Chronic sinusitis

Background

• Sinusitis lasting for at least 12 weeks
• May or may not be infectious

Microbiology

• The microbiology is of unclear significant
• The same bacteria as in acute bacterial sinusitis may be present, especially during acute exacerbations
• Other bacteria include Staphylococcus aureus, Gram-negative bacteria, anaerobes, coagulase-negative staphylococci, and Corynebacterium

Risk Factors

• Systemic factors: viral infection, allergic inflammation, cystic fibrosis, immune disorders, ciliary dyskinesia, tobacco smoke
• Mechanical factors: choanal atresia, deviated septum, nasal polyps, foreign body, tumour, ethmoid bullae
• Local factors: facial trauma, swimming and diving, rhinitis medicamentosa, nasal intubation

Clinical Manifestations

• Symptoms of rhinosinusitis lasting for more than 12 weeks
• Can include nasal discharge, nasal obstruction, facial pain, hyposmia or anosmia, and dysgeusia

Management

• Treat acute exacerbations as acute bacterial sinusitis
• Large-volume nasal rinses are likely helpful
• Antihistamines should be used if underlying allergic disease
• Decongestants may be helpful
• Antihistamines and decongestants should be avoided in children due to the lack of known benefits and risks
• Depending on the underlying risk factors, sinus surgery may be beneficial