More than 4 million people visit their doctor with chronic sinusitis each year. Unlike acute sinusitis, chronic sinusitis refers to an inflammation of the sinuses that persists for a long time, despite treatment.
Chronic sinusitis can interfere with the way your sinuses drain, leaving you feeling ”stuffed up” or with swollen or tender sinuses for more than three months.
In this article, I’ll describe the difference between acute and chronic sinusitis, and its common symptoms and causes.
I’ll also cover how chronic sinusitis is diagnosed and treated, and some prevention strategies. Finally, I’ll describe the risks and complications of chronic sinusitis, and when you should reach out to your doctor for care.
What is Chronic Sinusitis?
Sinusitis, sometimes called rhinosinusitis or simply a sinus infection, is caused by inflammation in your sinuses, the air-filled passages around your nasal cavities.
When these cavities are infected, mucus can build up, causing the familiar symptoms of nasal congestion, or feeling “stuffed up.”
Chronic sinusitis is long-lasting inflammation or infection of the sinuses; this type of infection lasts more than three months, and can even last for years.
Often, chronic sinusitis doesn’t resolve after initial treatment, and may even require several types of treatment.
Chronic vs. acute sinusitis
Acute sinusitis refers to a short-term inflammation or infection that generally lasts 10 days or less.
Most cases of acute sinusitis go away by themselves and the symptoms can be managed with at-home remedies.
Chronic sinusitis, on the other hand, refers to inflammation or infection of the sinuses that lasts more than 12 weeks, despite medication or medical intervention.
Chronic vs. Recurrent Sinusitis
People with recurrent sinusitis have four or more bouts of sinusitis per year, but with symptom-free periods in between.
Chronic sinusitis symptoms persist for long periods of time without those periods of symptom-free relief.
The main symptoms of chronic sinusitis are:
- Tenderness, pain, or pressure in the face
- Post-nasal drip (including mucus in the throat)
- Runny nose, or thick nasal discharge (yellow or green in color)
- Stuffy nose or difficulty breathing through the nose
- Loss or reduced sense of taste or smell
- Halitosis (bad breath)
There are several possible causes of chronic sinusitis, including:
- Growths and abnormal nose structures: Nasal polyps or a deviated nasal septum can restrict or block the sinuses. When mucous cannot drain properly, infection or inflammation may occur.
- Infections: Bacterial, viral, or fungal infections can all cause chronic sinusitis.
- Immune system-related diseases: Complications of cystic fibrosis, HIV, and other conditions can lead to nasal blockage or poor sinus drainage. Having a weakened immune system can also increase your risk of infections, including sinus infections.
- Allergies: Inflammation caused by allergies can block your sinuses.
Chronic sinusitis is often diagnosed based on the timeline and severity of your symptoms.
Your healthcare provider may also feel around your nose and face to check for tenderness and swelling.
In some cases, a specialist such as an otolaryngologist, or ENT, may use a nasal endoscope to look inside your nose.
A nasal endoscope is a thin, flexible, fiber-optic scope that helps to identify inflammation or other abnormalities.
Other possible methods for diagnosis include:
- Imaging tests, like a CT scan or MRI
- Allergy testing
- Nasal or sinus discharge sample
- Biopsy, if your provider is concerned that the infection has spread
Treatment of chronic sinusitis can vary depending on the cause.
Possible treatment options include:
Most sinusitis is not caused by bacteria, so antibiotics will not be useful. In fact, less than 2 percent of sinusitis cases are bacterial.
But if your provider feels your infection is bacterial, they will prescribe an antibiotic like amoxicillin-clavulanate (Augmentin). Azithromycin (“z-pack”) is not a good antibiotic choice for sinusitis, especially when chronic.
Other medication options include:
- Nasal corticosteroids: Nasal sprays, including fluticasone (Flonase) and triamcinolone, may help treat and prevent inflammation.
- Oral or injected corticosteroids: These are used to reduce nasal polyps and relieve inflammation from severe sinusitis.
- Allergy medications: If allergies are causing your sinusitis, your provider may recommend specific allergy medications, including topical or oral antihistamines.
- Antifungal medication: These are used to treat chronic sinusitis caused by fungus.
- Injections: If you have nasal polyps, a specialist may recommend an injection of dupilumab or omalizumab (Xolair) to help reduce the size of the polyp and reduce your congestion.
