OVERVIEW

What is chronic sinusitis?

Chronic sinusitis, also known as chronic rhinosinusitis, refers to inflammation of the nasal and sinus mucosa lasting more than three months. It is a chronic condition and a common disease in otolaryngology-head and neck surgery.

The main symptoms of chronic sinusitis include nasal congestion and mucoid or mucopurulent nasal discharge. Secondary symptoms may also include facial pressure or pain, as well as reduced or lost sense of smell. With advancements in medical and healthcare standards, chronic sinusitis now rarely causes severe complications. However, it can still adversely affect nearby organs such as the eyes, ears, throat, trachea, and digestive tract.

Symptoms like nasal congestion, runny nose, and headaches caused by chronic sinusitis can significantly impair quality of life and may even lead to mental health issues.

Patients with sinusitis are also carriers of bacteria, especially during acute episodes, making the condition somewhat contagious.

Treatment for chronic sinusitis includes medication and surgery, with the goal of controlling the disease. With proper treatment, patients can maintain a normal quality of life.

Are chronic sinusitis and rhinitis the same condition?

The medical community is increasingly adopting the term "rhinosinusitis" to encompass both "rhinitis" and "sinusitis."

This is because, on one hand, the nasal mucosa is continuous with the sinus mucosa, and nasal inflammation often affects the sinuses, while sinusitis is typically accompanied by nasal inflammation. On the other hand, the pathogenesis and pathophysiological processes of rhinitis and sinusitis are identical.

SYMPTOMS

What are the common manifestations of chronic sinusitis?

The main symptoms of chronic sinusitis are nasal congestion, and sticky or mucopurulent nasal discharge. Secondary symptoms may also include facial pain or pressure, and reduced or loss of smell.

What are the hazards of chronic sinusitis?

Serious complications of chronic sinusitis include meningitis, cavernous sinus thrombosis, orbital cellulitis, and optic neuritis, with the most severe cases potentially leading to death or blindness. However, due to the widespread use of antibiotics, these severe complications have become less common.

Chronic sinusitis can adversely affect adjacent organs such as the ears, throat, trachea, and digestive tract, leading to otitis media, pharyngitis, cough, and gastroenteritis. Symptoms like nasal congestion, runny nose, and headaches can significantly impair quality of life and may even contribute to mental health disorders.

For children with chronic sinusitis, long-term nasal congestion leading to mouth breathing can affect oral and maxillofacial development, resulting in an "adenoid facies" characterized by a high-arched palate, protruding teeth, thickened lips, and a lack of facial expression. Additionally, prolonged nasal congestion and hypoxia can negatively impact a child's growth and development.

CAUSES

What are the causes of chronic sinusitis?

Chronic sinusitis is caused by bacterial infections, often resulting from recurrent or unresolved acute sinusitis. Its causes are related to systemic and local factors. Systemic factors such as excessive fatigue, malnutrition, anemia, and diabetes can weaken overall immunity, while unclean living or working environments are also contributing factors.

Local causes include nasal polyps, anatomical abnormalities of the nasal cavity or sinuses, allergic rhinitis (which blocks sinus openings), and infections spreading from nearby areas like the tonsils, nasopharynx, or periodontium.

Who is more prone to chronic sinusitis?

Chronic sinusitis is common in individuals with weakened immunity due to excessive fatigue, malnutrition, vitamin deficiencies, or underlying conditions like diabetes, anemia, or hypothyroidism.

Additionally, those working or living in unclean environments are more susceptible. People with allergic rhinitis, deviated nasal septums, or anatomical abnormalities in the nasal cavity or sinuses have a higher risk of developing chronic sinusitis.

Is chronic sinusitis contagious?

Sinusitis patients can carry bacteria, especially during acute flare-ups, making the condition somewhat contagious.

How is chronic sinusitis transmitted?

It spreads mainly through respiratory droplets and contact with nasal or oral secretions.

Therefore, patients should maintain personal hygiene—avoid discarding tissues or handkerchiefs contaminated with nasal discharge or sputum carelessly, and refrain from spitting. Sharing towels, toothbrushes, washbasins, or tableware with family members should be avoided. Wearing a mask during acute episodes and covering sneezes can help prevent transmission.

DIAGNOSIS

When Should You Be Alert to Chronic Sinusitis?

If symptoms such as nasal congestion, thick or purulent nasal discharge persist for more than 3 months, or if there is long-term facial pain or reduced sense of smell, you should be alert to the possibility of chronic sinusitis.

What Tests Are Needed for Chronic Sinusitis?

If chronic sinusitis is suspected, a medical consultation is necessary for the doctor to examine the nasal cavity and sinuses. Depending on the situation, nasal endoscopy or sinus CT scans may also be required. Due to radiation exposure, sinus CT scans are not recommended for children unless absolutely necessary.

