Chronic Sinusitis

Diagnosis

Your physician may inquire about your symptoms during a physical examination, feeling for any soreness in your nose and face and examining inside your nose.

There are several ways to identify chronic sinusitis:

• Imaging tests. Your sinuses and nasal area can be seen in detail in computed tomography (CT) or magnetic resonance imaging (MRI) images, which could identify physical obstructions or deep inflammatory conditions that are difficult to see with an endoscope, such as polyps, tumors, or fungi.
• Looking into your sinuses. Your doctor can view the interior of your sinuses by inserting a small, flexible tube through your nose that has a fiber-optic light inside. This may enable your doctor to detect polyps, tumors, or a deviated nasal septum.
• An allergy tests. If your doctor suspects allergies may be causing your chronic sinusitis, they may advise a skin test for allergies. Skin testing is rapid, safe, and can identify the allergen causing your nasal flare-ups.
• Nasal cultures. In most cases, cultures are not necessary for the diagnosis of chronic sinusitis. However, if the problem doesn’t improve with treatment or is getting worse, your doctor may take samples from inside your nose to help identify the cause, such as bacteria or fungi.

Treatment

Chronic sinusitis is treated with:

• Nasal corticosteroids. Inflammation can be treated and prevented by using nasal sprays such as fluticasone, triamcinolone, budesonide, mometasone, and beclomethasone. If the sprays are not sufficiently effective, your doctor may advise using a nasal mist of the solution or rinsing with a saline solution containing drops of budesonide.
• Saline nasal spray or solution irrigation. Decreases drainage and flushes allergens and irritants away.
• Oral or injected corticosteroids. These drugs are used to treat severe sinusitis inflammation, especially if you also have nasal polyps. Only severe symptoms are treated with oral corticosteroids because prolonged use of these medications can have serious side effects.
• Allergy medications. Your doctor might advise taking allergy drugs if allergies are the root cause of your sinusitis.
• Aspirin desensitization therapy. If you experience aspirin-related responses that result in sinusitis and nasal polyps. You gradually receive higher aspirin doses while under physician supervision in order to build tolerance.
• Antifungal treatment. You might receive antifungal medication if fungi are the cause of your infection.
• Medication to treat nasal polyps and chronic sinusitis. Your doctor might administer an injection of dupilumab or omalizumab to treat your persistent sinusitis and nasal polyps. These drugs could relieve nasal congestion and shrink nasal polyps.
• Balloon sinus ostial dilation. Places a balloon inside a sinus cavity to widen it and create extra space.
• Antibiotics. When a bacterial infection is the cause of your sinusitis, antibiotics may be required. Your doctor may advise taking an antibiotic, often together with other medications, if an underlying infection cannot be ruled out.
• Immunotherapy. If your sinusitis is caused by allergies, allergy shots (immunotherapy) that lessen the body’s response to particular allergens may ease the illness.
• Surgery. Endoscopic sinus surgery is a potential solution for cases where treatment or medication has been ineffective. The procedure involves the use of an endoscope, a thin tube with a light, to explore the sinus passages. Depending on the cause of blockage, the doctor may remove tissue or a polyp with various instruments, or widen a narrow sinus opening to promote drainage.