Sinusitis and Cystic Fibrosis

Information about sinus issues in Cystic Fibrosis (CF).

Sinus disease is quite common among people living with Cystic Fibrosis (CF) and can have a big impact on their quality of life. Here we outline some common symptoms, assessment and treatment of sinus problems in CF.

What are the sinuses?

The sinuses are a group of air-filled holes in the front of our skull, in the cheek bones, around the eyes and underneath the front part of the brain. They exist to warm, humidify and filter the air we breathe, make our skulls less heavy and improve the quality of our voice.

Sinus disease occurs when the lining of your sinuses becomes infected and inflamed. Sinus disease is common in CF because the thicker mucous found in the lungs is also found in the sinuses, which causes the mucous to get stuck and increases the risk of infection.

How is sinusitis diagnosed?

Symptoms

Facial pain/pressure
Frequently blocked nose
Thick or coloured snot
Poor sense of smell
Headaches
Bad breath
Tiredness
Cough/throat clearing due to postnasal drip

You may not notice these symptoms as they have often been there for a long period of time and you may get used to these things as feeling normal.

CT scan

Almost all people with CF will show ‘mucosal sinus disease’ on a CT scan but this has not been shown to predict the presence or severity of symptoms (Oomen and April, 2012)

Nasal Endoscopy

A camera is inserted into your sinuses to have a look at both the inside of your nose and sinuses. Nasal polyps are commonly found and are often a major cause of symptoms. Whilst this procedure is happening, a sample of mucous from inside the sinuses is taken to check for infection.

What are the treatment options for sinusitis?

All medical options for treating sinus issues should be tried before considering surgery. For medical therapies to work, they must be taken consistently and for at least a month. It is best to reassess progress using a symptom questionnaire such as the SNOT-22 or a follow up CT to determine whether this treatment is making gains.

Medical options for treatment include:

Antibiotics/anti-inflammatory medications (taken either by mouth, nasal spray or nasal nebuliser)
Sinus rinses

Sinus surgery is considered if symptoms are persisting despite maximal medical therapy. Surgery aims to make the sinus drainage pathways bigger and remove nasal polyps. It is important to understand that surgery is not a ‘cure’ and medical therapies will need to be maintained after the operation to prevent the symptoms coming back.

References

Oomen K. and April M., (2012) Sinonasal manifestations in Cystic Fibrosis, International Journal of Otolaryngology Volume 2012, Article ID 789572 Retrieved from https://doi.org/10.1155/2012/789572

Wang J., (2011), Cystic Fibrosis and Sinusitis, retrieved from https://med.stanford.edu/cfcenter/teens/Sinusitis.html