How Does Chronic Sinusitis Differ From Sinus Infection In Terms Of Symptoms And Treatment?

Introduction

If you lived through a winter, which let’s be honest if you can read this you probably have, you have experienced sinus problems. Whether that be a stuffy nose, difficulty breathing easily, or facial pain after a cold, almost everyone would have experienced sinus related discomfort.

It is quite common but these symptoms should go away shortly right? Well sometimes, as in the case of chronic sinusitis, they don’t and unfortunately, these sinus issues become a frustrating part of life. Managing something that is with you for only ten days or for a few months will require different approaches and this is why it is important to learn and understand the differences between acute and chronic sinus infections. In this article, we will try to cover the differences and similarities between both including symptoms and treatment.

Definition and Duration

Let's start from the basics. What is a sinus? Sinus in general means a cavity in the body, in this particular topic we will be talking about the small cavities we have in our facial bones. There are a few of these air-filled cavities in our skull. They are lined with a mucous membrane and help filter and humidify the air we breathe among other functions such as enhancing our voice resonance.^1,2 But during sinus related health issues, these areas inflame and even may become blocked resulting in disrupted airflow.

Something in medicine is called acute when it starts abruptly and doesn't linger for a long time. In this case acute sinus infection or sinusitis, as it’s more commonly known, happens when we catch a cold or get an upper respiratory tract infection. During this time the inflammation spreads to the facial sinuses and causes those membranes to get inflamed as well. This usually lasts for less than a month and will go away on its own after the initial condition is treated.^2,3

Chronic sinusitis on the other hand, as you may have guessed, is when this inflammation remains in the body for at least 12 weeks, sometimes even more. Chronic sinusitis can especially be frustrating because it may come back despite treatments. The reason behind this is that chronic sinusitis is usually linked to another underlying condition such as allergies, nasal polyps, or a deviated septum.^4,5

Causes

Understanding the cause and treatment of both kinds of sinus infections may require further reading. While in this article we will provide some rudimentary information, further information for acute and chronic sinusitis can be found on Klarity Health Library.

The most common cause of acute sinus infection is viruses. Oftentimes common cold causes a viral infection of the facial sinuses which causes the mucous membrane to swell up and produce mucus. Then, the person experiences pressure in the skull, blocked air flow, and runny nose.³ 

While it is less common, bacterial infections can also cause acute sinusitis, along with allergens and irritants such as dust, smoke, or some chemicals.^3-5

Although both sinus infections result in inflammation, chronic sinusitis is a more complex condition, immunologically speaking, and the resulting inflammation can linger around for much longer, sometimes even after the initial trigger is removed.³

Allergies such as hay fever are one of the most common causes of chronic sinusitis. Allergic reactions caused by the allergen can take a long time to subside which results in lingering inflammation of the sinuses and the nasal passage.

A similar situation can also happen when an acute infection doesn't clear up completely and contributes to a repeated infection which may end up in chronic sinusitis.^4,5

As you might have connected the dots here, the immune system plays an important role in sinusitis and any condition that weakens the immune system may also cause it to overreact and lead to a chronic inflammation.⁴

Physical problems such as nasal polyps and a deviated septum, which are small non cancerous growths inside the nose or a crooked nasal wall respectively, can also black the canals leading to sinuses. This can lead to reduced draining or complete blockage of the sinuses which causes a chronic condition.⁴

Symptoms

As expected there are common symptoms between the two conditions and while they may seem the same on paper, there might be key differences in the severity, pattern, and duration of these symptoms. 

Facial pain or pressure, nasal congestion, resulting headache and fatigue are the shared symptoms between the two but we can usually differentiate between them by duration and intensity because in acute sinusitis these symptoms are present for a shorter amount of time while being more intense.^2-4

Fever and thick yellow/green nasal discharge are usually associated with acute sinusitis only and they are related to an active ongoing infection.³

On the other side, reduced sense of smell, postnasal drip and resulting cough due to throat irritation are symptoms that are more closely associated with chronic sinusitis.^4,5

Diagnosis

The diagnosis process involves both a doctor’s investigation and a physical examination. In most acute cases there will not be any need for further investigation especially if the physician finds signs of a viral infection as these will clear up in around 10 days. Rarely, if the symptoms are severe enough, the doctor may order imaging such as an X-ray or a CT scan to eliminate possible other causes.^3,4

Diagnosing chronic sinusitis requires further investigations which may be in the shape of a CT scan to get a detailed view of the sinus and nasal bone structures and/or a flexible nasal endoscopy to investigate the nasal passages and the sinuses.

Depending on the symptoms these might be necessary to identify a nasal polyp or a deviated symptom. Allergy tests may also be ordered if the physician has a reason to believe that the symptoms are allergy related.^4,5

Treatment, Prognosis & Prevention

Detailed information on the treatment of acute and chronic cases can be found on Klarity but we will briefly cover them here too.

Acute Sinusitis 

As most of the acute cases are viral related; rest and proper hydration are the most important steps to regain the strength to fight the pathogens. The immune system will do the rest of the work and the condition is expected to clear in one to two weeks.

In the meantime decongestants can help with breathing, painkillers can ease the headaches as well as reduce the fever, and saline sprays can clear out the excess mucus to relieve congestion. In case the doctors think the cause is bacterial or fungal, they may also prescribe appropriate medications.^3,4

Rules for preventing viral and bacterial infection are quite important here. Washing hands frequently, especially during the cold season is essential as well as avoiding contact with people who are sick. Humidifiers are a good way to keep nasal passages to reduce the risk of pathogens sticking to the nasal passage.^3,4

Chronic Sinusitis

Being a long term condition, chronic sinusitis treatments require a long term approach. Depending on the cause ongoing long term treatment will be needed and unfortunately for some people, it will be a manageable but lifelong condition.⁴

Saline irrigation sprays are a common approach as they clear mucus and possible allergens. For reducing the inflammation, corticosteroid sprays or tablets might be needed. If there are signs of an ongoing bacterial infection antibiotics may also be required.

In the cases of allergic chronic sinusitis, antihistamines, and other allergy treatments will form the cornerstone of the treatment. Surgery is also a treatment option here if the cause is determined to be a structural issue such as a deviation or a polyp.^3-5 

Using saline irrigation regularly is a proven way to prevent flare-ups in chronic sinusitis as it flushes allergens and pathogens out while keeping nasal passages moist. Avoiding irritants such as dust, smoke, etc. as well as controlling any known allergies is also important in preventing chronic sinusitis flare-ups.^3-5

Summary

Acute and chronic sinusitis are somewhat similar conditions that share similar symptoms, such as facial pain, nasal congestion, and headaches, but their duration and underlying causes set them apart. Acute sinusitis as the name suggests is a short-term condition, often resulting from viral infections like the common cold, lasting less than a month. It typically resolves once the initial infection is treated. 

On the other hand, chronic sinusitis is a persistent condition lasting at least 12 weeks and is often linked to underlying issues such as allergies, nasal polyps, or a deviated septum. Chronic sinusitis tends to have flare-ups and may require ongoing management.

Treatment for both conditions varies depending on the cause and severity. Acute sinusitis is relatively simpler and it generally improves with rest, hydration, decongestants, and over-the-counter pain relievers, while severe cases might need antibiotics if bacterial infection is suspected. Chronic sinusitis, however, requires a long-term approach, often involving saline sprays, corticosteroids, and sometimes surgery if structural issues like polyps or deviations are present. 

Preventing flare-ups in chronic cases often includes managing allergies, avoiding irritants, and regular nasal irrigation. The immune system plays a significant role in both types, but chronic sinusitis tends to involve a more complex, prolonged inflammatory response.