Chronic sinusitis

Sinusitis is a common consequence of cold and flu season, but what do you do when it just won't go away? Acute sinusitis is generally caused by a bacterial infection after a cold and can last for up to 3 weeks. Chronic sinusitis, on the other hand, can last for months or even years.

Up to 10% of Australians suffer from this common yet complex condition.¹ If you're among them, you'll know how persistent it can be, and how difficult it is to manage. While a complete cure for chronic sinusitis is unlikely, some treatments can significantly reduce symptoms and improve your quality of life.

Chronic rhinosinusitis (CRS), also known as chronic sinusitis, is a persistent inflammation of the sinus passages that lasts for more than 3 months. The swelling stops the mucus from draining away, resulting in a stuffy nose that's hard to breathe through.

Sometimes it's accompanied by growths in the sinuses (called nasal polyps) or infection.

The cause of chronic sinusitis is often not known, but it can be aggravated by allergens, infections and cigarette smoke.

"Chronic sinusitis comes in 2 distinct forms," says Professor Richard Harvey of the Australian Society of Otolaryngology, Head and Neck Surgery (ASOHNS), the representative organisation for ear, nose and throat surgeons in Australia.

"Firstly, there's localised CRS, where the chronic inflammation is confined to one group of sinuses. This might be caused by an infected tooth, for example. Then there is diffuse CRS, where the inflammation occurs in all the sinuses, on both sides of the face. This is an inflammatory process similar to asthma or psoriasis."

While the main symptom of chronic sinusitis is congestion in the nose, there's far more to it than that.

"Localised CRS produces local pressure, discharge, and dysfunction on one side of the face," says Prof Harvey. "Diffuse CRS is associated with mucus, congestion, loss of smell, pressure, tiredness and lower airway disease such as asthma."

Other symptoms may include ear pain, headache, toothache, cough, sore throat and bad breath. As the weeks and months go by, the discomfort and stress may start to take a toll on your mental health. Various studies have found that patients with chronic sinusitis were more likely to experience symptoms of anxiety and depression.²

Your first port of call is your GP. They will be able to determine whether your symptoms are indeed due to diffuse CRS (sinus inflammation), or chronic rhinitis (such as hay fever) due to allergies.

Treatment for CRS typically involves a combination of medical management, including corticosteroid nasal sprays or tablets, saline nasal rinses, antibiotics and, in some cases, surgical intervention.³

"Symptoms should be investigated with a CT scan of the sinuses, and having an ear, nose and throat (ENT) surgeon assess the patient early," says Richard.

The ENT doctor will then have an accurate view of what's happening inside your sinuses and formulate a treatment plan.

"Surgery is ideal for localised CRS when medical therapy fails," says Prof Harvey. "It should be considered early and is usually curative.

"In cases of diffuse CRS, however, where the problem is not one of a mechanical blockage, surgery won't change the underlying condition."

Surgery may be recommended to remove polyps and improve sinus ventilation and drainage, but ongoing medical management is what will treat the actual condition.

While acute sinusitis will often resolve itself without treatment, chronic rhinosinusitis will not improve on its own in most cases.

"Diffuse CRS, like asthma, is classically active for many years," says Prof Harvey. "Most patients who have adult-onset diffuse CRS need to actively treat it for many years."

"As with other inflammatory conditions such as asthma, psoriasis or inflammatory arthritis, the disease can be pushed into 'remission', however, whereby patients can be symptom-free," he says.

"With the right holistic treatment strategy, most patients can have a normal sinus cavity and live a normal life."

The Australian Society of Otolaryngology, Head and Neck Surgery (ASOHNS) is the representative organisation for ear, nose and throat surgeons in Australia. Once you have a referral from your doctor, you can use their website to help you find a surgeon in your area.

The Australasian Society of Clinical Immunology and Allergy (ASCIA) offers information and support for Australians and New Zealanders living with allergies, providing medical practice, training, education and research.