Chronic Sinusitis - How Smoking Can Cause It

Smoking and Second-Hand Smoke Contribute to Chronic Sinusitis

Man with sinusitis at home
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Sinusitis is a persistent inflammatory response involving the paranasal sinuses and nasal passages. When this lasts 12 or more weeks, it is called chronic sinusitis. According to the National Health Interview Survey, 2-16% of people in the United States are affected by chronic sinusitis. This condition can occur in both childhood and adulthood. Symptoms between children and adults will vary slightly.

Both adults and children may have:

  • Nasal drainage and post-nasal drip (typically white or yellow coloration)
  • Nasal congestion or blockage
  • Facial pressure or pain, including frequent headaches

In adults, decreased or complete loss of smell may occur. This typically does not occur in children. Children with sinusitis will sometimes have a cough, which is not typically seen in an adult.

The University of Pennsylvania School of Medicine said in 2009 that sinusitis was responsible for 13 million doctors visits in the U.S. and cost the nation an average of 6 billion dollars per year.

How Smoking Causes Chronic Sinusitis

Smoking is a common cause of ENT disorders, including chronic sinusitis. Exposure to second-hand cigarette smoke can be just as harmful, (or more so), and children living in homes where another family member smokes indoors are at an increased risk for ENT disorders. To understand the harmful changes that occur in the airways of smokers, and how this leads to chronic sinusitis you first have to understand the normal function of the nasal passages.

The nasal passages act as a first barrier within the body to prevent infection. There are certain cells (epithelial cells) within the nose and airway passages, which bear the responsibility of trapping and removing irritants and harmful substances before they have a chance to enter the body. Removal is accomplished through an airway surface liquid and hair like structures called cilia.

Cilia are capable of movement. To sum up a somewhat more complicated process, mucous traps harmful substances and cilia function to "sweep" the mucous and unwanted debris back out of the body.

When exposed to mild amounts of smoke, the body can effectively clear irritants in the nasal passages. However with higher concentrations of smoke or second-hand smoke, the body’s natural defense system becomes impaired. Cigarette smoke adversely affects the specialized cells that line the airway. Changes in the basic structure of these epithelial cells can lead to chronic inflammation as the cells lose their ability to regulate the airway. The cilia lining the airways and nasal passages can become paralyzed. When this happens, these important structures are no longer able to clear the airway of harmful substances.

These anatomical changes in the body make smokers not only at a higher risk for chronic sinusitis but for throat pain, chronic laryngitis, ear infections, loss of taste or smell, voice hoarseness, breathing problems, lung cancer, and other health problems.

Smoking cessation can reverse or partially reverse some of these problems, with results varying between individuals and somewhat depending on how long you have smoked. Regardless of your personal circumstances, however, studies consistently show overall improved quality of health in individuals after they quit smoking, with health benefits increasing the longer it has been since you have quit.

Diagnosing Sinusitis

The most common tests to diagnose chronic sinusitis include rhinoscopy, nasal endoscopy and radiographic imaging (MRI or CT scan). Both rhinoscopy and nasal endoscopy can be done quickly in your doctor’s office. If further clarification of sinus involvement is needed, radiographic imaging is a next likely step. While an MRI may be performed, the most common radiographic test for diagnosing chronic sinusitis is a sinus CT scan.

Treating Sinusitis

Saline nasal rinses (also called nasal irrigation), such as with a neti pot, may be helpful in removing irritants such as environmental tobacco smoke from the nasal passages. While effective (according to most research), saline rinsing alone is not as effective as when used in combination with a nasal glucocorticoid like Flonase. Some studies have suggested that nasal irrigation can actually cause sinus infections so you may want to discuss nasal irrigation with your doctor.

Medications can be helpful in treating symptoms. Over-the-counter medications such as pseudoephedrine, can cause rebound congestion and may quickly lose their effectiveness in the case of chronic sinusitis. Nasal glucocorticoids such as Flonase may be helpful. Different nasal sprays are commonly prescribed and include Nasonex, which my reduce the risk of rebound congestion.

Antibiotics have limited use in chronic sinusitis and are more useful when treating an exacerbating infection, but not for chronic maintenance.

Sinus surgery should be considered when less invasive therapies such as nasal glucocorticoids have failed. The endoscopic surgery has been shown to have a 98% improvement rate.

Sources:

Benninger, M.S. (1999). The Impact of Cigarette Smoking and Environmental Tobacco Smoke on Nasal and Sinus Disease: A Review of the Literature. American Journal of Rhinology. 13(6): 435-8.

Hamilos, D.L. (2012). Clinical Manifestations, pathophysiology, and diagnosis of chronic rhinosinusitis. Retrieved on November 29, 2012 from http://www.uptodate.com/contents/clinical-manifestations-pathophysiology-and-diagnosis-of-chronic-rhinosinusitis (subscription required)

Hamilos, D.L. (2011). Medical management of chronic rhinosinusitis. Retrieved on November 29, 2012 from http://www.uptodate.com/contents/medical-management-of-chronic-rhinosinusitis (subscription required)

Reh, D.D., Higgins, T.S. & Smith, T.L. (2012). Impact of tobacco smoke on chronic rhinosinusitis: a review of the literature. Int Forum Allergy Rhinol, 2:362-369.

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