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Sinusitis - chronic

Definition

Chronic sinusitis is inflammation of the air-filled spaces (sinuses) behind the forehead, cheeks, and eyes, which continues for a long time or keeps coming back.

See also: Sinusitis

Alternative Names

Chronic sinus infection; Chronic sinusitis

Causes

The sinuses are openings in the bones around the nose. Four pairs of sinuses connect to small openings in the nose area. Normally, air passes in and out of the sinuses, and mucus and fluid drain from the sinuses into the nose.

Sinusitis is usually due to allergies or infection. When sinusitis keeps coming back or continues for a long period of time, it is considered chronic. Causes of chronic sinusitis include a deviated nasal septum or other blockage of the nose that can trap fluid in a sinus. Dental infections such as tooth abscess may spread into the sinus and also lead to chronic sinusitis. Allergy to the aspergillus species of fungus appears to cause a particularly difficult-to-treat form of chronic sinusitis.

Chronic sinusitis is much less common than acute sinusitis. Acute sinusitis is often associated with upper respiratory infections and is covered in a separate article. (See Acute sinusitis). Chronic sinusitis may produce less severe symptoms than acute sinusitis, but it can cause damage and destruction to the tissues of the sinuses.

Symptoms

Symptoms may last for 3 months or more.

  • Headache (in the front of the head or around the eyes)
  • Facial pain around the eyes or in the forehead or cheeks
  • Pain in the roof of the mouth or teeth
  • Nasal drainage (yellow, yellow-green, thick)
  • Cough

Exams and Tests

The health care provider will examine you and tap lightly on your face over your sinuses. This method is called percussion. It may reveal tenderness in the area.

Normal sinuses glow when light shines directly onto them. (See: Transillumination ). If sinusitis is present, the sinuses will not glow when your doctor shines a light onto them.

Other tests that may be done include:

These imaging tests may show the sinuses to be filled with fluid or reveal thickening of sinus tissues.

A method called aspiration may be done to determine what type of bacteria, if any, is causing the infection.

Treatment

The goal of treatment is to cure the infection and make symptoms go away.

Antibiotics may be given if the infection is caused by bacteria. Antibiotic treatment usually takes 3 to 4 weeks.

Oral decongestants, pills taken by mouth that help relieve a stuffy nose, are sometimes used. Nasal sprays (topical steroids) may help relieve symptoms of chronic sinusitis that are due to allergies.

Over-the-counter analgesics (pain killers) may be used to control pain.

Surgery to clean and drain the sinuses may be needed. Surgical repair of a deviated septum or nasal obstruction may prevent chronic sinusitis from returning.

Outlook (Prognosis)

Chronic sinus infections can usually be cured, but may require extended treatment.

Chronic sinusitis tends to come back, particularly if underlying conditions such as nasal blockages are not corrected.

Possible Complications

  • Chronic sinusitis comes back
  • Infection spreads to the bones of the face (osteomyelitis)
  • Infection spreads to the brain (meningitis)
  • Abscess forms, including (rarely) brain abscess

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms of chronic sinusitis develop. Also call if acute sinusitis symptoms do not improve with treatment.

Prevention

Using decongestants when you have an upper respiratory infection may reduce your risk of developing sinusitis. However, decongestant nasal sprays should only be used for short periods of time, or they can make congestion worse. This is called rebound congestion or rhinitis medicamentosa.


Review Date: 8/8/2006
Reviewed By: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network.
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