Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is the medical term for inflammation of the sinuses that has been ongoing for 3 months or longer. When the lining of the sinuses becomes inflamed, swelling blocks the natural sinus drainage pathways. This causes symptoms that usually include:

  • Nasal congestion
  • Nasal drainage
  • Facial pressure/pain
  • Decreased sense of smell
  • Cough
  • Low-grade fever
  • Ear discomfort

While several factors may contribute to the development of chronic rhinosinusitis, the most common causes are:

  • Viruses and bacteria
  • Allergies
  • Environmental irritants or allergens
  • A genetic predisposition
  • Obstruction of the sinuses

Most of the time, initial medical treatments, such as antibiotics, steroids, nasal sprays, and decongestants, will resolve symptoms. However, about 20% of the time, significant symptoms will persist despite medical treatment.

Chronic rhinosinusitis is diagnosed by your ENT physician after taking your history and performing a physical exam. It is important to note that symptoms of chronic sinusitis can often overlap with and mimic other disease processes, such as a viral upper respiratory infection, allergies, migraine headaches, and acid reflux. Therefore, it is important to make the correct diagnosis before initiating treatment.

Sometimes, a nasal endoscopy is performed during your clinic visit to help make the diagnosis. A nasal endoscopy helps the physician visualize your nasal passages in case a culture specimen needs to be taken.

A CT scan of the sinuses is often recommended to diagnose and evaluate your sinuses. Once chronic rhinosinusitis is diagnosed, prolonged medical therapy is often prescribed for anywhere from 3-6 weeks. Usually, this type of treatment successfully resolves the symptoms. Medical therapy may include:

  • An appropriate antibiotic
  • Steroids
  • Medicated nasal sprays
  • Allergy medications

Adequate hydration and fluid intake is very important because this will encourage mucus drainage and allow the natural defense mechanisms of the sinuses to function properly. Saline lavages or nasal irrigations of the nasal cavities are also helpful to physically remove retained mucus secretion and decrease swelling of the mucosal lining of the nasal passages. In addition to medical treatment, sometimes further testing is recommended, such as blood tests or allergy testing, to identify any predisposing factors that may be contributing to your illness.

If symptoms of CRS persist despite aggressive medical treatment, endoscopic sinus surgery may be considered. While each case is different, sinus surgery generally enlarges the natural sinus drainage pathways which may have the following results:

  • Improved ventilation
  • Removed sources of obstruction
  • Removed sources of infection
  • Reduced inflammation
  • Improved penetration of topical treatments to the lining of the sinuses

At the Raleigh Capitol Sinus and Allergy Center, our experienced surgeons will promptly evaluate your condition. After a thorough evaluation, our surgeons will discuss treatment options with you and help you decide which treatment option is best for you. If surgery is needed, our surgeons will use the latest techniques to safely and effectively perform your surgery. For an appointment, contact us.

For more information on this topic, we encourage you to visit the below links. 

Adult Sinusitis
Sinusitis