Chronic rhinosinusitis (CRS) is a common and prevalent disease in the United States. Symptoms include nasal congestion, drainage, facial pain or pressure and smell loss for at least twelve weeks. Previously bacterial infections were thought to be the reason for the symptoms, but now it is thought that chronic inflammation is the cause. The inflammation in sinusitis is similar to the chronic inflammation seen in asthma, and frequently people will have both disease processes. There are two main variants of chronic sinusitis – chronic sinusitis with polyps and chronic sinusitis without polyps.
Chronic sinusitis with polyps is largely an inflammatory disease and manifests with nasal obstruction, drainage and smell loss. Infections and pain are less frequent. Polyps are the end result from over-inflammation of the normal lining of the nose, in which the mucosa becomes swollen and eventually forms the grape-like polyps. They are not tumors, and are different from colon polyps. If treatment with topical nasal steroids fails, then endoscopic sinus surgery can improve quality of life for patients. Polyps do recur, however, revision sinus surgery is only required when the patient’s symptoms recur and cannot be controlled with medicine.
Chronic sinusitis without polyps has similar symptoms to CRS with polyps, but pain and infections are more common. Topical steroids and rinses are the initial treatment of choice. If the patient fails medical therapy then endoscopic sinus surgery can help through improved aeration and improved access for topical therapies to reach the sinuses.
Since both of the diseases are inflammatory, the treatments of choice to decrease inflammation are topical steroids. Flonase or any of the OTC topical steroid sprays are a good initial treatment option, in conjunction with a saline sinus rinse. If a patient continues to have symptoms then the addition of budesonide (a steroid used in treatment of asthma) to the saline rinses can have more efficacy.
Josh Meier, M.D. F.A.R.S.