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How do Sinus Infections Become Chronic?

Data from the Centers for Disease Control and Prevention (CDC) show that chronic sinusitis is quite common among Americans. In 2018, over 28 million American adults suffered from chronic sinusitis, and this number represents greater than 10% of all the adults in the US. In 2016, sinusitis was the chief reason for more than 4 million doctor’s visits. 

Obviously, chronic sinusitis is a huge problem for many people. But what exactly is chronic sinusitis, and what role do sinus infections play in sinusitis? We will take a deeper look at what constitutes sinusitis, reveal facts about sinus infections, and outline the prevention and treatment of these illnesses.

What is Sinusitis?

Simply put, sinusitis is an inflammation of the sinuses. The sinuses are spaces in the skull near the nose and around the eyes. Normally, sinuses contain only air. However, the sinuses fill with fluid during a case of sinusitis. This change presents an opportunity for infection and causes pain, a sensation of pressure, a runny nose, and multiple other symptoms.

A variety of factors can inflame the sinuses and lead to sinusitis. The causes include allergic rhinitis (inflammation of the nasal lining due to allergies), airborne irritants, structural abnormalities with the nose, and infections from microorganisms. Some people are especially sensitive to airborne irritants, such as environmental pollution and tobacco smoke. These individuals may encounter sinusitis triggered by exposure to automobile exhaust, smog, secondhand smoke, and other substances.

However, microorganism infections are the most common cause of sinusitis, with viral infections being the most frequent culprit. In fact, since infections are the source of so many sinusitis cases, many physicians and healthcare workers use the terms “sinusitis” and “sinus infections” interchangeably. This condition may also be called rhinosinusitis because it causes nasal symptoms as well as sinus problems.

Acute vs. Chronic

In medicine, an acute condition usually lasts for a relatively brief time. Common colds, for example, are typically acute. On the other hand, chronic disease or illness lasts for an extended period. Diabetes mellitus is one example of a chronic condition.

The symptoms of acute sinusitis usually arrive suddenly and resolve within 12 weeks. The limited lifespan of acute sinusitis does not affect the problem’s intensity. Acute sinusitis may feel like it will last forever, but it does eventually clear up. Conversely, the duration of chronic sinusitis is 12 weeks or longer. Chronic sinusitis originates from acute sinusitis, often from repeated episodes of acute sinusitis called recurrent acute sinusitis.

Recurrent acute sinusitis, as well as other problems like nasal polyps, can cause lasting damage to the sinuses. Furthermore, if the sinuses are frequently filled with fluid, they become a breeding ground for infectious viruses and bacteria. Chronic sinusitis can develop as a result of this microorganism growth.

Risk Factors

The risk factors of acute sinusitis are similar to those of chronic sinusitis. These risk factors include the presence of nasal polyps, frequent upper respiratory infections, a deviated nasal septum, or environmental allergies to substances like animal dander and pollen. Additionally, people who have suffered facial or nasal injuries have a higher likelihood of sinusitis than the general population.

Another risk factor for sinusitis is a compromised immune system. This state may results from HIV infections, taking immunosuppressant medications, or chronic disease. To decrease sinusitis risk, the immune system must be able to fight off harmful microorganisms effectively. Other risk factors include prolonged oxygen use for medical conditions and lying in a supine position (on the back) for extended periods. Oxygen administration may dry out and irritate the nasal passages, and lying down for long periods can allow fluid to accumulate in the sinuses.   

Symptoms

The most common sinusitis symptoms are:

Nasal inflammation – The inflammation can manifest as sore, swollen, and red nasal passages. Rhinitis, more commonly called a runny nose, is also a common sign and can cause nasal congestion. The nasal discharge may be colored white, green, or yellow.

Postnasal drainage – Also called postnasal drip, this is the discharge that runs down the back of the throat. Postnasal drainage is often foul-tasting and can cause nausea, frequent coughing, and the need for throat clearing.

Ear pain – Sinusitis may lead to ear pain, pressure, or a sensation of fullness or blockage in the ears.

Facial aching and pain – Pain from sinusitis usually focus on the forehead, cheeks, eyes, upper jaw, and even the teeth. Full body aches are uncommon, but patients may notice pain in the ears and into the neck area.

