Causes and Symptoms of Chronic Sinusitis Explained for Africans

 

By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team

Image of a woman experiencing sinus pain probably due to chronic sinusitis

 

Highlights

• Chronic sinusitis is an inflammation of the sinuses and nasal passages that lasts longer than 12 weeks at a time.

• The causes of chronic rhinosinusitis are numerous and overlapping.

• There is limited data on the prevalence of the condition in Africa.

• Neglected, chronic rhinosinusitis can lead to significant health complications.

 

 

Introduction

 

The bones of the skull and face contain air-filled cavities called sinuses (sinus, singular).  These cavities are connected to the nasal passages and lined with a tissue called mucous membrane. The job of the mucous membrane is to keep the cavities moist and clean. Typically, these structures contain air. However, bacteria, viruses or allergens can irritate them, causing them to become blocked and filled with fluid. These result in a condition called Sinusitis.

 

The term sinusitis only takes the sinuses into account; whereas,  this condition often also involves inflammation of the inside of the nose, a condition called rhinitis. Hence, most healthcare providers prefer the more inclusive term  Rhinosinusitis. 

 

When rhinosinusitis persists for an extended period, it is known as Chronic rhinosinusitis or Chronic sinusitis (chronic sinus infection). 

 

In this article, we will discuss:

• What chronic rhinosinusitis is

• Types of chronic rhinosinusitis

• Causes and risk factors of the disease

• Symptoms of chronic rhinosinusitis, and 

• How to distinguish between chronic rhinosinusitis and other types of rhinosinusitis

 

What is Chronic Sinusitis?

 

Chronic sinusitis or chronic rhinosinusitis (CRS) is an inflammation or swelling of the sinuses (in the bones of the face, front of skull, ear to name some) and nasal passages that lasts longer than 12 weeks at a time.

 

It is a common condition that affects between 5–15% of the general adult population worldwide [1] (although this figure may be understated due to underdiagnosis).  Research on this condition is equally few (especially in low resource countries) and findings are oftentimes conflicting. The case is not different in Africa where there are also limited research on small hospital based participants. For example, one study in Tanzania reported a CRS prevalence of 1.07%, [2] while another from Nigeria reported a prevalence of 5.7% [3]

 

The challenge to understanding CRS is due to the complex nature of the disease. CRS often presents differently in different people, has multiple overlapping causes and may also require different treatment approaches. 

 

In spite of the gap in knowledge in understanding the condition, scientists agree that CRS is generally characterized by a persistent inflammation of the mucous membrane of the nasal pathways and sinuses of the skull. It may affect one or more of these structures and can affect anyone regardless of age and gender although males in economically productive age range (21 – 40 years) are more affected. [3]

 

Types of Chronic Sinusitis

 

Chronic rhinosinusitis is divided into three types based on their different presentations.
 

1. Chronic rhinosinusitis with nasal polyposis (CRSwNP)

 

Sometimes, chronic rhinosinusitis may come with an abnormal, non-cancerous tissue growing inside the nose or sinuses called "nasal polyps". Cancerous polyps can however be very discomforting as they can become large enough to block nasal passageways and clog sinuses. Non cancerous polyps can also block the nasal passage and result in nasal congestion and a reduced sense of smell. To treat nasal polyps, doctors typically use medications to shrink the polyps or surgery to remove them, or both. 
 

2. Chronic rhinosinusitis without nasal polyposis (CRSsNP)

 

This is the most common type of CRS and as the name implies, there is no growth of polyps inside the nose and sinuses. However, other factors such as allergies, infection and irritants are responsible for the swelling and irritation of the sinuses and nasal passageway.
 

3. Chronic rhinosinusitis with fungal allergy (allergic fungal rhinosinusitis)

 

Chronic rhinosinusitis in some people may be due to an allergy to fungi. The air usually contains some fungi which typically do not pose any problem when inhaled.  However, in people with fungi allergies, it can cause inflammation of the mucosal lining of the sinuses.

 

What Causes Chronic Sinusitis?

 

CRS is a “multifactorial inflammatory disorder” (i.e., a disorder of soreness, puffiness and redness of multiple causes). [4, 5, 6] This means that the condition happens due to a combination of various factors which could be from both inside the body and outside (environment). These factors can be different for different people, and they can overlap or interact with each other. Hence, CRS is not a well-defined disease and neither are the causative factors well understood. Nonetheless, some factors that have been identified to cause or worsen the condition include:

• Allergies and environmental irritants

• Bacterial and fungal infections

• Genetic disorders (eg, cystic fibrosis)

• Asthma

• Metabolic abnormalities such as aspirin sensitivity

• Otitis media (inflammation or infection of the middle ear)

• HIV/AIDS

 

Notably, chronic rhinosinusitis may occur due to unresolved acute rhinosinusitis (ARS). However, the former manifests differently from the latter.

 

Risk Factors of Chronic Sinusitis

 

Other factors that increase your chances of developing chronic rhinosinusitis are summarised in fig 1 [4] and include:

• Cigarette smoking

• Other diseases and conditions associated with CRS such as gastroesophageal reflux disease,

• Autoimmune/inflammatory diseases, such as asthma, etc.

• Genetic factors.

• Immune system disorders.

• Airway diseases.