- Immunotherapy: If allergies are the main cause of your sinusitis, your provider may recommend allergy shots, also called immunotherapy, to help manage and limit your body’s reaction to triggering allergens.
Most cases of chronic sinusitis can be managed at home.
Lifestyle and at-home remedies that can help to soothe your symptoms include:
- Over-the-counter (OTC) pain relievers: OTC pain relievers, including acetaminophen (Tylenol) or ibuprofen (Advil), may help reduce pain.
- Nasal rinses: Rinsing your nasal passages with a neti pot or squeeze bottle filled with sterile salt water (saline) can help clear your sinuses of allergens, mucus, and irritants, and relieve your symptoms.
- Rest: As with many infections, getting adequate rest will help your body fight the infection and speed up recovery. Be sure to drink ample fluids, too.
- Vapor bath: Moistening your sinus cavities with a vapor bath may ease pain and help mucus drain. To do so, fill a bowl with hot water and place your head over the bowl while draping a cloth or towel over your head to keep the vapor directed toward your face. Taking a hot shower or bath may help, too.
While treating and managing your chronic sinusitis at home, keep in mind that finding relief often requires multiple modes of treatment.
If you notice persistent or severe symptoms that don’t resolve on their own, reach out to your provider or healthcare professional for help.
In rare cases of chronic sinusitis that does not respond to other methods, your provider or otolaryngologist (ENT) may recommend surgery.
Depending on the root cause of your chronic sinusitis, you may undergo surgery to remove polyps, fungal balls, or tumors, or to correct a deviated septum.
Another procedure called balloon sinus ostial dilation may be used to open up your sinus cavity.
Not all cases of chronic sinusitis are preventable.
Still, there are some things you can do to help reduce your risk of developing chronic symptoms:
- Treat any underlying conditions: Asthma, allergies, or conditions that weaken your immune system can contribute to sinusitis.
- Daily hygiene and risk mitigation: Help keep your upper respiratory tract healthy by avoiding infections as much as possible. Stay away from others when they’re sick and wash your hands thoroughly with soap and water often, especially before mealtime.
- Allergy management: If you have allergies, talk with your provider about the best way to keep your symptoms under control, including nasal sprays and antihistamines.
- Don’t smoke: Avoiding firsthand or secondhand tobacco smoke and other pollutants will help to keep your lungs and nasal passages healthy.
- Humidifier or air purifier: Using a humidifier will help add moisture to your at-home air, which can help to prevent sinusitis. If using a humidifier regularly, be sure to clean the humidifier as directed to keep it free of mold. Or, if the air quality in your home is poor, using an air purifier can also help keep your lungs and nasal passages healthy.
- Eat well and stay hydrated: Keeping your body in overall good health can help prevent acute sinusitis. This includes eating a diet full of whole foods, fruits, and vegetables, and staying hydrated throughout the day.
- Regular nasal lavage: Rinsing your nasal cavities regularly with a neti pot or designated squeeze bottle can help to keep your sinuses clear and healthy.
Risk Factors and Complications
There are some risk factors that can increase the likelihood of getting chronic sinusitis:
- Structural problems with your nose or sinus cavities
- Regular exposure to smoke or other pollutants
- An immune system disorder, like HIV/AIDS or cystic fibrosis
- Aspirin sensitivity
- A dental infection
- A fungal infection
Complications of chronic sinusitis are rare. In those cases, complications can include:
- Infections: Though very rare, some people with chronic sinusitis may develop infections of the brain and spine (meningitis), or an infection that spreads to the bones (osteomyelitis) or skin (cellulitis).
- Vision problems: If the infection spreads to your eye, it can cause impaired vision, or in rare cases, permanent blindness.
When to See a Healthcare Professional
If you experience persistent symptoms that don’t respond to treatment or antibiotic therapy, reach out to your healthcare provider.
In rare cases, it’s possible that your symptoms could be a sign of a more serious infection. If you experience any of the below symptoms, reach out to your provider immediately:
- Severe eye pain, swelling, or redness
- High fever
- Double vision or other vision changes
- Stiff neck
Finally, if your symptoms worsen after initially improving, it’s important to reach out to your provider as soon as you can.
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Chronic Sinusitis. (n.d.). https://www.cdc.gov/nchs/fastats/sinuses.htm
Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials. (2019). https://pubmed.ncbi.nlm.nih.gov/31543428/