The treatment for chronic sinusitis is multiple, and in some cases there is not a “Cure”. Sometimes the goal of treatment is to produce a relief in the facial pain and chronic nasal drainage that typically marks the symptoms of chronic sinusitis.

Chronic sinusitis is often caused by multiple things that effect a person’s overall health. This includes exposure to viruses, bacteria, pollution, and allergens. Individual nasal hygiene and personal habits. Nasal anatomy, immunological status, and allergies also play a major role.

Effective treatment will often require a thorough investigation into the patient’s medical history, prior treatments and their use of medications designed to treat sinusitis. This may include over the counter medications or previously prescribed medications. Also important is ascertaining if the patient has a significant allergy history.

Generally speaking, allergies are a response by the body’s immune system to certain types of proteins, chemicals, and environmental entities that the body reacts to in an adverse way. Typically in the nose and sinuses patients will experience nasal discharge, sneezing, runny eyes, and itchy red eyes. Almost everyone will respond to certain types of allergens if the exposure is strong enough, or the duration of the exposure is extended.

Anatomic abnormalities of the nose and sinuses cause complications of chronic sinusitis by causing an obstruction of sinus drainage outlets. If the outlets from the sinuses do not drain, then the mucus that is produced in the sinuses may back up, and become stagnate in the sinuses. If this occurs a combination of allergic, infectious and immunologic reactions occur that lead to infections. This will manifest as thick discolored nasal drainage, possible facial headaches, and generalized malaise and even fevers.

Treatment of sinusitis will entail evaluation of the patient’s allergic status, general health, environmental exposures, and nasal and sinus anatomy. Effective treatment should be oriented at alleviating any environmental factors like allergens, chemicals, or smoke exposure. An effective cleaning regimen should be established using some type of nasal lavage.

Many physicians will combine a regimen of a topical decongestant, saline lavage and topical nasal steroid. Combining this three-tiered system with an effective antibiotic that treats the common bacteria that contaminate the sinuses id the mainstay of treating chronic sinusitis. Sometimes a mucolytic (guaifensin) and maximizing hydration will improve sinuses drainage.

Prolonged use of antihistamines should be avoided because they may thicken the mucus and prevent improvement in sinus drainage. Topical nasal steroids are a much safer and more effective treatment than antihistamines. Patients need to be encouraged to try a nasal steroid for at least a month before they decide that it is not working.

If a patient does not respond to a conservative regimen of antibiotics, and the above mentioned medical therapies, than a more thorough work up may be indicated including a computed tomographic  (CT) study and possibly allergy testing.  The reason for these two tests is to determine if the patient has an anatomic problem and/or an allergic problem that is causing their chronic sinusitis.

Obviously, it is becoming apparent from the above information that the concept of a cure for chronic sinusitis is complex. Please refer to my writings regarding balloon sinuplasty, sinus surgery, nasal septal surgery, and turbinate therapy for more information regarding chronic sinusitis.

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