Understanding Chronic Sinusitis

Sinusitis is a condition in which the sinuses become inflamed in response to infection. The exact causes of sinusitis are not known, but research has shown that in patients with impaired immune systems, or other allergic conditions (e.g. asthma, allergic rhinitis). There are four regions of sinus passages. Swelling of these can cause headaches or nausea depending on severity of the inflammation. People with cystic fibrosis are prone to sinus infections for the same reason they are susceptible to lung infections. The thick, sticky mucus does not move easily through the sinus cavities, and can get stuck.

The 4 sinus regions are:

• Frontal
• Maxillary
• Ethmoid
• Sphenoid

(click on diagram above for larger image with labels)

The sinuses represent the upper respiratory tract. It is not uncommon to misdiagnose chronic sinusitis simply as a common head cold or headache. In people with CF, it is important to make sure that infections in the upper respiratory tract do not linger to the point of infecting the lower respiratory tract.

Since the role of the sinuses is to allow air flow into the body and to allow mucus out, anything that prevents this function can quickly become an uncomfortable, if not painful, problem. Chronic sinusitis in patients with CF is characterized by persistent sinus pain and pressure lasting 8 weeks or longer. Typically, if a doctor suspects sinusitis, he or she will conduct a quick examination that involves pressing on the face in the 4 sinus regions. If pain is indicated by the patient, or if swelling is suspected, the doctor might then order a CT scan and a visit to an ENT (ear-nose-throat specialist.)

Generally, the first course of treatment for sinus infections is prescription of an oral antibiotic. More aggressive CF clinicians may decide to start IV therapy in an attempt to prevent the infection from spreading and resulting in pneumonia. There is also the possibility that chronic sinusitis may be connected to ABPA, which is an allergic reaction to aspergillus, a fungus.

Damp weather and seasonal allergies may trigger episodes of sinusitis. Symptoms of the condition include:

• Fever
• Weakness
• Tiredness
• Coughing during the night
• Nasal congestion

Treating the symptoms and underlying cause of sinusitis can be difficult in cystic fibrosis patients. Products like Sudafed, which are designed to dry out the mucus membranes may cause more harm than good. Nasal steroids can be used to reduce inflammation, and antibiotics are useful in killing off a bacterial infection. In cases of ABPA, an antifungal such as Vfend or Sporanox is used.

A sputum culture may be taken in the doctor’s office. This is a useful tool in identifying bacterial infections. In order to obtain a sample, a long stick with a cotton swab on the end is touched to the back of the throat. The results are then sent to the laboratory for testing. The results of the test will determine the appropriate course of treatment. In the meantime, the doctor may recommend something like ibuprofen to reduce inflammation and pain.

A particularly useful, non-medicinal treatment option is to irrigate the sinus cavity with warm salt water. Over the counter saline nose sprays can be used for this purpose. Another method is to use a method called pulsatile irrigation. This is an effective means for flushing out the bacteria and sticky mucus.

Patients suffering from the complications of chronic sinusitis sometimes require surgery. A great deal of relief is experienced when the mucus is cleaned out. Once the sinus passages are no longer a breeding ground for bacterial infections, the frequency of antibiotic therapy can be reduced. Additionally, the threat of lower respiratory infections is greatly reduced.

For more information and related articles, please visit the following sites:

Endoscopic Sinus Surgery for CF

Cystic Fibrosis and Sinusitis

US Dept. of Health Sinusitis Fact Sheet

Dr. Hening, Stanford University CF Center: Sinusitis and CF

Sinusitis Info from eHealth-info

Sinusitis and Allergies (WebMD)

Pulsatile Irrigation Device (product ordering info)