Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen for at least 12 weeks, despite treatment attempts.
Also known as chronic rhinosinusitis, this condition interferes with drainage and causes mucus buildup. Breathing through your nose might be difficult. The area around your eyes and face might feel swollen, and you might have facial pain or tenderness.
Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or by a deviated nasal septum. The condition most commonly affects young and middle-aged adults, but it also can affect children.
At least two of the four primary signs and symptoms of chronic sinusitis must be present with confirmation of nasal inflammation for a diagnosis of the condition. They are:
- Thick, discolored discharge from the nose or drainage down the back of the throat (postnasal drainage)
- Nasal obstruction or congestion, causing difficulty breathing through your nose
- Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
- Reduced sense of smell and taste in adults or cough in children
Other signs and symptoms can include:
- Ear pain
- Aching in your upper jaw and teeth
- Cough that might worsen at night
- Sore throat
- Bad breath (halitosis)
- Fatigue or irritability
Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn't a common sign of chronic sinusitis, but you might have one with acute sinusitis.
When to see a doctor
You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment.
Schedule an appointment with your doctor if:
- You've had sinusitis a number of times, and the condition doesn't respond to treatment
- You have sinusitis symptoms that last more than seven days
- Your symptoms don't improve after you see your doctor
See a doctor immediately if you have any of the following, which could indicate a serious infection:
- High fever
- Swelling or redness around your eyes
- Severe headache
- Double vision or other vision changes
- Stiff neck
Common causes of chronic sinusitis include:
- Nasal polyps. These tissue growths can block the nasal passages or sinuses.
- Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
- Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases can result in nasal blockage.
- Respiratory tract infections. Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
- Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.
You're at increased risk of getting chronic or recurrent sinusitis if you have:
- A nasal passage abnormality, such as a deviated nasal septum or nasal polyps
- Asthma, which is highly connected to chronic sinusitis
- Aspirin sensitivity that causes respiratory symptoms
- An immune system disorder, such as HIV/AIDS or cystic fibrosis
- Hay fever or another allergic condition that affects your sinuses
- Regular exposure to pollutants such as cigarette smoke
Chronic sinusitis complications include:
- Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
- Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
- Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
- Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.
Your doctor will feel for tenderness in your nose and face and look inside your nose.
Other methods for diagnosing chronic sinusitis include:
- Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses. This also is known as rhinoscopy.
- Imaging studies. Images taken using a CT scan or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical obstruction that's difficult to detect using an endoscope.
- Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as bacteria or fungi.
- An allergy test. If your doctor suspects that the condition might be triggered by allergies, he or she might recommend an allergy skin test. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.
The goal of treating chronic sinusitis is to:
- Reduce sinus inflammation
- Keep your nasal passages draining
- Eliminate the underlying cause
- Reduce the number of sinusitis flare-ups
Treatments to relieve symptoms
These treatments include:
- Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase, Veramyst), triamcinolone (Nasacort 24), budesonide (Rhinocort), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).
If the sprays aren't effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide (Pulmicort Respules) or using a nasal mist of the solution.
- Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long term, so they're used only to treat severe symptoms.
- Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis. Under medical supervision, you're gradually given larger doses of aspirin to increase your tolerance.
Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. If your doctor can't rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens might improve the condition.
In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.
Depending on the source of obstruction, the doctor might use various instruments to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.
When you see your doctor, expect a thorough examination of your sinuses. Here's information to help you get ready for your appointment.
What you can do
Make a list of:
- Your symptoms, including any that seem unrelated to the reason for your appointment
- Key personal information, including whether you have allergies or asthma and family medical history
- All medications, vitamins or other supplements you take, including the doses
- Questions to ask your doctor
Take a family member or friend along, if possible, to help you remember the information you're given.
For chronic sinusitis, questions to ask your doctor include:
- What's likely causing my symptoms?
- What are other possible causes for my symptoms?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What's the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
These self-help steps can help relieve sinusitis symptoms:
- Rest. This will help your body fight inflammation and speed recovery.
- Drink fluids, such as water or juice. This will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, which can be dehydrating. Drinking alcohol also can worsen the swelling of the lining of the sinuses and nose.
- Moisturize your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of medium-hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air to help ease pain and help mucus drain.
- Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
Rinse out your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others), saline canister or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses.
If you make your own rinse, use water that's contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water, and let air-dry.
- Sleep with your head elevated. This will help your sinuses drain, reducing congestion.
Take these steps to reduce your risk of getting chronic sinusitis:
- Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before meals.
- Manage your allergies. Work with your doctor to keep symptoms under control.
- Avoid cigarette smoke and polluted air. Tobacco smoke and air contaminants can irritate and inflame your lungs and nasal passages.
- Use a humidifier. If the air in your home is dry, such as it is if you have forced hot air heat, adding moisture to the air may help prevent sinusitis. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.