CHRONIC SINUSITUS

What is CRS?:

Chronic Rhinosinusitis (CRS) is inflammation of the sinuses that lasts more than 8-12 weeks.

It is usually classified as:

  • Chronic Rhinosinusitis without polyps
  • Chronic Rhinosinusitus with polyps
  • Allergic Fungal Rhinosinusitis

CRS without polyps:

The thin lining of the sinuses becomes thick and inflamed. The natural openings from the sinuses to the nose can get blocked, which prevents air from flowing freely from your nose into the sinus cavity.

Due to the negative pressure that is created, fluid builds up in your sinuses which then in turn allows bacteria to grow. This can lead to chronic infection and inflammation.

It is the most common type of chronic sinusitis

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Causes:

There are many reasons why people may develop chronic sinusitis, but in many cases we are not sure why some patients develop this disease. Known causes include:

  • Allergies: Your sinuses become inflamed in response to certain allergens. Many medical treatments are available to reduce your symptoms before considering surgery.
  • Anatomy of your nose and sinuses: Sometimes, the anatomy of your sinuses may be slightly different. For example, the natural openings of your sinuses can be blocked by an extra air cell or a big nasal turbinate at the opening of the sinus. A deviated septum can also block the opening of your sinus. If the air cannot flow in and out of your sinuses, fluid can build up.
  • Genetic diseases: Conditions like Cystic Fibrosis or Ciliary Dyskinesia can cause chronic inflammation of your sinuses.
  • Immune system disorders: Autoimmune diseases or immune system dysfunction can lead to chronic inflammation of your sinuses. If your surgeon suspects that you are suffering from such disease, he/she may ask for blood-work or tissue biopsies to confirm these rare conditions.
  • Infections: Viruses, bacteria and fungus can cause chronic infections in your sinuses
  • Smoking & other air-irritants: Tobacco and other air pollutants like dust, mould, or exposure to excessive cleaning products can cause chronic inflammation of your sinuses.

CRS with polyps:

Nasal polyps are grape-like swollen/inflamed tissue that can block your nose and sinuses.

It is not clear why some individuals develop these polyps but patients who have them may also have associated conditions such as: asthma, chronic cough or allergies to Aspirin and other Salicylate containing compounds.

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Allergic Fungal CRS:

It is normal for the air to contain a small amount of fungus. Although most people do not react to these fungi, some people develop an allergic reaction to the fungus in the air and cannot clear them from their nose and sinuses; this leads to chronic sinusitis often with polyps.

What are the symptoms of CRS?

Symptoms of Chronic rhinosinusitis (CRS) with or without polyps can include common symptoms such as:

  • Nasal obstruction or congestion causing difficulty breathing through your nose
  • Facial pain (pain behind your cheekbones, forehead and eyes)
  • Headaches
  • Chronic thick drainage from your nose or in the back of your throat (post-nasal drip)
  • Reduce sense of smell and taste

You could also experience :

  • Chronic cough
  • Ear pain
  • Fatigue
  • Bad breath
  • Sore throat
  • Dental pain

What are the tests and investigations?

If you have symptoms of chronic sinusitis, your doctor or surgeon may ask for different tests:

  • CT scan of the sinuses: this will show if your sinuses are full of fluid or pus and/or polyps and if the anatomy of your sinuses may be the cause of your symptoms
  • Allergy testing: If your symptoms seem to be triggered by certain allergens, you may need a formal allergy testing.
  • Cultures: Your doctor or surgeon may take a swab of the fluid draining from your nose to see if there is bacteria or fungus.
  • Blood work: If your doctor suspects an immune disease to be the cause of your symptoms, he/she may order blood tests to confirm the diagnosis or refer you to an immunologist for an assessment.

What is the Treatment of CRS?

Before considering surgery, there are many medical treatments that can improve your symptoms of chronic sinusitis:

  • Life-style modifications: Avoiding cigarettes, allergic triggers, mould and chemical irritants can reduce your symptoms
  • Saline rinses: Daily use of saline rinses can help your sinuses get rid of the irritants causing your symptoms. Saline rinses are like a daily shower for your sinuses!
  • Nasal steroids: Nasal steroid sprays or rinses can help reduce the inflammation in your sinuses and dramatically reduce your symptoms.
  • Anti-histamines: If your symptoms are worse when you are exposed to allergens, anti-histamine medications such as Claritin or Benadryl may decrease the allergic response and improve your symptoms.
  • Steroid pills: In some cases (polyps), your doctor can recommend steroid pills such as prednisone to help reduce the inflammation.
  • Antibiotics: If bacterial infection is thought to be the source of your symptoms of sinusitis, your doctor may prescribe an antibiotic to get rid of the infection. In most cases, chronic sinusitis is caused by inflammation without infection.
  • Leukotriene modifiers: In rare cases, your doctor may suggest a class of medications called leukotriene modifiers. They reduce inflammation in a different manner than steroids. They are usually helpful for patients that have nasal polyps or asthma.
  • Immunotherapy: For some cases of allergic sinusitis, your doctor may recommend immunotherapy. The goal of this treatment is to help your immune system get used to certain allergic triggers without developing allergic symptoms.

Surgery should be considered only after trying medical therapy. If your symptoms do not improve with medical therapy or if you do not get enough relief of your symptoms from medical treatment, your surgeon may recommend surgery.