Why Are Nasal Endoscopy and CT Scans Needed for Chronic Sinusitis?

Nasal endoscopy helps doctors assess whether there is mucosal swelling, polyps, anatomical variations, secretions, or adhesions in the nasal cavity, nasal passages, or sinus openings. Before the procedure, the doctor will administer topical anesthesia, such as nasal sprays or gauze packing, to numb the nasal cavity.

The doctor will select an appropriately sized endoscope based on the patient's nasal cavity size. Most adults and children can tolerate the procedure. The most common side effect is minor nasal bleeding due to mucosal irritation.

A sinus CT scan provides the most direct visualization of fluid accumulation in the sinuses and the anatomical relationship between the nasal cavity and sinuses. However, due to radiation exposure, sinus CT scans are not routinely recommended for children unless medically necessary.

TREATMENT

Which department should I visit for chronic sinusitis?

Otolaryngology Head and Neck Surgery (some hospitals may call it ENT Department or Ophthalmology & Otorhinolaryngology Department).

Can chronic sinusitis be left untreated?

Without treatment, chronic sinusitis can not only cause nasal symptoms like congestion, thick nasal discharge, and reduced sense of smell but may also lead to complications in nearby organs such as the eyes, ears, throat, trachea, and digestive tract, including otitis media, pharyngitis, cough, and gastroenteritis.

Therefore, if you suspect you have chronic sinusitis, seek medical attention promptly for standardized treatment.

What are the treatment options for chronic sinusitis?

Treatment for chronic sinusitis includes medication and surgery.

Nasal irrigation is an effective method for managing sinusitis. Using saline solution to rinse the nasal cavity is safe and suitable for long-term use. Many commercial products are available for convenient use.

Medications include nasal corticosteroids (e.g., Rhinocort, Flixonase) or oral corticosteroids, antibiotics, and mucolytics (e.g., Myrtol, Ambroxol). If allergic rhinitis or asthma is present, antihistamines may be added.

Some popular imported nasal sprays may contain ephedrine, which can be used but not for more than 7 days, as prolonged use may lead to drug-induced rhinitis. Avoid using imported medications with unclear ingredients.

Traditional Chinese medicine (TCM) can serve as an adjunct therapy for chronic sinusitis but is not recommended for long-term use. Due to insufficient evidence on safety and efficacy, TCM is not advised for children with chronic sinusitis.

Surgical treatment typically involves minimally invasive endoscopic procedures without visible facial or nasal scars. The goal is to unblock sinus openings, allowing mucus and pus to drain and preventing symptoms.

Nasal medications vary for children of different ages, and self-medication is not recommended. Surgery is generally not advised for children under 12.

What are the common risks of surgery for chronic sinusitis?

Common risks include intraoperative or postoperative bleeding, damage to nearby organs like the eyes or meninges, reduced sense of smell, nasal adhesions, congestion, and sinusitis recurrence.

Can chronic sinusitis be cured?

Chronic sinusitis cannot be completely cured, but treatment aims to control symptoms and maintain quality of life.

If symptoms persist despite standard medication, surgery may be considered.

Surgery opens blocked sinus passages to drain mucus and pus, preventing symptom recurrence. Postoperative care includes medication and nasal irrigation to restore mucosal function and reduce relapse.

For patients with recurrent sinusitis after surgery, further treatment plans are based on symptoms, nasal examination, and sinus CT scans.

DIET & LIFESTYLE

What should patients with chronic sinusitis pay attention to in their diet?

Patients with chronic sinusitis should avoid excessively hot, spicy, and irritating foods in their diet, as these can cause blood vessel dilation and increase glandular secretion, thereby worsening symptoms like nasal congestion and runny nose.

What should patients with chronic sinusitis pay attention to in daily life?

Patients with chronic sinusitis should maintain personal hygiene, avoid carelessly discarding tissues or handkerchiefs contaminated with nasal mucus or phlegm, and refrain from sharing towels, toothbrushes, washbasins, or tableware with family members.

Improve work and living environments to maintain cleanliness.

Avoid excessively hot, spicy, or irritating foods in the diet.

Avoid overexertion and repeated colds, strengthen immunity, and actively manage underlying conditions such as diabetes, hypothyroidism, or anemia if present.

PREVENTION

How to Prevent Chronic Sinusitis?

Strengthening immunity and avoiding repeated colds can help prevent chronic sinusitis.

Acute sinusitis should be treated properly. Typically, treatment should continue for one week after symptoms improve to prevent recurrence and progression to chronic sinusitis. If allergic rhinitis or other nasal conditions are present, active treatment and symptom control are necessary to avoid complications like chronic sinusitis.

Diabetic patients should manage blood sugar levels to enhance immunity and prevent infections.