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Acute and Chronic Rhinosinusitis

Patients with chronic rhinosinusitis experience inflammation of the sinuses and the nose, and nasal obstruction with ongoing nasal drainage that can be thin or thick and often discolored, either from the front of the nose or from the back of the nose to the throat. Other symptoms include smell loss, headaches, facial pain and pressure, fatigue, and sometimes ear fullness.

Acute Rhinosinusitis

Acute rhinosinusitis is typically caused by a virus and only lasts for about 7-14 days. In many patients, acute rhinosinusitis recurs one to two times per year. Medication is not needed to fight these viral infections, as the body is able to fight them on its own. Over the counter nasal decongestants can help with symptoms to reduce inflammation of the sinuses so that you can breathe better and to allow your sinuses to drain properly. Sometimes nasal steroid sprays are recommended to help decrease the length of a cold or viral sinus infection.

More rarely, these viral infections can create an environment that allows bacteria to grow, sometimes resulting in a bacterial sinus infection. If symptoms persist for 10-14 days, an antibiotic may be prescribed to treat the bacterial infection.

If you experience any unusual symptoms such as eye swelling or severe fever with rhinosinusitis, please see your ear, nose, and throat doctor.

Metson, Ralph; Mardon, Steven, The Harvard Medical School Guide to Healing Your Sinuses, McGraw-Hill Professional, Figure 3.1, pg. 27.

Chronic Rhinosinusitis

Rhinosinusitis becomes “chronic” when symptoms persist throughout and beyond a three-month period. Chronic rhinosinusitis is not caused by an infection; rather, it is thought to be more of a response to something in the environment, similar to an allergy.

An ear, nose, and throat doctor will make a diagnosis of chronic rhinosinusitis based on the patient’s symptoms and on the findings from an endoscopic exam. Sometimes a sinus CT scan is ordered to aid in diagnosis. Because there are a variety of conditions that can cause the same symptoms as chronic rhinosinusitis, the Sinus Center follows a strict clinical practice guideline to reach this diagnosis.

There is no cure for chronic rhinosinusitis, but there are treatments available to alleviate the symptoms. Initial treatments include medications such as topical nasal steroids, allergy treatments, and saline nasal washes to help reduce the swelling and to allow proper drainage of the sinuses.

When medical therapies are not enough, sinus surgery is sometimes recommended to help the sinuses drain properly, to help them exchange air, and to help patients get medication into those areas to decrease the inflammation. The goal of sinus surgery for chronic rhinosinusitis is to make the openings of the sinuses larger. The surgery is performed under general anesthetic and patients are usually able to go home that day. Patients should refrain from exercise or strenuous activity for a week or two following surgery. Many patients feel tired and some patients experience headaches during recovery, but pain is usually mild and easily controlled. Patients are usually seen 7-10 days after surgery to clean out the sinus cavities and to make sure that everything is healing properly.

Metson, Ralph; Mardon, Steven, The Harvard Medical School Guide to Healing Your Sinuses, McGraw-Hill Professional, figure 15.1 Sinuses before and after surgery, pg. 137.

Nasal Polyps from Chronic Rhinosinusitis

When the inflammation reaches a certain degree, patients will sometimes develop nasal polyps. Not everyone with chronic rhinosinusitis develops polyps. Polyps that develop from chronic rhinosinusitis are not cancerous. They are an indication of serious inflammation in the sinuses caused by chronic rhinosinusitis.

Metson, Ralph; Mardon, Steven, The Harvard Medical School Guide to Healing Your Sinuses, McGraw-Hill Professional, Figure 4.3 Polyps, pg. 43.

For more information on acute and chronic rhinosinusitis, please speak with your physician.