Infections lasting several weeks begin to shift into the realm of chronic rhinosinusitis (CRS) where a specialists’ visit, imaging, or endoscopic nasal culture  may be helpful in sorting out the condition and making the best treatment recommendations.

While Acute vs Chronic Sinus Infection is fairly intuitive to sort out, there is an intermediate condition that remains frustrating and under-studied: Recurrent Acute Sinusitis (or Recurrent Acute Rhinosinusitis, RARS).  RARS is basically the condition of relapsing episodes of short-lived sinus infections.  Studies have shown these can have quality-of-life and reduced productivity impairments similar to Chronic Rhinosinusitis.  Unlike CRS however, patients are more likely to be managed by recurring visits to their primary care provider or walk-in clinic.  Patients are also less likely to have inflammatory changes on CAT-scan imaging (in large part because most insurers pay for cat scanning only following a long course of antibiotics, which we know will temporarily resolve acute sinusitis, so the CAT scan may be timed to “miss” the sinus infection).

Treatment of RARS is somewhat open to dispute.  Many studies find surgical treatment of RARS to have similar positive effects of surgical treatments for the more standard CRS.  A number of anatomic variants seen on CT scans are closely associated with the diagnosis of recurrent acute sinusitis (including Haller cells, variant middle turbinates, narrow sinus openings, and septal spurs).

The tool of balloon sinus dilation / sinuplasty and our subsequent improvement in other office sinus surgical techniques gives greater access to treatments for RARS.  Now we do not need to have the greater risk and recovery-time of endoscopic sinus surgery to adequately address these anatomic problems.  Balloon sinuplasty to treat RARS is very valuable at improving quality of life and reduced sick days, with only very small risks compared to more aggressive surgery and anesthesia.