• Environmental pollution

Illustration of the risk factors for chronic rhinosinusitis. Click on imae to enlarge. Image credit: Min J-Y and Tan BK, 2015 [4]

 

Symptoms of Chronic Sinusitis

 

If you have any of the types of chronic rhinosinusitis mentioned above, you may experience any or a combination of some of these symptoms. [6, 7]

 

Major symptoms:

• Blocked, stuffy or congested nose 

• Discharge from the nose (runny nose)

• Mucus at the back of the throat

• Swelling, tenderness and  pain in the face, especially around the nose, eyes and forehead 

• Reduced or complete loss of the senses of smell and taste

 

Minor symptoms:

• Ear discomfort/pain 

• Sore throat

• Bad breath (halitosis) 

• Teeth pain (upper teeth)

• Persistent dry cough (primarily in children)

• Weakness and a feeling of being unwell (malaise)

• Visual disturbances

• Unexplained fever

• Worsening of asthma

• Headache

 

How does Chronic Sinusitis differ from Acute Sinusitis

 

While both acute and chronic rhinosinusitis involve inflammation of the sinuses, they differ in their duration and underlying causes, which also influences their treatment approaches.

 

Duration

•  Chronic rhinosinusitis: Chronic rhinosinusitis involves persistent inflammation of the sinuses lasting for 12 weeks or longer, despite attempts at treatment. 

• Acute rhinosinusitis: This condition is characterized by a sudden onset of symptoms that typically last less than 4 weeks.

 

Underlying Causes

• Chronic rhinosinusitis: Chronic rhinosinusitis may result from a combination of factors, including persistent infections (bacterial or fungal), allergies, nasal polyps, deviated vertical midline nasal bone (nasal septum), or other structural abnormalities in the nasal passages or sinuses.

• Acute rhinosinusitis: Acute cases are often triggered by viral infections, such as the common cold or influenza. However, bacterial and fungal infections can also be responsible in some cases. Bacterial infections can occur as a complication of a viral infection or independently.

 

Treatment Approach

• Chronic rhinosinusitis: Treatment for chronic cases may involve a combination of therapies, including nasal corticosteroids, nasal saline irrigation, oral corticosteroids, antibiotics (if a bacterial infection is present), allergy medications, and in some cases, surgery to correct structural issues or remove nasal polyps.

• Acute rhinosinusitis: Treatment for acute cases typically focuses on relieving symptoms and may include over-the-counter or prescription decongestants, pain relievers, nasal saline irrigation, and sometimes antibiotics if a bacterial infection is suspected.

 

Other Types of Sinusitis

 

Aside from chronic and acute rhinosinusitis, you may also experience a subacute and recurrent condition.

 

Subacute rhinosinusitis describe the disease if symptoms persist for longer than 4 weeks but less than 12 weeks.

 

Recurrent rhinosinusitis happens when you have symptoms for more than 4 to 6 times a year. Usually, this comes with symptom-free periods in between episodes.

 

Conclusion

 

Chronic rhinosinusitis (CRS) is a widely varying condition that significantly impacts the lives of millions worldwide. It is not by itself contagious; however, if there is a bacterial, viral or fungal infection, the micro-organisms can be transferred from one person to another.

 

CRS can manifest differently in each person, influenced by several factors including genetics, environmental triggers, and underlying health conditions. Understanding this diversity helps to emphasise the  importance of personalized approaches to diagnosis and treatment, tailored to addressing the specific needs and circumstances of each patient.

 

If you think you may have chronic rhinosinusitis, it is important to see a physician as soon as possible because neglected CRS can lead to health complications including brain diseases.

 

References:

1. Hopkins C, Slack R, Lund V, Brown P, Copley L, Browne J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope. 2009;119:2459-2465. Available from here.

2. Zephania Saitabau Abraham ZS, Gabriel R, Kahinga AA. Ntunaguzi D, Mapondella KB, Massawe EB. Prevalence of chronic rhinosinusitis at Muhimbili National Hospital, Dar es Salaam. South Sudan Medical Journal. 12(3) 2019. Available from here.  

3. Afolabi OA, Alabi BS, Omokanye HK, Ayodele SO, Segun-Busari S, Dunmade AD, Ologe FE. Management and Outcome of Rhinosinusitis in Nigeria. OTO Open. 2017 Jan 18;1(1):2473974X16685545. doi: 10.1177/2473974X16685545. Available from here.

4. Min J-Y, Tan BK. Risk factors for chronic rhinosinusitis. Current Opinion in Allergy & Clinical Immunology. 2015 Feb;15(1):1–13. doi:10.1097/aci.0000000000000128 Available from here.  

5. Lee S, Lane AP. Chronic rhinosinusitis as a multifactorial inflammatory disorder. Current Infectious Disease Reports. 2011 Feb;13(2):159–68. doi:10.1007/s11908-011-0166-z. Available from here.

6. Kwon E, O'Rourke MC. Chronic Sinusitis. StatPearls; [Internet. 2023 Aug.] Accesseed March 18, 2024. Available from here. 

7. Buchheit KM. Patient education: Chronic rhinosinusitis (Beyond the Basics). [Internet, 2023 Oct.]. Cited 2024 Mar 19. Available from here.    

 

 

Related: Chronic Rhinosinusitis: Diagnosis, Treatment and Prevention Information for Africans

 

 

 

Published: April 1, 2024

© 2024. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content for non-commercial purposes without alteration or modification and subject to attribution as to source.