitis-strong allergic responses to airborne fungal spores causes the sinuse lining to produce thick dense mucus which blocks up the sinus causing symptoms

Chronic sinusitis lasts for 12 weeks or more despite been treated and is characterized by:

1- Nasal congestion or blockage
2- Thick yellow or green discharge from the nose
3- Mucus dripping down the throat from the back of the nose (post nasal drip)
4- Facial pain/pressure/fullness made worse on bending forward
5- Reduced smell or lack of smell

SNOT 22 is a self-administered questionnaire that gives us insight into the diagnosis of chronic sinusitis

There are several factors that increase the risk of getting chronic sinusitis or making it worse:

1- Allergies
2- Smoking or exposure to smoke
3- Airborne irritants
4- Immune system disorders
5- Viral infections
6- Structural abnormalities in the nose e.g deviated nasal septum
7- Asthma
8- Asprin intolerance

The ENT doctor can diagnose chronic sinusitis from the classic symptoms elicited in the history, a physical examination of the nose, endoscopic evaluation of the interior of the nose and CT scan or rarely MRI images of the nose and sinuses

Because chronic sinusitis is caused more by inflammation than infection, the treatments for chronic sinusitis are meant to control the inflammation.

Lifestyle modification-this is by stopping smoking or exposure to harmful airborne irritants.

Allergy avoidance and/or treatment- if they are a contributing factor, control of allergies markedly improve chronic sinusitis.

Daily nasal washing-flushing the nose with saline (salt water) removes allergen particles, clears debris, reduces mucus and alleviates symptoms.

Nasal steroid sprays or drops- this aim to reduce the swelling and inflammation within the nose and sinuses and shrink any polyp. Correct administration is key to efficacy of nasal sprays.

Oral steroids- This can result in better treatment of the inflammation and more dramatic improvement in symptoms. However, glucocorticoids taken by mouth suppress normal immune responses throughout the body and can cause side effects.

Antibiotics-although infection is not the main cause of chronic sinusitis, sinus infection may develop and make it worse. Prolonged periods of antibiotics are not uncommon.

Leukotriene modifiers- this new molecule works by reducing inflammation in a different way than glucocorticoids.

Surgery-sinus surgery is required if medical treatment has failed, severe allergic fungal sinusitis or polyps not sufficiently shrunk by steroids. It aims at opening up the passageways into the sinuses and removing the trapped mucus or polyps

Surgery for the sinuses is done when the symptoms can’t be controlled with medications and other treatments. The most common type of surgery for the sinuses is called Functional Endoscopic Sinus Surgery (FESS), because a pencil-sized scope (“endoscope”) is used to see inside the nose and sinuses and guide the surgery. The purpose of the surgery is to widen the natural drainage pathways between the sinuses and the nose, allowing mucus to get out of the sinuses and air to get in. Medications that are delivered to the surface of the nose and sinuses, like sprays and irrigations, can get into the sinuses better after surgery as well.

FESS does not directly treat the underlying inflammation, sinus surgery MUST be followed by medical management to control inflammation, or symptoms will invariably return