Chronic Sinusitis

Sinusitis is a condition that refers to an inflammation of the lining within the paranasal sinuses. Sinusitis can be classified by location or duration.

Location classification includes:

  • ethmoid, which causes pain or pressure between or behind the eyes
  • frontal, which causes pain or pressure above and behind the eyes
  • maxillary, which causes pain or pressure in the cheek area
  • sphenoid, which causes pain or pressure behind the eyes

Duration classification includes:

  • acute lasts for four weeks or less
  • subacute lasts four to twelve weeks
  • chronic lasts more than twelve weeks
  • recurrent consists of several acute attacks within a year

Acute cases of sinusitis are usually caused by an inflammation of the sinuses that eventually result in a bacterial infection. Chronic sinusitis is caused when the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed. This constant inflammation is often due to allergies, chronic bacterial infection or nasal polyps.

Sinusitis affects 37 million people in the U.S. each year, making it one of the most common health problems.1 Sinusitis is more prevalent than heart disease or asthma, and it has a greater impact on quality of life than chronic back pain or congestive heart failure.2 Symptoms may significantly affect people physically, functionally, and emotionally.

chronic sinusitis medical image

To understand sinusitis, it is important to first learn about your sinuses.

The sinuses are air spaces behind the bones of the upper face, between the eyes and behind the forehead, nose and cheeks. The sinuses are covered with a mucus layer and cells that contain little hairs on their surfaces called cilia. These help trap and push out bacteria and pollutants.

Each sinus has an opening that allows mucous to drain - this drainage is essential to keeping your sinuses working well and you healthy. Anything that obstructs the flow may cause a buildup of mucus in the sinuses and trigger sinusitis symptoms.

Experts agree that healthy sinuses are a key to a good quality of life and that unhealthy sinuses may cause some unwanted complications.

Sinusitis Defined

Sinusitis is defined as an inflammation of the sinus lining commonly caused by bacterial or viral infections and structural issues such as ostial (sinus opening) blockage. Symptoms include nasal congestion, facial discomfort, nasal discharge, headache, and fatigue.

Types of Sinusitis

There are two main categories of sinusitis: acute and chronic.

Sinusitis is usually preceded by a cold, allergy attack or irritation from environmental pollutants. Often, the resulting symptoms, such as nasal pressure, nasal congestion, a "runny nose," and fever, run their course in a few days. However, if symptoms persist, a bacterial infection or acute sinusitis may develop.

Most cases of sinusitis are acute (or sudden onset); however, if the condition occurs frequently (more than 4 times each year) you may have recurrent acute sinusitis. If your sinusitis symptoms last 12 weeks or more, you may have chronic sinusitis.

Facts About Sinusitis

  • Sinusitis affects approximately 14% of the adult U.S. population.3
  • Sinusitis affects 17% of women and 10% of men each year.3
  • Chronic sinusitis (not including acute sinusitis) results annually in an estimated 7 million physician office visits.1-4
  • Direct healthcare expenditures due to sinusitis cost are well over $8 billion each year.*5
  • Sinusitis is also responsible for a 38% loss of workplace productivity.6
  • Total restricted activity days due to sinusitis are over 58 million per year.5

* Inflation Adjusted 

Chronic Sinusitis Treatments

Functional Endoscopic Sinus Surgery (FESS)

Surgery of the nose and sinuses has experienced remarkable progress in the past 50 years, benefiting from improved imaging, better understanding of anatomy, and image-guided surgical techniques. FESS is the primary approach today for treating chronic sinusitis that doesn’t respond to other medical treatment.

There are, however, many other situations that the FESS procedure may address, including nasal polyps, excision of some tumors, closing leaks of cerebrospinal fluid, decompression procedures of the eye socket and optic nerve, as well as for removing foreign bodies from the nose and sinuses. Though FESS is a surgical procedure, it is minimally invasive, as cutting occurs only for procedures requiring tissue removal. Fiber optics aid the surgeon’s navigation and CT imagery may assist the process. Improvement of symptoms for patients with chronic sinusitis has around a 90% success rate, and FESS has a much lower complication rate than conventional sinus surgery.

Image-Guided Sinus Surgery

Given the senses and organs that surround the nasal and sinus regions, surgical precision is essential to treat sinus issues without affecting other systems. Image-guided surgery provides a powerful assist to the surgeon by providing instant feedback on the location of an endoscope or probe during a procedure.

CT or MRI imagery and a guidance computer combine with sensors to give precise location of the device, providing margins of safety when the surgeon is near critical structures around the sinuses. Two systems, each providing different information, are in common use today. Optical systems use infrared light to report the probe’s location in combination with reflectors or emitters attached to the patient with a headband or adhesive. Electromagnetic systems use magnetic fields to locate apparatus, again using sensors placed on the patient’s head.

Balloon Sinuplasty

An alternative to traditional endoscopic procedures, balloon sinuplasty, or BSP, provides a less invasive treatment with fast recovery and little patient impact. A balloon catheter is placed at the entrance to an inflamed sinus. As the balloon inflates, it expands the sinus opening.

To treat sinusitis, for example, the sinus would then be flushed with saline solution to clear the sinus of mucus and pus, permitting the sinus to heal. Typically, the sinus opening remains open after the balloon catheter is deflated and removed from the patient, without upsetting the integrity of the sinus walls. Recovery time averages about two days until a patient resumes regular activities. A study of patients receiving a balloon sinuplasty to treat chronic sinusitis reported significant symptom reduction two years post-procedure.

Adenoidectomy

Along with the tonsils, the adenoids are part of the immune system, in this case part of the lymphatic path. In children, the adenoids and tonsils serve as part of the front line of the immune system, and both can be frequently inflamed. When inflamed, the adenoids may make breathing difficult, while blocking the eustachian tubes and preventing drainage from the middle ear.

This may lead to frequent ear infections, problems swallowing, sore throats, obstructive sleep apnea, and difficulty breathing through the nose. When a child has several ear and throat infections annually and does not respond to antibiotic treatments, adenoidectomy may be the best solution to prevent further issues.

1. Benninger, M. et al. Adult chronic rhinosinusitis: Definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003; 129S: S1-S32

2. Soler, et al. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope 2011; 121: 2672-2678.

3. Pleis, JR. et al. Summary health statistics for U.S. adults: National Health Interview Survey, 2006. National Center for Health Statistics 2007. Vital Health Stat 10(235).

4. Bhattacharyya N. Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis. Laryngoscope 2006; 116(Suppl 110):1-22

5. Ray, N. et al. Healthcare expenditures for sinusitis in 1996: Contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol 1999; 103: 408-414. (Inflation Adjusted as per CPI to 2010 dollars.)

6. Stankiewicz J. et al. Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum. Int Forum Allergy Rhinol 2011; 1: 38-45

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