Chronic sinusitis

See also Acute sinusitis

Definition

Chronic sinusitis is the persistance of insidious symptoms beyond 12 weeks, with or without acute exacerbations.

Pathophysiology (see also sinus anatomy)

Chronic sinusitis is considered to be more likely a structural defect of the sinus anatomy causing drainage problems and subsequent chronic infection.  However, this may result from inadequate treatment of an acute sinusitis or chronic allergic disease/polyps etc.  or from previous sinus surgery (Congenital defects are actually rarer).

Microbiology

In contrast with acute sinusitis, the majority of chronic sinusitis is caused by:

  • Anaerobic bacteria
  • Staph aureus
  • Fungal organisms (aspergillus, cryptococcus)- especially in immunodeficient patients.
    • The bacteria that cause acute version are also seen, but with persistent infection, anaerobes predominate

Signs/Symptoms

(Similar to acute sinusitis):

  • Nasal stuffiness and discharge/postnasal drip
  • Facial pain/pressure/congestion/fullness
  • Facial erythema
  • Hyposmia
  • Hallitosis/fetid breath is often a feature
  • Malaise/fatigue

Investigation

Like acute sinusitis, it is largely a clinical diagnosis.  CT/imaging is often used in these patients to look for structural problems as well as an air/fluid level (although an air/fluid level is not specific for disease).

Management

Functional endoscopic sinus surgery is more routinely done in chronic sinusitis than acute, and is usually the mainstay of treatment (as it is likely these patients will have tried acute treatments first).

Beclamethasone is often used post-operatively too.

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