Ahmad R. Sedaghat, MD, PhD, FACS
How do I know if I have chronic sinusitis?
Chronic rhinosinusitis (CRS), also referred to as chronic sinusitis, is an inflammatory condition of the nose and sinuses. I often compare it to “asthma of the sinuses”. Many people are familiar with asthma and are aware of asthmatics amongst their friends or families. Interestingly, CRS is just as common as asthma but there seems to be less awareness of it because people tend to attribute it to “allergies” or just don’t pay attention to the symptoms. The symptoms of CRS may not seem “serious” or life-threatening like the shortness of breath that asthmatics experience, but a lack of awareness of CRS or ignoring its symptoms is a big mistake in my opinion. It is well established by studies that we and others have done that the symptoms of CRS cause a significant decrease in quality of life and cause affected individuals to miss many days of work and school every year. Between medications and lost productivity due to uncontrolled and poorly treated CRS, it is estimated that CRS may cost society and the healthcare system billions of dollars every year.
CRS is defined by 12 continuous weeks of at least 2 out of the 4 symptoms of: nasal obstruction, nasal drainage, facial pain/pressure and decreased sense of smell. The diagnosis of CRS also depends on the presence of objective evidence of inflammation in the sinuses that a doctor can ascertain by looking in a patient’s nose with an endoscope or by getting a sinus CT scan. These criteria are described in the table/figure that I've provided below, which is from the “Adult Sinusitis Clinical Practice Guidelines” published by the American Academy of Otolaryngology – Head and Neck Surgery. Objective evidence of sinus inflammation is required for the formal diagnosis of CRS because the symptoms of CRS may also occur in the setting of other conditions such as severe, perennial or persistent allergies. What makes the situation even trickier is that CRS patients frequently have allergies, so a positive allergy test does not mean that there isn’t CRS as well (in fact the opposite is more likely the case). However, other conditions such as sinonasal tumors may cause the symptoms of CRS as well. It is important to make the distinction between CRS or other conditions such as allergies because CRS is treated differently and there are very specific treatments for CRS that are very effective. Even more seriously, if a sinonasal tumor is causing the symptoms, that should be discovered as soon as possible!
I have met many patients who for years have been told that they have “just allergies” and they continue to suffer from their CRS symptoms because they are being treated for allergies rather than CRS. For example, immunotherapy (which comes in the forms of “allergy shots” or sublingual drops) is an excellent treatment for allergies but its efficacy for CRS is still under question. The same is true for antihistamines (such as Claritin, Zyrtec or Allegra, amongst others). On the other hand, there are other treatments that are specifically used for effective care of CRS, such as steroid nasal irrigations and new biologic medications (such as dupilumab and omalizumab), which target the inflammatory chemicals that cause CRS, and in some cases sinus surgery.
We try to raise awareness of CRS because, as I alluded to above, there are so many easy and effective treatments for CRS. There is absolutely no reason to suffer from the quality of life detriment and lost productivity that comes from untreated CRS. If you meet the “symptoms” criteria of CRS (12 continuous weeks of at least 2 out of the 4 symptoms of: nasal obstruction, nasal drainage, facial pain/pressure and decreased sense of smell), I encourage you to seek out a sinus specialist to get an evaluation for CRS. The symptoms may very well be just allergies, but by knowing with certainty, you can be reassured that you are receiving the best treatment for your specific situation and feel confident that your symptoms will improve.