Chronic rhinosinusitis is inflammation of the lining of the nose and sinuses lasting 12 weeks or longer. It affects around one in ten adults. It exists in two main forms, with and without nasal polyps, which behave and are treated somewhat differently.
It is primarily an inflammatory disease, like asthma of the upper airway, and only rarely a persistent infection, which is why repeated antibiotics seldom solve it. Surgery opens the sinuses and allows medication to reach them; it does not remove the tendency to inflammation.
Symptome
- A blocked or congested nose on both sides
- Thick discoloured discharge from the nose or down the back of the throat
- Facial pressure or fullness, though facial pain alone is rarely sinusitis
- Reduced or lost sense of smell, typical of polyps
- Cough, particularly at night
- Tiredness and poor sleep
- Bad breath, ear pressure or upper tooth ache
Ursachen und Risikofaktoren
Several factors combine: an overactive immune response in the lining (type 2 inflammation in most polyp disease), allergy, asthma, smoking and air pollution, and anatomical narrowing of drainage pathways. Aspirin-exacerbated respiratory disease combines polyps, asthma and reactions to anti-inflammatory painkillers. One-sided disease may originate from a dental root infection, a fungal ball or, rarely, a tumour, and always deserves imaging. Cystic fibrosis, immune deficiency and ciliary disorders should be considered in children and in severe cases.
Wie es diagnostiziert wird
- Nasal endoscopy: A thin camera in the clinic shows polyps, pus and swelling, and is required to confirm the diagnosis.
- CT of the sinuses: Done after medical treatment has been tried, to map disease and anatomy before any surgery. It is not needed for every patient.
- Allergy testing: Skin prick or blood tests when symptoms suggest allergy.
- Blood eosinophils and total IgE: Help identify type 2 inflammation and eligibility for biologic drugs.
- Smell testing and asthma assessment: Document baseline function, as the two airways are closely linked.
Behandlungsmöglichkeiten
- Saline irrigation: High-volume rinsing once or twice daily, the basis of all treatment.
- Intranasal corticosteroids: Sprays, drops or steroid added to rinses, used long term. They are safe for ongoing use.
- Short courses of oral steroids: Shrink polyps and restore smell temporarily. They are limited to one or two courses a year because of side effects.
- Antibiotics: Reserved for clear bacterial flare-ups, with longer low-dose macrolide courses in selected non-polyp disease.
- Functional endoscopic sinus surgery: Opens blocked sinuses and removes polyps through the nostrils when three months of proper medical treatment has failed. Most people still need their rinses and sprays afterwards.
- Biologic therapy: Dupilumab, mepolizumab or omalizumab injections for severe recurrent polyps after surgery.
- Treating the source: Dental treatment for tooth-related sinusitis, and aspirin desensitisation in selected patients.
Wenn es dringend ist
Swelling or redness around an eye, double or reduced vision, a severe headache with high fever, neck stiffness, or swelling of the forehead mean infection may be spreading beyond the sinuses. This is an emergency needing hospital care the same day, wherever you are.
Reisen nach Türkiye zur Behandlung
Medical treatment is long-term and belongs at home. Endoscopic sinus surgery, often combined with septoplasty, is a realistic planned procedure abroad: one night in hospital and 7 to 10 days before flying, since early flights risk bleeding and pressure pain. Ask for a CT taken after a full course of medical treatment, not during a cold. Post-operative cleaning of the nose in clinic during the first weeks influences the outcome, so arrange an ENT review at home as well.
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Häufig gestellte Fragen
Will surgery cure my sinusitis for good?
It improves symptoms for most people, but polyps recur in a substantial proportion over the years, and sprays and rinses remain necessary.
Are steroid nasal sprays safe long term?
Yes. Very little is absorbed into the body, and they have been used safely for decades.
Will my sense of smell return?
It often improves with steroids, surgery or biologics in polyp disease, though not always completely.
Is balloon sinuplasty an alternative?
It can help limited disease of the frontal or maxillary sinuses without polyps. It does not treat polyps or widespread disease.