Chronic Sinusitis

Chronic sinusitis, also known as chronic rhinosinusitis, is inflammation of the sinuses and nasal passageway that lasts over 12 consecutive weeks. It is a common condition, affecting 1-12% of people worldwide.

Chronic sinusitis is often mistaken as an infection, but it's actually an inflammatory disorder that can be worsened by viral/bacterial infections and other factors.

The interaction between systemic, local host and environmental factors contribute to sinus inflammation and to the development of this disease. Systemic factors include genetic diseases (ex. cystic fibrosis), immunodeficiency, autoimmune disease, and aspirin exacerbated respiratory disease. Local host factors include anatomical abnormalities of the sinuses or nose, complications from prior surgery (ex. scar), tumours/neoplasm, or foreign bodies. Environmental factors that can contribute include bacterial or fungal infections, allergy, environmental pollutants, and smoking.

Stages of Chronic Sinusitis

Chronic sinusitis typically progresses through several stages, which may eventually lead to the need for sinus surgery if other treatments fail.

These stages include:

Chronic sinusitis often begins with inflammation of the nasal and sinus lining, commonly triggered by allergies, viral infections, or environmental irritants. Intermitent symptoms of mild nasal congestion, facial pressure, and/or nasal discharge may occur.

As inflammation persists, recurrent acute episodes of sinusitis can develop. Symptoms such as nasal blockage, thick nasal discharge, and/or facial pain/pressure become more frequent, often returning after temporary relief from medical treatments. These episodes are often triggered by viruses and bacteria.

In the chronic phase, sinusitis symptoms last for months and may fluctuate in intensity. Constant nasal congestion, facial pressure/pain, and post-nasal drip may disrupt sleep, reduce concentration, and lead to fatigue. At this stage, inflammation may have caused structural changes. Some patients may even start to develop asthma symptoms.

When chronic sinusitis does not improve with consistent medical therapies—such as nasal corticosteroids, saline rinses, oral steroids, and/or antibiotics—it is considered a failure of medical management. The symptoms remain unresponsive to standard treatments, indicating that further intervention may be needed.

If medical treatments fail, sinus surgery may be considered to relieve chronic symptoms and set the stage to better control the condition in the long-term. Procedures like endoscopic sinus surgery aim to open and drain the sinuses, reduce sinonasal blockage, and allow for better airflow, helping to restore normal breathing and improve quality of life.

Factors, Symptoms, Diagnosing, and Beyond:

What are the common symptoms of chronic sinusitis?

Chronic sinusitis presents with key symptoms such as nasal blockage, discharge, reduced sense of smell, and facial pain/pressure.

How is chronic sinusitis diagnosed by an ENT specialist?

Chronic sinusitis requires two of four key symptoms for 12 consecutive weeks, plus evidence of sinus inflammation on endoscopy or CT.

What are the best treatment options for chronic sinusitis?

Effective management of chronic sinusitis focuses on controlling inflammation through treatments like steroid sprays/rinses, oral steroids, antibiotics, saline rinses, and biologics. Managing asthma and allergies may also help in some cases. If symptoms persist despite these treatments, surgery can reduce inflammation, improve medication delivery, and decrease acute infections. However, surgery complements medical therapy and does not replace it. After surgery, ongoing medical treatment is still necessary.

Dr. Yip specializes in minimally invasive endoscopic sinus surgery, though open surgery is rarely needed.

Requirements For Referral:

Referral requires sinonasal symptoms lasting 8-12 weeks with medical therapy (e.g., corticosteroid sprays or rinses) for at least 2-3 months. It also requres an accompanying non-contrast CT sinus to assess for chronic rhinosinusitis.

Chronic Sinusitis

Chronic sinusitis is often mistaken as an infection, but it's actually an inflammatory disorder that can be worsened by viral/bacterial infections and other factors.

Stages of Chronic Sinusitis

Chronic sinusitis typically progresses through several stages, which may eventually lead to the need for sinus surgery if other treatments fail.

These stages include:

Initial Inflammation

Recurrent Episodes

Chronic Phase

Failure of Medical Management

Surgical Consideration

Factors, Symptoms, Diagnosing, and Beyond:

What are the common symptoms of chronic sinusitis?

How is chronic sinusitis diagnosed by an ENT specialist?

What are the best treatment options for chronic sinusitis?

Dr. Yip specializes in minimally invasive endoscopic sinus surgery, though open surgery is rarely needed.

Requirements For Referral:

Referral requires sinonasal symptoms lasting 8-12 weeks with medical therapy (e.g., corticosteroid sprays or rinses) for at least 2-3 months. It also requres an accompanying non-contrast CT sinus to assess for chronic rhinosinusitis.

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Nasal, Sinus + Skull Base Surgeon in Calgary and Western Canada

Dr. Jonathan Yip MD, FRCSC, MSc

Chinook ENT

6700 Macleod Trail SW, Unit 150

Calgary, Alberta, Canada T2H 0L3

Phone: 825.540.3545

Fax: 403.288.6992

@uofc_rhinology