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  • Writer's pictureDr. Koralla Raja Meghanadh

Acute On Chronic Sinusitis: Causes, Diagnosis, and Prevention Tips

Updated: Apr 23

Acute On Chronic Sinusitis: Causes, Diagnosis, and Prevention Tips

What is acute on chronic sinusitis?

Acute means severe, and chronic means long-lasting. "Acute on chronic" sinusitis is when a person with chronic sinusitis experiences sudden and severe symptoms of sinusitis.

Chronic sinusitis is a condition in which the inflammation and swelling of the sinuses persist for more than 45 days. In this condition, the severity and the number of symptoms are very low, and the symptoms are almost negligible.

When a patient with chronic sinus infection experiences an explosion of symptoms, it indicates acute on chronic sinusitis. This particular scenario serves as a hallmark of this medical condition. It can be a complex condition to manage. Still, with the proper treatment, most people can find relief from this sinusitis.

What causes acute on chronic sinusitis?

Acute on chronic sinusitis is caused in chronic patients when

  1. Exposed to cold weather

  2. Exposed to the Dusty environment or pollution

  3. Viral or bacterial infection

  4. Weakened immunity

Cold weather

Cold weather can worsen sinus problems by causing inflammation in the sinus walls. This can make it harder for the sinuses to drain properly, leading to more bacteria growing and causing infection. This can create a cycle where the infection causes more blockages, leading to more severe symptoms and making it harder to go about daily life.

Dusty environment or pollution

Dust and pollutants can cause allergic reactions that irritate the sinuses, increasing fluid secretion and inflammation. This can worsen sinus infections, turning previously chronic sinusitis into an acute on chronic condition that can be very bothersome and disruptive to daily life.

Viral or bacterial infection

When we get sick with a viral or bacterial infection, a part of our immune system's attention is diverted away from chronic sinusitis, making it easier for bacteria to flourish. If the infection affects the nose, it can cause additional swelling in the sinuses, leading to more blockages and fluid stagnation. This can cause worsening of the sinusitis, resulting in more severe and potentially new symptoms.

Weakened immunity

When our immune system weakens, it can upset the balance between immunity and bacteria in chronic sinusitis, leading to acute on chronic sinusitis. Dr. K. R. Meghanadh says it's common to see patients develop acute on chronic sinusitis after important exams or even traumatic events like accidents, which can cause mental stress and weaken the immune system. Simple factors like lack of sleep or exhaustion from exercise can also weaken immunity and trigger acute on chronic sinusitis, disrupting our daily lives.

Symptoms of acute on chronic sinusitis

Sinusitis is a condition that can cause a range of symptoms, which will vary in severity depending on the stage of the illness. In acute on chronic sinusitis, the symptoms are similar to those of acute sinusitis but can be more severe and longer lasting.

Some of the common symptoms experienced in any stage of sinusitis include

  1. Nasal blockage or congestion

  2. Runny nose

  3. Headache

  4. Facial pain

  5. A sensation of mucus going down the back of the nose into the throat

  6. A constant need to clear the throat

  7. Sore throat and throat pain that occur frequently

  8. Frequent attacks of coughing

In chronic sinusitis, patients usually experience one or two mild symptoms. However, as the condition progresses to acute on chronic sinusitis, the number and severity of symptoms tend to increase. This is because any disruption in the sinuses or a weakening of the immune system can lead to an increased risk of infection, causing the balance between the disease and the body to shift. Acute on chronic sinusitis symptoms are similar to acute sinus infection but more severe, and patients may experience four to five symptoms with higher severity.

Diagnosing acute on chronic sinusitis

When diagnosing acute on chronic sinusitis, doctors will begin by reviewing the patient's medical history and assessing their symptoms. Next, they will perform a nasal endoscopy and CT scan to determine the extent and severity of the condition.

