Sinusitis – Chronic Rhinosinusitis

What is chronic rhinosinusitis?

Chronic rhinosinusitis is a condition characterised by inflammation of the lining of the nose and sinuses for more than 12 weeks.

What are the symptoms?

The main symptoms are nasal blockage or congestion and a runny nose or postnasal drip (mucus dripping into the throat from the back of the nose). Other symptoms include facial pressure or pain and a reduction in sense of smell. Some symptoms are present on most days but periods of exacerbation may occur.

What causes it?

The cause is unknown. The following factors may play a role in the inflammation of chronic rhinosinusitis: bacteria or fungi present in the sinuses; an abnormal immune response by the patient – this may have genetic or allergic components; blockage of the pathways which drain mucus from the sinuses into the nose or abnormalities of the cilia (hair cells) which move the mucus along; inflammatory conditions of the lungs, such as asthma.

How is it treated?

Unfortunately, there is no cure for chronic rhinosinusitis but there are effective treatment options. Generally, medical treatment is given first. If troublesome symptoms persist, a combination of medical and surgical treatment may be offered.

Medical treatment

Medical treatment aims to reduce the inflammation causing the symptoms:

Initial treatment

This usually consists of an initial course of tablets for a number of weeks. A steroid tablet, such as prednisone, an antibiotic, or both may be used. In addition to the tablets, a steroid nasal spray, such as Nasonex and a saline rinse or spray is required daily to treat the nose topically.

Maintenance treatment

After the tablets finish, it is important to continue on the maintenance treatment of a steroid spray and saline rinse daily until advised otherwise by your doctor.

What do the medications do?

The steroids reduce any over-active immune response occurring in the sinuses and the antibiotic helps to fight any bacterial infection. Some antibiotics also help to reduce the patient’s immune response.

Are there any side effects?

Prednisone can cause insomnia, increased appetite, weight gain, depression, anxiety and irritability. Diabetics must carefully monitor their blood sugars. There is a very small incidence of damage to the hipbone.

What about surgical treatment?

Surgical treatment aims to remove any blockage of the nose and sinuses in order to allow more efficient drainage of the mucus from these areas and also to let the steroid spray and saline rinse penetrate the sinuses more effectively. This allows more effective topical medical treatment of the inflammation causing the symptoms. Surgery is not a substitute to medical treatment: it is important to continue the topical nasal sprays after surgery.