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Chronic Sinusitis

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Overview

Sinusitis is the inflammation of the mucosa of the nasal cavity and paranasal sinuses. It is also known as rhinosinusitis, as the nose is often involved as well. Chronic sinusitis is this inflammation lasting more than 12 weeks.

Epidemiology

  • Chronic sinusitis is very common and affects 1 in 10 people
  • Prevalence increases with age

Risk Factors

Presentation

Patients classically have facial pain and nasal discharge/blockage lasting for >12 weeks. Features are:

Facial pain – palpation of the affected sinuses may elicit pain

  • Nasal obstruction – due to discharge/blockage
  • Nasal discharge – usually discoloured
  • Post-nasal drip – patients often have a tickling “dripping” burning feeling down the throat
    • They may have a chronic cough as a result

Differential Diagnoses

Acute sinusitis

  • Symptoms last <12 weeks
  • Symptoms are generally more severe

Allergic rhinitis

  • Symptoms are usually after exposure to an allergen such as pollen or animal fur
  • Patients have sneezing, rhinorrhoea, and itchy eyes
  • Facial pain and pressure are less commonly seen

Granulomatosis with polyangiitis

  • Patients have nasal crusting, epistaxis and sinusitis
  • They may have glomerulonephritis and haemoptysis
  • There may be a “saddle-shape” nose deformity

Diagnosis

All patients

  • Diagnosis is clinical – based on the history and examination, including rhinoscopy

Referral

Patients should have an urgent referral if any of the following are present (as they can be the first presentation of tumours):

  • Unilateral symptoms
  • Epistaxis
  • Blood-stained discharge
  • Crusting
  • Symptoms persisting >3 months

The following patients should be admitted to the hospital immediately:

  • Eye symptoms e.g. signs of orbital cellulitis/orbital diplopia/reduced visual acuity
  • Neurological signs/symptoms
  • The patient is severely unwell

Management

All patients

  • Consider nasal irrigation with saline
  • Consider intranasal corticosteroids for up to 3 months

Patient Advice

  • Patients should try to have good control of associated conditions such as allergic rhinitis or asthma. This can improve sinusitis.
  • Patients should avoid allergic triggers, and stop smoking, and swimming.

Complications

  • Problems with sleep, fatigue, and depression
  • Decreased quality of life
  • Acute sinusitis
  • Orbital cellulitis
  • Osteomyelitis

Prognosis

  • Chronic sinusitis may last several months and may persist for the long term.

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