By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team
Image of a woman experiencing sinus pain probably due to chronic sinusitis
The bones of the skull and face contain air-filled cavities called sinuses (sinus, singular). These cavities are connected to the nasal passages and lined with a tissue called mucous membrane. The job of the mucous membrane is to keep the cavities moist and clean. Typically, these structures contain air. However, bacteria, viruses or allergens can irritate them, causing them to become blocked and filled with fluid. These result in a condition called Sinusitis.
The term sinusitis only takes the sinuses into account; whereas, this condition often also involves inflammation of the inside of the nose, a condition called rhinitis. Hence, most healthcare providers prefer the more inclusive term Rhinosinusitis.
When rhinosinusitis persists for an extended period, it is known as Chronic rhinosinusitis or Chronic sinusitis (chronic sinus infection).
In this article, we will discuss:
Chronic sinusitis or chronic rhinosinusitis (CRS) is an inflammation or swelling of the sinuses (in the bones of the face, front of skull, ear to name some) and nasal passages that lasts longer than 12 weeks at a time.
It is a common condition that affects between 5–15% of the general adult population worldwide [1] (although this figure may be understated due to underdiagnosis). Research on this condition is equally few (especially in low resource countries) and findings are oftentimes conflicting. The case is not different in Africa where there are also limited research on small hospital based participants. For example, one study in Tanzania reported a CRS prevalence of 1.07%, [2] while another from Nigeria reported a prevalence of 5.7% [3]
The challenge to understanding CRS is due to the complex nature of the disease. CRS often presents differently in different people, has multiple overlapping causes and may also require different treatment approaches.
In spite of the gap in knowledge in understanding the condition, scientists agree that CRS is generally characterized by a persistent inflammation of the mucous membrane of the nasal pathways and sinuses of the skull. It may affect one or more of these structures and can affect anyone regardless of age and gender although males in economically productive age range (21 – 40 years) are more affected. [3]
Sometimes, chronic rhinosinusitis may come with an abnormal, non-cancerous tissue growing inside the nose or sinuses called "nasal polyps". Cancerous polyps can however be very discomforting as they can become large enough to block nasal passageways and clog sinuses. Non cancerous polyps can also block the nasal passage and result in nasal congestion and a reduced sense of smell. To treat nasal polyps, doctors typically use medications to shrink the polyps or surgery to remove them, or both.
This is the most common type of CRS and as the name implies, there is no growth of polyps inside the nose and sinuses. However, other factors such as allergies, infection and irritants are responsible for the swelling and irritation of the sinuses and nasal passageway.
Chronic rhinosinusitis in some people may be due to an allergy to fungi. The air usually contains some fungi which typically do not pose any problem when inhaled. However, in people with fungi allergies, it can cause inflammation of the mucosal lining of the sinuses.
CRS is a “multifactorial inflammatory disorder” (i.e., a disorder of soreness, puffiness and redness of multiple causes). [4, 5, 6] This means that the condition happens due to a combination of various factors which could be from both inside the body and outside (environment). These factors can be different for different people, and they can overlap or interact with each other. Hence, CRS is not a well-defined disease and neither are the causative factors well understood. Nonetheless, some factors that have been identified to cause or worsen the condition include:
Notably, chronic rhinosinusitis may occur due to unresolved acute rhinosinusitis (ARS). However, the former manifests differently from the latter.
Other factors that increase your chances of developing chronic rhinosinusitis are summarised in fig 1 [4] and include:
Illustration of the risk factors for chronic rhinosinusitis. Click on imae to enlarge. Image credit: Min J-Y and Tan BK, 2015 [4]
If you have any of the types of chronic rhinosinusitis mentioned above, you may experience any or a combination of some of these symptoms. [6, 7]
While both acute and chronic rhinosinusitis involve inflammation of the sinuses, they differ in their duration and underlying causes, which also influences their treatment approaches.
Duration
Underlying Causes
Treatment Approach
Aside from chronic and acute rhinosinusitis, you may also experience a subacute and recurrent condition.
Subacute rhinosinusitis describe the disease if symptoms persist for longer than 4 weeks but less than 12 weeks.
Recurrent rhinosinusitis happens when you have symptoms for more than 4 to 6 times a year. Usually, this comes with symptom-free periods in between episodes.
Conclusion
Chronic rhinosinusitis (CRS) is a widely varying condition that significantly impacts the lives of millions worldwide. It is not by itself contagious; however, if there is a bacterial, viral or fungal infection, the micro-organisms can be transferred from one person to another.
CRS can manifest differently in each person, influenced by several factors including genetics, environmental triggers, and underlying health conditions. Understanding this diversity helps to emphasise the importance of personalized approaches to diagnosis and treatment, tailored to addressing the specific needs and circumstances of each patient.
If you think you may have chronic rhinosinusitis, it is important to see a physician as soon as possible because neglected CRS can lead to health complications including brain diseases.
Related: Chronic Rhinosinusitis: Diagnosis, Treatment and Prevention Information for Africans
Published: April 1, 2024
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