Chronic Rhinosinusitis: Symptoms, Causes, Treatment

What are the symptoms of chronic rhinosinusitis?

Chronic rhinosinusitis (CRS) is a long-term inflammation of the nasal and sinus passages, lasting 12 weeks or more despite treatment. Symptoms include:

• Nasal congestion or obstruction, leading to difficulty breathing through the nose.
• Thick nasal discharge, which can be yellow or green, draining from the nose or down the throat (postnasal drip).
• Facial pain or pressure, especially around the forehead, eyes, or cheeks.
• Decreased or loss of sense of smell.
• Cough that may worsen at night due to postnasal drip.
• Fatigue, due to the chronic inflammation and reduced airflow.

Some individuals also experience ear pain, bad breath, and a sore throat. The condition may occur with or without nasal polyps.

What are the causes of chronic rhinosinusitis?

Chronic rhinosinusitis (CRS) can be caused by a variety of factors, which often combine to lead to persistent inflammation in the nasal and sinus passages. Common causes include:

• Allergies, such as hay fever or dust mites, causing ongoing inflammation.
• Respiratory infections that fail to clear completely, leading to chronic inflammation.
• Nasal polyps, which are growths that obstruct nasal passages and block sinus drainage.
• Structural abnormalities, such as a deviated septum, that impair sinus drainage.
• Immune system disorders, which affect the body’s ability to fight infections.
• Environmental irritants, like pollution or smoke, that can damage the mucosal lining of the nose and sinuses.

Other contributing factors may include fungal infections, certain medications, or conditions like asthma or gastroesophageal reflux disease (GERD), which can exacerbate symptoms of CRS.

How is the diagnosis of chronic rhinosinusitis made?

The diagnosis of chronic rhinosinusitis (CRS) is typically made based on a combination of clinical history, physical examination, and imaging studies. Here’s how it is done:

• Medical history: Doctors evaluate symptoms such as nasal obstruction, facial pain, nasal discharge, and loss of smell, lasting at least 12 weeks.
• Physical exam: Using a nasal endoscope, a doctor can look inside the nasal cavity for signs of inflammation, polyps, or drainage.
• Imaging: CT scans of the sinuses may be used to assess the extent of inflammation, blockages, or structural abnormalities.
• Allergy or immune testing: Sometimes, tests for allergies or immune function are performed if these are suspected contributors to CRS.

Combining these methods allows for a thorough assessment of the condition and helps guide treatment.

What is the treatment for chronic rhinosinusitis?

The treatment for chronic rhinosinusitis (CRS) focuses on reducing inflammation, relieving symptoms, and addressing any underlying causes. Common treatments include:

• Saline nasal irrigation to flush out mucus and reduce inflammation.
• Nasal corticosteroid sprays to reduce inflammation in the nasal passages.
• Oral or injectable corticosteroids for more severe inflammation.
• Antibiotics if a bacterial infection is present.
• Antihistamines or decongestants for allergy-related CRS.
• Surgery may be recommended if medications and other therapies are ineffective, especially for structural issues or polyps.

Treatment is often personalized based on the patient’s specific condition and response to therapies.