Chronic sinusitis, also known as chronic rhinosinusitis, describes a condition of sinus inflammation persisting for 12 weeks or longer. Swelling blocks the small passages between the sinuses and the nasal cavity, leading to trapped mucus and increased sinus pressure. Characteristic symptoms of chronic sinusitis include facial pain, nasal obstruction, decreased sense of smell and thick nasal drainage. Treatments for chronic sinusitis focus on symptom relief, re-establishment of sinus drainage and prevention of sinusitis recurrence.
Nasal Steroids
Long-standing inflammation of the lining of the nose and sinuses is the fundamental abnormality leading to sinus blockage in most people with chronic sinusitis. To break the inflammatory cycle, doctors commonly prescribe nasal steroid sprays, notes the Cleveland Clinic. The steroid sprays have a local anti-inflammatory effect with minimal absorption into the bloodstream, which limits potential side effects. Examples of nasal steroid sprays include triamcinolone, mometasone, fluticasone and budesonide. Steroid sprays are frequently used in combination with other medications and treatments for chronic sinusitis.
Oral Steroids
In people with marked inflammatory thickening of the nasal tissues, a short course of oral steroid treatment may reverse chronic sinusitis-associated swelling and inflammation, reports the National Institute of Allergy and Infectious Diseases. A short course of treatment minimizes the risk for complications associated with long-term steroid administration.
Antibiotics
Chronic bacterial sinusitis is frequently treated with an extended course of antibiotics, according to the American Rhinological Society. Commonly used antibiotics include doxycycline, trimethoprim-sulfamethoxazole, amoxicillin, amoxicillin/clavulanate, erythromycin, moxifloxacin and cefuroxime. "The Merck Manual for Healthcare Professionals" reports that four to six weeks of treatment remains a typical course of antibiotic therapy for chronic bacterial sinusitis. A longer course of antibiotics may be required for some patients.
Immunotherapy
Many patients develop chronic sinusitis due to persistent nasal allergies that inflame the nasal lining. Immunotherapy, more commonly known as allergy shots, can help decrease allergic reactions, explains the Mayo Clinic. This long-term strategy to reduce the likelihood of recurrent sinusitis is generally undertaken simultaneously with other treatments to relieve symptoms and re-establish sinus drainage.
Decongestants
Oral decongestant medications such as pseudoephedrine and phenylephrine may be prescribed to decrease swelling of the nasal and sinus tissues. Short-term use of decongestant nose drops or nasal sprays can also provide symptom relief. The American Academy of Otolaryngology–Head and Neck Surgery warns, however, that prolonged use of topical nasal decongestants can lead to rebound nasal congestion.
Surgery
Patients who continue to experience symptoms of chronic sinusitis despite a full course of medical therapy may require sinus surgery to remove inflamed tissues blocking the sinus openings. Sinus surgery is usually performed with a fiber-optic instrument inserted into the nose, notes the American Academy of Otolaryngology–Head and Neck Surgery.
References
- Cleveland Clinic: Sinusitis
- American Rhinological Society: Sinusitis FAQs
- American Academy of Otolaryngology–Head and Neck Surgery: Sinusitis
- National Institute of Allergy and Infectious Diseases: Sinusitis (Sinus Infection) Treatment
- American Academy of Otolaryngology–Head and Neck Surgery: Sinus Surgery
