| Sinus
infection that persists more than eight weeks is referred
to as chronic sinusitis. It may follow an acute sinus infection
that fails to clear completely with treatment. Another common
situation is a patient who has recurrent bouts of sinusitis.
If you have more than four episodes of sinusitis per year,
it is termed chronic sinusitis.
Additionally, if you seem to have sinus symptoms
for many months and even years, this too is chronic sinusitis.
People who have chronic sinusitis need further evaluation
and treatment in order to avoid future flare-ups and improve
their quality of life.
Chronic sinusitis is a complicated spectrum
of diseases that share chronic inflammation of the sinuses
in common. The causes are multifactorial and may include allergy,
environmental factors such as dust or pollution, bacterial
infection, and/or fungus (either allergic, infective or reactive).
Symptoms include: Nasal congestion; facial
pain; headache; fever; general malaise; thick green or yellow
discharge; feeling of facial 'fullness' worsening on bending
over; aching teeth.
Attempts have been made to provide a more
consistent nomenclature for subtypes of chronic sinusitis.
Recent studies which have sought to further
determine and characterize a common pathologic progression
of disease have resulted in an expansion of proposed subtypes.
Many patients have demonstrated the presence of eosinophils
in the mucous lining of the nose and paranasal sinuses.
As such the name Eosinophilic Mucin RhinoSinusitis
(EMRS) has come into being. Cases of EMRS may be related to
an allergic response, but allergy is often not documentable,
resulting in further subcategorization of allergic and non-allergic
EMRS.
A more recent, and still debated, development
in chronic sinusitis is the role that fungus may play. Fungus
can be found in the nasal cavities and sinuses of most patients
with sinusitis, but can also be found in healthy people as
well. It remains unclear if fungus is a definite factor in
the development of chronic sinusitis and if it is, what the
difference may be between those who develop the disease and
those who do not.
Allergies are frequently associated with chronic
sinusitis. People with asthma have a particularly high frequency
of chronic sinusitis. Inhalation of airborne allergens (substances
that provoke an allergic reaction), such as dust, mold, and
pollen, often set off allergic reactions. Allergic reactions
often contribute to the frequency of sinus infections.
Damp weather and pollutants in the air and
in buildings may also affect people with chronic sinusitis.
It is often difficult to treat chronic sinusitis
successfully. It is difficult because symptoms persist even
after prolonged courses of antibiotics. In general, the treatment
of chronic sinusitis involves antibiotics and decongestants.
Nasal sprays are occasionally used for long-term
treatment for patients with chronic sinusitis. The long-term
safety of nasal sprays is not fully understood, and the benefits
and risks need to be balanced.
For patients with severe chronic sinusitis,
a doctor may prescribe oral steroids, such as prednisone.
Because oral steroids can have significant side effects, they
are prescribed only when other medications have not been effective.
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