Sore throat – A sore throat during sinusitis is usually the result of irritation from postnasal drip and coughing. However, a sore throat can also be caused by a concurrent infection, such as strep throat.

Fever – Fever is not a frequent symptom of chronic sinusitis, but fever may be present during cases of acute sinusitis.

Preventing Sinus Infections

There are several simple measures that can effectively inhibit many cases of acute sinusitis, and, in turn, help to avoid chronic sinus infections. Perhaps chief among these is preventing upper respiratory infections. Frequent handwashing and avoidance of sick individuals can go a long way toward infection prevention.

Management of allergy problems is also important for sinus infection prevention. Patients with environmental allergies should work with their healthcare team to avoid allergens and keep their symptoms under control. All patients, whether they have allergies or not, should refrain from smoking and limit their exposure to secondhand smoke whenever possible. People who are particularly sensitive to environmental allergens can also reduce their sinusitis risk by staying indoors on days with high pollen counts or poor air quality. Exposure to mold can also be a sinusitis trigger, so everyone should be on guard against mold problems in their homes and workplaces.

It may seem counterintuitive, but dry air can actually irritate nasal passages and sinus, leading to fluid-filled sinuses. Using air humidifiers can help, especially during cold and dry winter months. However, patients should be careful as humid environments can also breed mold, which can contribute to sinus infections.

Sinus Infection Treatment

Treatment of acute sinusitis may consist of only over-the-counter medications and time off work to recover. These medications may include decongestants, anti-inflammatory drugs like acetaminophen, and saline nasal sprays and rinses to soothe the nasal passages and keep them moist. Many patients with acute sinusitis do not need to visit their doctors. However, persistent or recurrent symptoms may mean a larger problem is at hand, and the development of a fever is a reason to schedule a doctor’s appointment immediately.

Recurrent acute sinusitis or chronic sinusitis usually indicates an underlying problem. Patients suffering from these conditions may have a deviated nasal septum, an immune system issue, or sinus obstruction. Ear, nose, and throat specialists (ENTs) and other physicians usually first try prescription medications, such as steroids and/or antibiotics, to resolve the issue. However, a doctor may forgo these measures if they suspect the sinus infection is due to another cause.

Tests to determine the origin of sinusitis can include MRI scans or x-rays of the sinuses, allergy testing, and cultures of nasal discharge or sinus fluid to identify harmful microorganisms. ENTs may also perform a sinuscopy where they pass a tiny scope into the sinuses to inspect their condition.

Unfortunately, approximately 20% of chronic sinusitis cases do not respond to medication and saline rinse therapies. These patients usually have sinuses that cannot freely drain because the passages are blocked by tissue or bone. Older treatment for this condition consisted of invasive sinus surgery where the ENT surgeon would shave excess tissue from the sinuses, opening them so that they could drain. This surgery generally has a recovery time of at least three to five days and can leave scarring in the sinus cavities.

Newer Treatment

However, a more attractive alternative to traditional sinus surgery is now available. Called balloon sinuplasty, the Food and Drug Administration (FDA) approved this treatment for chronic sinusitis in 2005. Balloon sinuplasty is much less invasive than traditional sinus surgery and results in less bleeding and an average of just two days off work. It is an outpatient procedure, meaning it does not require hospital admission and can be performed in an ENT’s office or hospital outpatient surgery center.

During balloon sinuplasty, the ENT guides a small catheter containing a balloon through the nose to the sinuses. They then gradually inflate the balloon, gently enlarging the sinuses so that they can drain. Studies have shown that the number of positive outcomes from balloon sinuplasty meets or exceeds those from traditional sinus surgery. Balloon sinuplasty is generally non-traumatic and does not cause nearly as much bleeding or scarring as older sinus surgery techniques.

Balloon sinuplasty may be available without general anesthesia, using only local anesthetic. The vast majority of patients who undergo balloon sinuplasty experience results that last an average of nine months to two years. The procedure requires evaluation prior to evaluation by an ENT, and the outcomes can be incredibly beneficial for patients who struggle with chronic sinusitis and want a minimally-invasive solution.