Chronic Sinusitis – How To Treat and Manage

Diagram of the Human Sinuses

If you have been suffering from what seems like a persistent cold, with blocked or runny nose, productive coughing with phlegm, catarrh and headaches, then you may actually have sinusitis. If these symptoms have lasted for more than a few weeks then the problem may have developed into chronic sinusitis.

Chronic sinusitis is when the lining of the sinuses becomes inflamed  causing an immune reaction which in turn leads to the production of excessive mucus and phlegm. The condition often follows a cold or upper respiratory tract infection. Sometimes allergies, such as dust mites and hayfever, can trigger the condition.

What Are Sinuses?

The sinuses are small chambers behind the facial bones which fill with air and open into the nasal cavity behind. Sinuses are lined with the same membrane as your nose, and so are irritated by the same pathogens. It is this membrane that produces mucus. The function of mucus is the keep the nose moist and also to prevent pathogens from entering the body.

There are actually 4 sets of sinuses:

• Maxillary sinuses (Sinus maxillaris) – these are behind the cheekbones.
• Frontal sinuses – (Sinus frontalis) – these are above the eyes on the forehead.
• Ethmoid sinuses – (Cellulae ethoidales) these are behind the bridge of the nose between the eyes.
• Sphenoid sinuses (Sinus sphenoidalis) – these are behind the eyes, above the upper nose.

Typical Symptoms

The first clear sign that someone is suffering from sinusitis rather than a prolonged cold is that the sinuses become sore and painful. Sometimes it is just a feeling of tightness across the face that is often accompanied with a need to blink, wash or massage the face or just lie down and close eyes to rest a while.

Due to the inflammation a blocked or runny nose is also common. Sometimes the nose will run during the night while asleep leading to an accumulation of phlegm in the oesophagus (gullet) which has to be coughed up. This is known as Postnasal drip. Sometimes people feel the need to vomit after eating breakfast – the result often is a lot more phlegm than food being brought up.

Headaches are also common due to the pressure on the head that the inflamed sinuses cause. Some people notice a reduced sense of smell, although many people are not aware of this. Halitosis (bad breath) is another problem, usually caused by germs and bacteria being caught up in the phlegm.

Each of the sinuses can cause slightly different symptoms, especially when it comes to pain;

• Maxillary sinusitis – can cause tooth ache, pain in jaw and cheeks.
• Frontal sinuses – pain above the eyebrows – the forehead can become tender
• Ethmoid sinuses – pain around the eyes and to the side of the nose
• Sphenoid sinuses – pain around the eyes, on temples and top of head, plus earache and neck pain.

What Causes Sinusitis?

It starts when the nasal drainage channels, the ostia, become narrowed or blocked during an infection. Mucus cannot drain properly and the build-up causes further irritation, plus a runny nose or the constant need to blow ones nose.

Often the condition only lasts for a couple of weeks after an infection. However, sometimes conditions persist. Chronic sinusitis is when the problems continue for anywhere from a month to indefinitely. Some people suffer as a result of constant exposure to common irritants:

• Infections from viruses, fungi or bacteria
• Allergies from pollen and dustmites
• Tobacco smoke and other air pollutants
• Household cleaning sprays
• Chronic drug misuse, specifically snorting cocaine
• Cystic fibrosis can cause sinusitis

Treatment

Chronic Sinusitis by its nature is a condition which the body’s immune system alone cannot successfully treat.  Chronic conditions are defined as those which are permanent. However, there are several remedies which can alleviate the condition.

Medical Treatments

There are various medical treatments for chronic sinusitis. If the sinuses become very painful then both paracetamol or ibuprofen can help relieve pain. Ibuprofen may also help to reduce inflammation.

Decongestant nasal sprays can help to breakdown mucus and reduce swelling and inflammation. For cases of chronic sinusitis a doctor may prescribe steroid sprays.

Sinusitis can be made worse by bacterial infections to the upper respiratory tract, and in these cases a course of antibiotics may be prescribed to help clear the infection.

Antihistamines should be taken if the sinusitis is triggered by allergens, such as pollen (hay fever , cat hairs, dust mites etc..

Surgical Treatments

Chronic sinusitis may require surgery to cure. The surgical process unblocks and widens the sinuses to help airflow and help the sinuses to clear quicker. There are several types of sinus surgery available:

• Functional endoscopic sinus surgery (FESS) – An endoscope is used to wash out the sinuses and then widen the drainage holes. The process is carried out under a local or general anaesthetic.
• Balloon sinuplasty – A small surgical balloon is inserted into the sinuses via the nose and then expanded which forcibly unblocks the sinus cavity. This method is also called balloon catheter dilation of paranasal sinus ostia. See Balloon treats blocked sinuses (BBC website) for more on this procedure.
• Removal of nasal polyps – Only relevant is they are present and obstructing the sinuses. See Polyps, nose (NHS website) to find out more about nasal polyps.

 Self-Help Treatment / Alternative Treatments

There are several treatments you can perform at home which may help symptoms  However, it is always advisable to consult a doctor before starting any treatment.

• To ease pain and discomfort placing a flannel soaked with warm water on your face can help.
• Facial massage has helped some people. Indian Head Massage may be useful. The idea is that this helps to dislodge the sinuses.
• Drinking plenty of fluids can help to thin the mucus so it is easier to blow out.
• Inhaling from a bowl of hot water (boiled) that has had a few drops of Olbas Oil (contains clove oil, eucalyptus, juniper berry and cajuput), Karvol (menthol, cinnamon, and pine oil) or similar can help. This opens up the airways and can help you to naturally clean out the sinuses. Always read the label and do not use beyond the recommended time.
• Saline nasal sprays / nasal irrigation can also help to dislodge mucus and scar tissue resulting from damage to the nasal passage.
• Chicken soup – science may not properly explain why it helps, but for many people it does. Ideally a freshly prepared chicken soup rather than a tinned one.

Further Advice

There is a fair amount of conflicting advice on sinusitis so it is always wise to read a few different pages on the topic before taking action.

• Chronic Sinusitis – Patient.co.uk
• Sinusitis – NHS Choices
• Sinusitis – BUPA
• An Overview of Sinusitis – WebMD
• Sinus Conditions – Centers for Disease Control and Prevention