Chronic (long-term) sinusitis is characterised by symptoms of sinus inflammation lasting more than 12 weeks. Most of the chronic sinusitis cases are linked with either bacterial or fungal infections. However, it is very difficult to manage most cases. Many patients, who are with chronic sinusitis, need repeated antibiotic courses and multiple sinus surgeries. Therefore, they have a significant risk of colonisation with antibiotic-resistant micro-organisms and of surgical complications. They usually suffer significant morbidity, sometimes over several years.
Chronic bacterial sinusitis
Chronic bacterial sinusitis occurs due to impairment of mucous (secretion) drainage through the opening of the affected sinus from repeated infections. However, most of the patients with chronic sinusitis don’t have obvious underlying causes, which lead to the impairment of mucous drainage or reduced immunity.
Patients feel persistent nasal congestion and facial pressure, which may last for several years. Sometimes, they may have severe symptoms intermittently.
CT scan of the sinuses helps define the extent of chronic sinusitis and the response to treatment. The otolaryngologist will conduct nasal endoscopic examinations and obtain biopsies for histologic examination and culture.
It is very difficult to manage chronic bacterial sinusitis. Repeated culture-guided antibiotic treatments, sometimes for three to four weeks at a time, are needed. Intranasal glucocorticoid spray or drops and sinus irrigation with sterile saline can help manage the condition. If these measures fail, surgery is indicated. Sometimes, surgery gives significant, but short-term relief.
Chronic fungal sinusitis
Chronic fungal sinusitis is a condition of immunocompromised patients. Most of the cases are non-invasive and sometimes; it can be an invasive condition with slow progression. Non-invasive chronic fungal sinusitis is usually linked with Aspergillus species. Some non-invasive cases can be associated with Curvularia or Bipolaris species.
Usually, repeated failures of antibiotic treatment cause mild, indolent cases of chronic fungal sinusitis. CT scan of the sinuses shows nonspecific changes of the lining of affected sinuses in this situation.
Most cases of the chronic fungal sinusitis resolve with endoscopic surgery, without anti-fungal drugs.
Sometimes, chronic fungal sinusitis can occur in a single sinus, causing symptoms of a side of the face. CT scan shows a fungus ball (mycetoma) within the sinus. An endoscopic surgery can cure this condition too. However, it can be rarely associated with erosion of the bone. Intravenous (injection) anti-fungal drugs are recommended in this situation.
Some patients, who have a history of asthma, nasal polyps, and multiple sinus surgeries, can have a condition known as allergic fungal sinusitis. They produce thick mucous with the consistency of peanut butter. Histologic examination of mucous may show the fungus. Most of the patients with allergic fungal sinusitis have the condition in all sinuses.
Recurrences of chronic fungal sinusitis are common.
- Biopsies – Tissue samples
- CT – Computed tomography
- Intranasal – Administered by way of the nasal structures
- Morbidity – The quality or state of being morbid
- Otolaryngologist – A physician, who specialised in diagnosing and treating diseases of the head and neck, especially those involving the ears, nose, and throat (ENT).
- Polyps – Abnormal growths of tissue, projecting from a mucous membrane
(Photo courtesy: Lisa Brewster)