How common is sinusitis?
Sinusitis is one of the most common chronic illness in the US, afflicting over 15% of the population.  It seems to be more common in women and certain geographic areas (such as the Southeast) have a higher incidence of sinusitis. Sinusitis resulted in 11.7 million visits to doctor’s offices in 2000. The prevalence of sinusitis has soared in the last 1-2 decades, possibly due to increased pollution or other environmental factors.

What causes chronic sinusitis?
The underlying causes/mechanisms of chronic sinusitis are not completely understood. One of the central events is swelling of the sinus lining that leads to obstruction of the sinus openings. This leads to retained secretions in the sinuses and the potential for subsequent bacterial infection.

It is currently thought that certain individuals may have a hyperactive or “revved up” immune system. This predisposes them to have significant inflammation in the sinus lining triggered by certain environmental factors. This can be thought of as “asthma of the nose.” When patients are exposed to these environmental “triggers” a flare-up may occur and patients can experience significant congestion, drainage, and swelling in their mucosa. This can result in facial pain/pressure, headache, and fatigue when the sinuses are obstructed.

The external triggers differ for each individual, but may include environmental allergies (pollens, trees, dust, molds, etc.), viral, bacterial, or fungal infections, or even pollution or tobacco smoke. Once a susceptible patient is exposed to an external trigger, a cycle of inflammation begins. Often the resultant swelling and congestion leads to a secondary bacterial infection that further exacerbates the inflammation.

Other causes of sinus obstruction can include trauma or previous surgery. Scarring from prior sinus surgery may actually lead to blockage of the sinuses. When this happens, a detailed evaluation is needed by a surgeon with extensive experience in revision sinus surgery, as repeated surgery may be needed.

Less common causes of sinusitis include diseases such as cystic fibrosis, Wegener’s granulomatosis, sarcoidosis, and immunodeficiency.  These are highly complex cases and usually require the care of a sinus specialist.

 More information on Fungal Sinusitis

Other Online Resources:
 Sinusitis (National Institute of Allergy and Infectious Diseases)

 Sinusitis (American Academy of Family Physicians)

 Sinusitis (American Academy of Family Physicians)- Español

 Tips to Remember: Sinusitis (American Academy of Allergy, Asthma, and Immunology)