What is sinusitis and what are its symptoms?

Sinusitis or rhinosinusitis is a common condition which can become chronic and lead to other health issues. Consultant ENT surgeon Mr Jonathan Joseph is here to shed some more light on symptoms, causes and treatment of this condition.

Sinusitis is now correctly referred to by experts as rhinosinusitis. It is a condition causing inflammation of the lining of the nasal cavity and the surrounding air-filled sinuses. The inflammatory process causes the lining to become very swollen and in some people results in polyp formation. This all leads to nasal blockage and congestion which also reduces the senses of smell and taste. Inflammation also leads to increased discharge which either comes out of the front of the nose or drips down the back into the throat. This in turn can cause a persistent cough and sometimes a chest infection. The impaired drainage from inflamed sinuses makes persistent infection more likely and therefore prolongs the problem.

Many patients also complain of a pressure sensation in the face, forehead and around the eyes. It is usually only painful during an acute infection. If someone has persistent head or facial pain in the absence of other nasal symptoms it usually suggests there is another cause such as neuralgia, muscular tension or atypical migraine. 

What causes chronic sinusitis?

Chronic rhinosinusitis is defined as persistent symptoms lasting for 12 weeks or longer. It can often start with a simple infection that never seems to resolve. This could be due to inadequate treatment in the first few weeks, but there are many other factors as well. Some people have a deviated septum affecting the drainage pathways so the sinuses become more easily blocked. Previous surgery can cause scarring which also blocks drainage.

Allergies to dust and pollen will often exacerbate sinus problems, although are not usually the underlying cause. Others have a genetic predisposition making them more prone to sinusitis and in particular the development of polyps. Any cause of immune deficiency will also lead to more problems with the sinuses. A relatively common cause which is sometimes forgotten is dental decay of the upper teeth. If it spreads upwards into the sinuses it can lead to usually one-sided problems. Very rarely, a tumour can cause chronic rhinosinusitis which again would usually be one-sided.

Once the nose becomes chronically inflamed, the normal processes that protect and clear the nose become less effective. In some cases, the lining becomes permanently damaged which makes chronic or recurrent problems more likely.

Can chronic sinusitis be cured?

When there is a localised infection, this can usually be treated effectively with either medication or surgery. However, many people with chronic symptoms either have an inherent genetic predisposition or the nasal lining has been permanently altered. In such cases, the symptoms can usually be managed very well with a combination of medical and surgical treatments.

It is essential to comprehensively investigate all chronic rhinosinusitis patients as there may be an underlying issue, such as immunodeficiency or an auto-immune condition often known as vasculitis. Only when these are treated can the sinuses be improved in the long term. If my investigations reveal such a condition, I would involve one of my expert medical colleagues so we can manage the patient jointly.

We have also learnt that the nose and sinuses form one continuous system with the chest. As a result, unless any chest problems such as asthma or bronchitis are treated, control of nasal symptoms will be impaired.

What happens if chronic sinusitis is left untreated?

If left untreated, in most cases the symptoms will just persist with varying severity. This can have a profound impact on quality of life. The symptoms of chronic rhinosinusitis can cause sleep disturbance, reduced exercise tolerance, lack of energy and loss of sense of smell and taste. It can also cause social embarrassment with constant sneezing, dripping from the nose and sounding ‘like you have a cold’ all the time. In rare cases, the infection can spread to surrounding structures like the eye or even the brain, causing an abscess.

How does an ENT surgeon decide on the best treatment for chronic sinusitis?

This will depend on any treatments that have been tried already and also the results of my assessment and investigations. Treatment is usually based on regular nasal rinsing with saltwater, nasal steroid sprays and careful use of antibiotics.  I also use minimally invasive surgical procedures which can be carried out with just local anaesthetic or light sedation. These can be very effective in managing the problem and preventing the symptoms from worsening. However, if the situation has progressed further, then formal sinus surgery under general anaesthetic may be required. 

Mr Jonathan Joseph is a reputable consultant ENT surgeon and sinusitis specialist from London. Visit his Top Doctors profile, where you can find out more information about him and request an appointment.