WHY YOUR SINUSITIS NOT GOING AWAY

When the sinusitis doesn't subside even after  12 weeks, then it has turned chronic. Chronic sinusitis is  of two types, one  associated with nasal  or sinus polyp and  the other without any polyp. 

WHAT ARE THE CONDITIONS PREDISPOSING TO  CHRONICITY

Persistent mucosal edema  or the lining of the nose and sinuses , will have persistent inflammatory edema or  congestion . Persistent infection by bacteria or fungus, be it drug resistant bacteria, or inadequate or irregular treatment in some cases . Impairment or defective mucus drainage from the sinus, due to mucociliary defect  is another cause, it may be congenital or hereditary in some cases . Allergies,  those with asthma, aspirin sensitivity and nasal polyp,  smoking, poor nutrition, acid reflux, immunodeficiency,  patients with chronic inflammatory conditions are also contributory factors. Structural or functional abnormalities also another cause. 

WHAT ARE THE FEATURES ? 

Persistent nasal block, nasal discharge, postnasal discharge, occasional facial pain. Some times nasal polyp will be present, which are basically edematous mucosa, seen as grape like lesions with inflammatory cell infiltrate (on tissue microscopy) . Polyp can be visualized in the nasal cavity, if it's long standing. In some patients there will be only polypoidal changes of the  nose and sinus lining. 

WHAT IS THE  PATHOLOGY ? 

Persistent mucosal inflammation leads to congestion, mucosal edema leading to polypoidal changes or polyp obstructing the sinus openings leading to retention of mucus discharge and infection  by bacteria or fungus. 

HOW CAN IT BE TREATED? 

Medical management is the mainstay of treatment. I am emphasizing this point because some of my patients told me ,that they were initially hesitant to visit an ENT  as they thought that we do only surgeries. We treat  the cases medically first and surgery is for selected cases like those with nasal polyp or any complications, or no response to medicines. 

Medical treatment is aimed at reducing mucosal edema of nose and sinuses in the form of topical and oral medicines. Antibiotics for exacerbations due to infections. Other supportive measures for drainage of mucus also to be done. 

Surgical treatment is reserved for polyp, those people where medical treatment not responding and  for complications of sinusitis. Endoscopic sinus surgeries  and others are performed in such  situations. 

Hope this post was useful. 

(Fungal sinusitis will be dealt later)