Condition: Chronic Rhinosinusitis

Acute rhinosinusitis (ARS) is a term that can be used to describe any short-lasting condition that causes inflammation of the lining of the nose and sinuses, but it is typically associated with short-lived symptoms that follow a common cold.

The word “chronic” in chronic rhinosinusitis means that the condition is long-term (a patient has had it for at least 12 weeks, or in some cases, even years) and may not always have a cure but symptoms can usually be well controlled. This distinguishes it from “acute rhinosinusitis”, which usually gets better within 2 to 3 weeks.

Chronic rhinosinusitis can be divided into categories. Some kinds of chronic rhinosinusitis cause the patient to develop nasal polyps (chronic rhinosinusitis with nasal polyps), and some kinds do not (chronic rhinosinusitis without nasal polyps). Nasal polyps are benign inflamed swellings which fill the sinuses and nasal cavity.

Unlike acute rhinosinusitis, which is usually caused by infection, chronic rhinosinusitis has several associated causes and risk factors.

Chronic rhinosinusitis without and without nasal polyps may be caused by:

• Genetics
• Asthma
• Immune deficiency
• Viral infections
• Bacteria
• Allergies
• Smoking and passive smoking
• High pollution levels and some chemical exposures

Additional causes of chronic rhinosinusitis with nasal polyposis include:

• Allergy to fungal spores
• Non-steroidal anti-inflammatory drugs (NSAIDs) - NSAIDs such as aspirin may worsen symptoms in those who also have asthma
• Systemic disease - Nasal polyps are common in patients with cystic fibrosis and eosinophilic granulomatosis with polyangiitis

The most common signs and symptoms of chronic rhinosinusitis include:

• Nasal inflammation
• Thick, green or yellow mucus discharge from the nose
• Drainage of mucus down the back of the throat
• Blocked or stuffy (congested) nose making it difficult to breathe through the nose
• Pain, tenderness, pressure and swelling around the eyes, cheeks, nose or forehead
• Reduced sense of smell and taste

Other signs and symptoms associated with chronic rhinosinusitis are:

• Ear pain
• Headache
• Aching in the upper jaw and teeth
• Coughing or throat clearing
• Sore throat
• Bad breath
• Fatigue and difficulty sleeping

Chronic rhinosinusitis is diagnosed based on the patient having at least two symptoms of the condition for more than 12 weeks, with one of the symptoms being blockage or discharge.

In addition to an assessment of symptoms, chronic rhinosinusitis can also be diagnosed by examining the inside of the nose with an endoscope (a thin telescope which is usually attached to a camera). This allows the consultant to see evidence of an inflamed nasal lining, or abnormal coloured mucus draining from the sinuses and also determine whether nasal polyps are present.

Although not essential for all patients, a CT scan may be suggested if the diagnosis is unclear or if further treatment needs to be planned.

Blood tests are also not essential for the diagnosis of chronic rhinosinusitis. However, some patients may have them for the diagnosis of possible allergies, immune deficiency or autoimmune diseases. Some patients may also have a swab of nasal secretions taken, to determine which kinds of bacteria are present.

Although there may not be a one of sure cure for chronic rhinosinusitis it can usually be controlled with a combination of medical and surgical treatments including:

• Saline Irrigation (Saltwater rinses)
• Intranasal corticosteroids (Nasal steroid sprays or drops)
• Antibiotics
• Corticosteroids
• Biologics
• Surgery

Read more about treatment for chronic rhinosinusitis on this page.