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Chronic Rhinosinusitis

Overview of Chronic Rhinosinusitis

The sinuses are hollow, air-filled cavities located within the bones of the face and head. They are believed to help protect the brain during trauma. The sinuses are lined with a thin layer of tissue that normally produces a small amount of mucus. This mucus keeps the sinuses moist, healthy, and helps flush out germs.

Rhinosinusitis occurs when the lining of the sinuses becomes inflamed or infected. This causes swelling of the sinus lining and increased mucus production. Swelling can also block the natural drainage pathways of the sinuses, leading to mucus build-up and persistent nasal congestion.

What Is Chronic Rhinosinusitis?

Chronic rhinosinusitis is defined as inflammation of the sinuses lasting 12 weeks or longer, despite appropriate treatment.

A diagnosis requires two or more of the following symptoms:

  • Persistent nasal congestion or blocked nose
  • Mucus discharge from the nose or mucus dripping down the back of the throat (post-nasal drip)
  • Facial pain, pressure, or a feeling of fullness
  • Reduced or lost sense of smell (anosmia)

Chronic rhinosinusitis is different from acute sinusitis, which usually follows a cold and resolves within a short period. Chronic rhinosinusitis is a long-standing condition that often requires a specialised treatment approach by an ENT doctor in Dubai.

Because symptoms are often low-grade but persistent, the condition is frequently overlooked by patients and healthcare providers.

If you have required multiple courses of antibiotics in a year or experience ongoing nasal congestion for much of the year, an ENT consultation is recommended.

Causes of Chronic Rhinosinusitis

Unlike acute sinus infections, chronic rhinosinusitis is not caused by infection alone. While infections may worsen symptoms, most patients have underlying chronic inflammation.

Chronic rhinosinusitis is commonly classified into three main types:

1. Chronic Rhinosinusitis Without Nasal Polyps

This is the most common form.

Inflammation of the sinus lining may be caused by:

  • Environmental allergies
  • Airborne irritants
  • Recurrent or unresolved infections

The contributing factors vary between individuals.

Inflammation causes swelling of the sinus lining, which blocks drainage pathways and leads to mucus accumulation.

2. Chronic Rhinosinusitis With Nasal Polyps

Some patients develop nasal polyps, which are soft, painless, jelly-like growths inside the nasal passages or sinuses.

When polyps enlarge or multiply, they can:

  • Block the sinuses
  • Cause severe nasal congestion
  • Reduce the sense of smell

Treatment may involve medications to shrink the polyps or sinus surgery, and some patients require both.

3. Allergic Fungal Rhinosinusitis

In this condition, patients develop an exaggerated allergic reaction to fungi (airborne spores) present in the sinuses.

Although fungal spores are commonly present in the air and usually harmless, some individuals develop:

  • Thick, dense mucus filling the sinuses
  • Persistent nasal blockage
  • Chronic inflammation

Diagnosis requires:

  • Identification of thick fungal mucus during sinus endoscopy
  • Microscopic evidence of fungi
  • Confirmation of fungal allergy through testing

Risk Factors for Chronic Nasal Congestion and Sinusitis

Several factors increase the risk of developing or worsening chronic rhinosinusitis:

Allergies

Year-round allergies (dust mites, mould, animal dander, cockroaches) are common in patients with chronic sinus disease. Poorly controlled allergies worsen symptoms.

Tobacco Smoke & Environmental Irritants

Exposure to cigarette smoke and airborne chemicals increases sinus inflammation.

Immune System Disorders

Patients with immune deficiencies may experience recurrent sinus, ear, or chest infections.

Viral Infections

Repeated viral infections may contribute to the development of chronic rhinosinusitis.

Deviated Nasal Septum & Enlarged Turbinates

A deviated septum can contribute to nasal blockage, although it does not usually cause chronic sinusitis on its own.

Symptoms of Chronic Rhinosinusitis

Symptoms must include two or more of the following:

  • Persistent nasal congestion
  • Thick nasal discharge or post-nasal drip
  • Facial pain or pressure
  • Reduced sense of smell (especially in patients with nasal polyps)

Many patients also experience fatigue, which significantly impacts quality of life, although it is not part of the diagnostic criteria.

Diagnosis of Chronic Rhinosinusitis

Diagnosis is based on symptoms lasting at least three months, plus objective evidence of sinus disease.

Sinus CT Scan

A CT scan provides detailed images of:

  • Sinus lining inflammation
  • Mucus build-up
  • Nasal polyps or obstruction

Nasal Endoscopy

An in-office procedure using a thin camera to:

  • Visualise the nasal passages and sinuses
  • Identify inflammation, polyps, or infection
  • Collect sinus mucus samples when needed

Samples taken from the front of the nose do not accurately represent sinus disease.

Conditions Associated With Chronic Rhinosinusitis

Asthma

Approximately 20% of patients with chronic rhinosinusitis also have asthma, particularly those with nasal polyps.

Aspirin-Exacerbated Respiratory Disease (AERD)

Some patients with asthma, nasal polyps, and sinusitis experience worsening symptoms after taking aspirin or NSAIDs.

Symptoms may include:

  • Sudden nasal blockage
  • Sinus pain
  • Wheezing or chest tightness

Paracetamol is usually safe. Patients with suspected AERD should consult an ENT specialist.

Chronic Rhinosinusitis Treatment in Dubai

Treatment is individualised and may include:

Lifestyle Modifications

  • Smoking cessation
  • Reduction of allergen exposure

Nasal Saline Irrigation

Daily saline washes help:

  • Clear mucus
  • Improve drainage
  • Enhance effectiveness of medications

Steroid (Glucocorticoid) Therapy

Steroid nasal sprays, drops, or washes reduce inflammation, mucus production, and polyp size.

  • Sprays reduce swelling in nasal passages
  • Drops and washes reach deeper sinus cavities

Antibiotics

Used when bacterial infection is present. Long courses may be required in chronic cases.

Leukotriene Modifiers

Helpful in selected patients, especially those with asthma and nasal polyps.

Biologic Therapy for Nasal Polyps

Biologic medications are monoclonal antibodies that target specific inflammatory pathways.

They:

  • Reduce nasal polyp size
  • Improve sinus symptoms
  • Are used alongside steroid nasal therapy

Biologics are particularly useful for patients with recurrent polyps after surgery. Eligibility may depend on associated asthma or eczema.

When to See an ENT Doctor in Dubai

Consult an ENT specialist if you experience:

  • Nasal congestion lasting longer than 12 weeks
  • Recurrent sinus infections
  • Loss of smell
  • Facial pressure or pain
  • Poor response to medications

Early diagnosis improves outcomes and reduces complications.