Chronic sinusitis describes inflammation of the nasal sinuses lasting 12 or more weeks, and is one of the most common chronic conditions in the United States. When these ongoing sinus infections occur four or more times per year, this is called recurrent chronic sinusitis. We have four sets of hollow cavities inside our heads, called the frontal, maxillary, ethmoid and sphenoid sinuses.   These sinuses are lined with mucosa and help keep our noses clear of pollen, dust, mold, germs and pollutants. When sinusitis occurs, the sinuses become inflamed and unable to drain mucus effectively. Colds, allergies, deviated nasal septum, nasal polyps, environmental pollutants, cystic fibrosis, and gastroesophageal reflux can all cause blocked sinuses. This can result in fever, nasal congestion, postnasal drip, discolored nasal drainage, mouth breathing, facial pain, headaches, and malaise.

Proper diagnosis of chronic sinusitis includes allergy testing (skin prick testing, immunodeficiency workup, immunoglobulin testing, pneumococcal titers, and testing for other underlying problems like Vitamin D deficiency, CT scanning, and/or flexible rhinoscopy (nasal endoscopy) to look directly at your nasal cavity.   Once you are accurately diagnosed, treatment includes medical or surgical options. With the help of a board-certified allergist, surgery can often be avoided. Allergies cause over 50 percent of sinus problems, and unless you treat the underlying medical problem, surgery won’t correct your symptoms. Allergists treat the underlying medical causes of chronic sinusitis. Non-surgical treatment options include antibiotics, steroids, nasal saline irrigation, mucus-thinning agents, antihistamines, nasal decongestants, and analgesics. If the sinusitis is caused by a structural problem, such as a deviated nasal septum, or if medical treatments fail, then you will be referred to an otolaryngologist (ENT doctor) for surgical treatment. If surgery does become necessary, new minimally-invasive options now exist, such as balloon sinus surgery.

In one clinical scenario, a 13-year old Freedom Allergy patient suffered from chronic sinusitis, wheezing, and frequent headaches. Oftentimes, deficiencies in antibodies like the streptococcus pneumoniae antibody may predispose patients to recurrent chronic sinusitis. Dr. Agrawal tested this patient’s streptococcus pneumoniae serotypes (immune cells), and found them to be low. The patient was administered the pneumovax immunization, and one month later her pneumococcal titers notably increased, demonstrating the effectiveness of the vaccine in her body. As a result of this immunization, the patient’s sinusitis and headaches improved, and she was able to resume running and conditioning at school with no problems. This one simple treatment helped the patient avoid surgery and a potential painful recovery process. This is just one among many success stories Dr. Agrawal has experienced with treating chronic sinusitis in a non-surgical manner.

References:

Brook I, Brusch JL. Chronic Sinusitis. Medscape Reference. 2015. Accessed in http://emedicine.medscape.com/article/232791-overview.

Carr TF, Koterba AP, Chandra R, et al. Characterization of Specific Antibody Deficiency in Adults with Medically Refractory Chronic Rhinosinusitis. Am J Rhinol Allergy. 2011;25(4):241-244. Accessed in http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387730/.

Texas Sinus Center. Common Sinus Problems. 2015. Accessed in http://www.texassinuscenter.com/common-sinus-problems/.

Texas Sinus Center. Titers. 2015. Accessed in http://www.texassinuscenter.com/titers/.