Nasal endoscopy is a procedure that allows doctors to examine the nasal and sinus passages for signs of mucoid discharge, nasal polyps, and pus. In this examination, a thin, flexible tube with a light and camera attached is inserted into the nose, allowing the doctor to examine the nose and sinus openings carefully. This could give a picture of the patient's condition.

A CT scan can provide a detailed image of the sinuses in the head, allowing doctors to identify any structural abnormalities responsible for fluid build-up. It can also differentiate between different sinus contents, with air-filled sinuses appearing black and pus or fluid appearing grey or showing fluid level, respectively. Additionally, a CT scan can detect the presence of a fungal infection in the sinuses, which a grey shadow with a white shadow inside may indicate.

In summary, nasal endoscopy and CT scan allow doctors to comprehensively view the patient's sinuses, leading to a more precise diagnosis of acute on chronic sinusitis. This, in turn, will enable doctors to develop a personalized treatment plan that targets the root cause of the problem, resulting in more effective symptom relief and a faster recovery.

Treatment for acute on chronic sinusitis

The approach to treating acute on chronic sinusitis is similar to that of acute sinusitis in terms of the course duration. However, the antibiotics used may differ because the bacteria present in acute on chronic sinusitis are different from those in acute sinusitis. Initially, doctors will prescribe antibiotics that effectively treat both chronic and acute sinusitis. However, once the cultural studies are completed, they will identify the specific bacteria present in the sinuses and tailor the treatment accordingly. Whether to use antibiotics that target chronic and acute sinusitis or just chronic sinusitis depends on the surgeon's experience and judgment, as it is difficult to determine.

Chronic sinusitis can become acute on chronic sinusitis when new bacteria enter the sinuses, or the patient's immune system is weak. Depending on the situation, doctors must decide whether to prescribe antibiotics that act on both gram-positive and gram-negative bacteria or only one. This is why we cannot explain certain aspects of treatment easily; they must come with experience. So it is essential to learn from a senior surgeon while studying medicine as we cannot learn everything from textbooks.

Complications of acute on chronic sinusitis

Complications in acute on chronic sinusitis are rare. Still, when our immunity is down, the infection may spread beyond the sinuses, affecting nearby structures such as the eyes, brain, and teeth. Fortunately, this only occurs in a small percentage of the population - around one in every hundred thousand individuals. So, anything that reduces immunity can cause this complication.

Complications of acute on chronic sinusitis include:

  1. Orbital cellulitis: It is a condition where the sinus infection spreads to the eyes. It causes eye pain and swelling and can even lead to vision loss.

  2. Orbital abscess: The accumulation of pus in the eye socket can occupy the additional space, restricting eye movement and blood supply to the optic nerve. This restriction of blood supply to the optic nerve can result in vision loss, making it crucial to seek immediate medical attention. When the nerve's blood supply is lost, the vision might not return even after the treatment.

  3. Meningitis: When the infection spreads to the brain's coverings, it is called meningitis. It causes neck pain, neck stiffness, fever, and vomiting without the feeling of nausea.

  4. Encephalitis: When the infection spreads to the brain's contents, it is called encephalitis. It causes high fever, seizures, and coma, followed by death.

How to prevent acute on chronic sinusitis?

Tips for preventing acute on chronic sinusitis:

  1. Boost your immunity: Maintaining a strong immunity can prevent chronic sinusitis from turning into acute on chronic sinusitis.

  2. Reduce stress: Stress can weaken our immunity, causing acute on chronic sinusitis.

  3. Avoid cold and dusty climates: Exposure to cold or dusty weather can irritate sinuses and cause inflammation.

  4. Good hygiene: Good hygiene can prevent viral infections that can aggravate chronic sinusitis and cause acute on chronic sinusitis.

  5. Treating sinusitis: Treating chronic sinusitis on time will prevent acute on chronic sinusitis.

Following these steps can reduce your risk of developing acute on chronic sinusitis and promote overall sinus health.

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