Let’s Clear Things Up: Chronic Sinusitis

You know that feeling, when your nose is so stuffed that you feel like your head is filled with wet cotton, your thoughts seem foggy and every breath is a burning struggle? Well, multiply that by ten, and you get chronic sinusitis.

What causes this case of the perpetual sniffles? Well that’s the big question.

An article by Inofei Chen, “When Sinus Problems Won’t Go Away,” published in The New York Times in 2011, explored the different theories explaining chronic sinusitis that have emerged over the last couple of years.

Clarification: sinusitis does not equal chronic sinusitis. Sinusitis is a short-term condition that lasts for a couple of weeks, and is usually caused by an infection.

But in millions of cases, boring old sinusitis can become recurrent, and drag on for weeks, months, even years – chronic sinusitis.  For a full list of symptoms, click here.

Sinuses are hollow spaces filled with air that lead to the nose cavity. Lined with the same mucus-membrane as the nose, sinuses produce mucus, which keep the nasal passages moist. Sinusitis causes swelling in the sinuses and nose, preventing the mucus from being drained out. The result is pain and pressure around the eyes, sore teeth, and a seemingly endless stream of snot.

In the past decade, doctors have raised the possibility of chronic sinusitis being more of an inflammatory disease process, rather than an infection. The difference? An infection comes about when bacteria attack your immune system. An inflammatory disease on the other hand, is like asthma, a recurring condition that makes a body part swell – in this case, the sinuses. One can be fought off with antibiotics; the other, not so much.

In order to target the inflammatory symptoms, physicians switched from antibiotics to steroids.

One of the main difficulties in treating chronic sinusitis, Chen wrote, is that for a long time doctors couldn’t even agree on how to define it.  It wasn’t until 2003 that medical societies defined the condition as an umbrella term for a group of conditions marked by symptoms like sinus and nasal inflammation.

Even today, chronic sinusitis still isn’t fully understood. The newest theory, explained by Chen in his article, is that communities of bacteria referred to as biofilms may be causing those chronically mucus-clogged sinuses.

Biofilms are not a new discovery by any stretch of the imagination. Thomas Edison’s light bulb is a baby by comparison. But even though they were originally observed nearly 350 years ago, researchers still had trouble coming to terms with the notion of a bacterial community (Regardless of what Mucinex commercials will have you believe, bacteria aren’t floral-shirt-wearing Vegas gangsters with wives that look like future Snooki).  It is only in the past 30 years that real progress has been made in treating and diagnosing these pesky bacterial sects.

Scientists believe that these groups of bacteria, specifically those containing Staphylococcus aureus or Pseudomonas aeuruginosa, essentially cause the immune system to overreact.  Instead of fighting off the bacteria, the body produces an inflammatory reaction that causes the symptoms of chronic sinusitis.

But even this theory is far from certain, and the sad reality is that for many people, there is no cure in sight. For now, the best they can hope for is to manage the symptoms, and keep a steady supply of Kleenex close at hand.

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