This is the “million-dollar question” that rhinologists, allergists, immunologists and ear, nose and throat doctors all over the world are trying to answer. The cause is probably multifactorial. It seems that many patients with chronic sinusitis have an overactive immune response to inhaled foreign particles.
Some researchers believe the chronic inflammation is due to certain bacteria residing in the nose and sinuses which cause a chronic infection that is resistant to standard treatments because they have formed a sticky protective blanket (biofilm) shielding the bacterial cells from antibiotics, nasal rinses and sprays. Others believe that bacteria in the nose and sinuses secrete a toxin ultimately leading to inflammation in the sinuses. Multiple reports also point to inhaled fungal spores, and the body’s reaction to them, as a cause for persistent inflammation. Some patients may have other medical conditions predisposing them to chronic sinus inflammation or infection (Cystic Fibrosis, Wegener’s Granulomatosis, Sarcoidosis, HIV/AIDS, Kartagener’s Syndrome, immunodeficiencies).
A patient’s unique nasal and sinus anatomy (narrow drainage pathways, deviated septum, obstructing sinus cells) may also result in inefficient sinus mucous drainage and subsequent recurrent or persistent inflammation.
Every sinusitis patient is unique and therefore deserves a thorough ENT evaluation. Because the etiology of sinusitis is often multi-factorial, several treatment modalities exist. Treatments are recommended and prescribed based on the patient’s specific contributing factors. Patients are best served by a dedicated, meticulous evaluation and treatment plan rather than a “cookie-cutter” or generic approach to therapy.