Sinuses are hollow air pockets in the bones of the skull. These pockets are usually lined by a thin layer of tissue that usually makes small amounts of mucus. This mucus usually keeps these sinuses healthy by slushing away germs and keeping these sinuses lubricated. 

Rhinosinusitis usually happens when this layer of cells gets infected or irritated, which would cause swelling, congestion, and production of extra mucus. That congestion and swelling might interfere with drainage of mucus and leads to worsening of overall congestion.

In chronic rhinosinusitis symptoms usually last for at least 12 weeks, despite attempts to treat it. This condition usually causes at least two of the following symptoms:

● Nasal congestion

● Mucus discharge from the nose or mucus that drips down the back of the throat

● Facial pain, pressure, or “fullness”

● A decreased sense of smell

In chronic rhinosinusitis symptoms are usually more persistent, requiring a more intensive and specific approach of treatment. Since symptoms are usually less severe and lasting over prolonged period of time, chronic rhinosinusitis can be overlooked by both patients and health care providers. 

Schedule an appointment with one of our allergists at The Allergy Suite if you have any of the above symptoms, or if you have been treated multiple times per a year with antibiotics for a sinusitis.

Chronic rhinosinusitis causes: 

Chronic rhinosinusitis is divided into three different categories, depending on their clinical features:

Chronic rhinosinusitis without nasal polyposis

This is the most common form of chronic rhinosinusitis. In this form, congestion in the lining of the sinuses may be caused by allergies, irritation from the environment and infections. Patients might require allergy testing to identify some of these factors. 

Chronic rhinosinusitis with nasal polyposis

In this type, symptoms are usually caused by an abnormal growth in the lining of these sinuses of the nasal mucosa. These abnormal growths are called nasal polyps. One of the common symptoms that patient present with is loss of sense of smell. 
Treatment include medications, surgeries, and sometimes both. With recent advances in medications, biologics are very effective treatment options for nasal polyps. 

Chronic rhinosinusitis with fungal allergy (“allergic fungal rhinosinusitis”)

Some people have allergies to fungi inside their sinuses. It is normal for air to contain small amounts of fungi (mold). If a person is allergic to fungus, sinus linings might become congested whenever there is exposure to the fungi spores. In order for this type to be diagnosed, an allergist must find thick mucus in sinuses, see fungi in the mucus under microscope, and show (with allergy testing) that patients are allergic to fungi. 

Chronic rhinosinusitis treatment: 

People with chronic rhinosinusitis usually need life-long treatment to keep their symptoms under control. Potential treatments for rhinosinusitis:

Lifestyle modifications

Smoking or smoking exposure would only worsen rhinosinusitis. If patients have environmental sensitizations, following certain avoidance measures would improve symptoms. Your allergist at The Allergy Suite will discuss details of these avoidance measures after doing allergy testing. 

Daily nasal saline washing 

Many different options are available to perform nasal saline washing or flushing. Washing nasal passages daily with saline (salt water) helps reduce symptoms. A variety of devices, including squeeze bottles, syringes, and Neti pots, may be used to perform nasal irrigation. 

Steroid nasal sprays

Steroid nasal sprays decrease the inflammation involved with rhinosinusitis. They also help reducing mucus production and would improve most of the nasal polyps by shrinking them. You should discuss with your allergist the proper way to use nasal sprays, as this is crucial to benefit from nasal sprays in general, and specifically steroid nasal sprays. 

Antibiotics

If sinus infection is there, it can only make rhinosinusitis worse. Sometimes long course of antibiotics is required in order to treat chronic rhinosinusitis. 

Steroid pills

Not the first line treatment for rhinosinusitis given side effect profile of systemic steroids. Sometimes though we need to use them to provide relief of symptoms. 

Biologics for nasal polyposis

Advances in biologics were made in the past decade. Recently multiple biologics have been FDA approved for treating nasal polyposis. 

Schedule your appointment to see one of our allergists at The Allergy Suite and get a comprehensive evaluation of your recurrent sinus infections.