This article is on Chronic Rhinosinusitis, a condition frequently experienced by patients and seen by General Practitioners/Otolaryngologists. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What are the sinuses?

To best understand chronic rhinosinusitis you may want to read our page on nose and sinus anatomy which provides some background

 

What is Chronic Rhinosinusitis?

Chronic rhinosinusitis (CRS) is a condition involving persistent inflammation within the noses and sinus for longer than 12 weeks. Shorter periods of inflammation of the nose and sinuses are termed Acute sinusitis. CRS is generally not a dangerous condition but can cause irritating symptoms and treatment is directed towards trying to minimise symptoms.

Chronic Rhinosinusitis

 

Who gets Chronic Rhinosinusitis?

CRS is common and occurs in around 1 in 10 adults. CRS most commonly becomes a problem in young adults but it can affect children and adults of all age groups. There are some rare medical conditions that can increase the chances of CRS occurring although most people with CRS are otherwise healthy.

CRS Subtypes:
– CRS with Nasal Polyps (CRSwNP)
– CRS without Nasal Polyps (CRSsNP)
– Allergic Fungal rhinosinusitis (AFRS)

 

What are the causes?

The exact causes of CRS are complicated and not completely understood. Previous theories about infection and allergy have been largely disproven. There appears to be some disruption in the normal barrier that exists between the bodies immune system and the bugs that live within the nose and sinuses. There are some similarities between CRS in the sinuses and asthma in the lungs with regards to them being longer-term problems caused by uncontrolled inflammation.

Risk Factors:
– Allergic Rhinitis
– Asthma
– Aspirin sensitivity
– Smoking
– Environmental exposure
– Immunodeficiency
– Mucociliary clearance defect
– Systemic diseases

 

What are the symptoms?

The 5 main symptoms are:

  1. Blocked noseNasal discharge (coloured)
  2. Discharge through the nostrils or swallowed at the back of the nose.
  3. Snotty nose (can be clear or yellow / green)
  4. “Post-nasal drip” which is a sense of excess secretions running back into the throat
  5. Facial fullness and pressure (although severe pain is uncommon in CRS and should generally cause other diagnoses to be considered)
  6. Reduced sense of smell

Other general symptoms include cough, sleep disturbance, fatigue and throat irritation. A significant proportion of CRS patients also have lung problems, most commonly asthma.

 

How is it diagnosed?

Diagnosis is made through a combination of symptoms, examination of the nose and scans of the sinuses. In some, but not all CRS cases, “polyps” are seen inside the nose.

Diagnostic Criteria:
– 2 or more of the 4 main symptoms for >12 weeks AND
– Evidence of mucosal inflammation
– Direct visualisation (Nasal enodoscopy)

 

What are the potential complications?

Most cases of CRS are not risky and complications are very rare. When complications occur this involves infection spreading out of the sinuses into the eye socket, brain or the face. Usually this makes patients very unwell with associated fever.

Symptoms of potential complications include:

  • double vision, blurry vision, swelling/redness around the eye or pain with eye movement
  • swelling of forehead
  • neck stiffness, severe headache, sensitivity to bright lights

Complications:
– Orbital/Facial Cellulitis
– Cavernous sinus thromboses
– Meningitis
– Intra-cranial abscess
– Osteomyelitis
– Pott’s puffy tumor

 

What are the treatment options?

Control of symptoms and improvement of quality of life are the aims of CRS treatment. Using a bottle designed for washing salt water through the nose and nasal sprays containing anti-inflammatory steroid medicines are safe and effective initial options.

Antibiotic and steroid tablets are options for some patients and a review by an ENT Surgeon may also be required if symptoms are not well controlled. Endoscopic Sinus Surgery is commonly offered to patients with CRS who do not respond to routine medical treatment.

An acute sinus infection can still occur, please see Acute Rhinosinusitis for management options.

 

Can you prevent CRS?

While CRS is generally not preventable, avoiding cigarette smoke will reduce the risk of CRS developing and where CRS occurs this will also improve both symptoms and the effectiveness of treatment.

 

What is the prognosis?

With appropriate medical and surgical treatment, most patients will have significant improvements to their symptoms. The aim of the treatment is to improve the overall quality of life and allow normal functioning on a day to day basis. It is normal to still have persisting but reduced symptoms after treatment.

 

Further reading:

1. Chronic Sinusitis – Mayoclinic.org
2. Chronic Sinusitis – Clevelandclinic.org

 

References:
1. Hamilos D, Holbrook E. Chronic Rhinosinusitis. 2019. UpToDate.
2. Morcom S, Phillips N, Pastuszek A, Timperley D. Sinusitis. 2016. AFP. 45(6):374-377.

 

Author + Affiliation:
Dr Johnny Wu, Department of Otolaryngology, Waikato Hospital.
Reviewed by Dr Andrew Wood, Otolaryngologist, Waikato Hospital

Date of Publication +/- Review:
Date of Publication:
Date of Review: 14 April 2021

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