What Is Chronic Sinusitis?

  • Alaa Soliman Master's in Health Care Administration/Management, Walden University, USA
  • Maha Ahmed MBBS, Intarnal Medicine and General Surgery, Cairo University, Egypt
  • Katheeja Imani MRes Biochemistry, University of Nottingham, UK

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Overview

Chronic sinusitis is the inflammation in the spaces inside the head and nose (sinus). The sinus is engorged, swollen, and inflamed for three months or more, even with treatment.1

This well-known health condition interferes with the draining of the mucus and congests your nose. Breathing through the nose could become difficult, and the area around the eyes may be tender or painful due to swelling.

Chronic sinusitis can also be caused by an infection, polyp, nasal tumours or nasal fractures, as they can prevent the mucus from draining. Chronic sinusitis is also named (rhinosinusitis), and the disorder can occur at any age so it is common in both children and adults.1

Causes of chronic sinusitis

Chronic sinusitis could be caused by many reasons. These include, for example:

  • Blocked or congested sinus due to other health conditions like asthma, allergies, or is associated with chronic diseases such as cystic fibrosis
  • Infections that cause chronic sinusitis could be viral, bacterial, or fungal
  • Atypical nose structures, like a deviated septum, a medical condition in which the cartilage line and the area of bone below the middle area of the nose is curved or off sideways, is another cause of chronic sinusitis.
  • Polyps (abnormal noncancerous growths)
  • Weak immunity system

Signs and symptoms of chronic sinusitis

Sinusitis is diagnosed as a chronic condition after signs and symptoms are present for 12 weeks or more.

Acute sinusitis regularly occurs due to cold and fades along when the hard ends. To consider the case chronic, the individual should have a minimum of two of the following symptoms:

  • Problem in smelling or tasting foods or drinks
  • Discoloured coloured mucus dripping from the nose
  • Nasal passage blocked by dry or hard-bitten mucus
  • Leaking of the mucus down to the back of the throat
  • Face discomfort, pain, and tenderness, mainly in the forehead, cheeks, and around the eyes

Other associated symptoms of chronic sinusitis may include:

  • Headaches due to the heaviness and swelling in the sinus
  • Throat, tooth, and jaw soreness
  • Feeling nauseated
  • Bad breath or odder
  • Cough, which usually becomes worse at night
  • Pain in the ear
  • Fatigue

Diagnosis of chronic sinusitis 

The initial step for diagnosing chronic sinusitis is typically a physical exam. Your clinician can examine your nose to assess your face and nose in detail. Your healthcare provider will also ask you about the symptoms you have been experiencing. Following this, if your healthcare provider suspects you have chronic sinusitis, then your healthcare provider will request different investigations to confirm the diagnosis. These include: 

  • Endoscopic examination: to get a detailed look into your sinuses. This will help in diagnosing the presence of any polyps or a deviated septum.
  • Allergy testing: this is done to check if the chronic sinusitis was due to an allergy
  • Nasal swabs: they are usually taken to look for the primary reason for chronic sinusitis (viral, bacterial, fungal)
  • Imaging analysis: an MRI or CT scan is done to get a clear view of your sinus; it can help look for the  presence of bad inflammation or blockage by a polyp or mucous collection or a tumour

Management and treatment for chronic sinusitis

Many lines of management are recommended for chronic sinusitis. You will be able to do some of them at home. Other treatment options include treating the primary reason for your sinusitis.1

Medications

Over-the-counter medicines like ibuprofen and acetaminophen (analgesic) can help with relieving pain due to a headache and compression from swelling. 

Corticosteroids nasal spray can help with inflammation. In addition, nasal sprays like mometasone may help in reducing the size of nasal polyps. This can help you to breathe better and improve the symptoms, especially in case of nasal passage blockage.

If your sinusitis is due to an infection, your clinician may recommend antibiotics to avoid complications. If sinusitis is due to allergies, your GP may refer you to specialists for more investigations to determine what you’re allergic to. They can help you with specific treatments to relieve allergy symptoms in the long term.

Home remedies

One of the home remedies that can be of help is using salt water to moisturise your nasal passage can be helpful. This supports mucus to drain more simply. This technique can also release swelling. Steam inhalation from the humidifier helps mucus drain and improves inflammation.

Surgery

In rare cases, your healthcare provider might recommend surgery if home remedies and medicine don't help. Surgery options for chronic sinusitis include:

  • Endoscopic surgical procedure: Your surgeon will insert a tiny tube with a light attached to the camera into your sinus to detect if the sinus is blocked by either mucus, polyps, or other tissues. Your surgeon will then remove that blockage. In some conditions, your surgeon may increase the sinuses’ space to help you breathe better through balloon sinuplasty
  • Deviated septum operation (septoplasty) or nose surgical procedure (rhinoplasty): Your surgeon will restructure the septal wall between the tissues of the nose to make it straight. This can help you breathe more smoothly from both nostrils.

FAQs

How can I prevent what is chronic sinusitis?

The following steps can decrease your risk of getting chronic sinusitis:

  • Try to reduce your chances of getting infections by washing your hands regularly and keeping away from anyone with an infection
  • Treat your allergies. With the help of your clinician, you should work to control the symptoms
  • Avoid smoking as it can aggravate and irritate your respiratory system, nasal pathway, and lungs.

Who is at risk of chronic sinusitis?

You possibly have more risk of chronic sinusitis if you have one or more of the following conditions:

  • A structural anomaly in the nasal passage. A deviated nasal septum or polyps may affect the mucous flow from the nasal passage.
  • Asthma, hay fever, or any other allergic disorder. It is a common association that almost half the people who are diagnosed with moderate to severe asthma likewise have sinusitis.
  • Immune system diseases and disorders can increase your risk for sinusitis
  • Genetic disorders, like cystic fibrosis, cause mucous thickness and nasal passage blockage
  • Smoking, air pollution, and pollutants can affect the cilia in the nose, which help mucous movement through the sinuses.
  • Sinusitis risk increases with age. Over time, nasal passages tend to get dry, and the nasal cartilage weakens. Furthermore, the immune system could be more compromised. 
  • Atmospheric pressure changes: Exposure to changes in atmospheric pressure during activities like flying, swimming, or climbing to high altitudes can precipitate sinus blocking and increase the risk of sinusitis

How common is chronic sinusitis?

Chronic sinusitis is very common in the UK and affects 1 in 10 adults. Sinusitis accounts for 18-22 million visits to the doctor per year.

When should I see a doctor?

Talk to your healthcare provider if your symptoms last for several weeks, even after treatment. Be aware of the duration of sinus symptoms since this is, to some degree, what your doctor will ask you. 

Summary

Chronic sinusitis is the inflammation in the space between the head and the nose (sinus). It interferes with the draining of the mucus and congests your nose. Breathing through the nose could become difficult, and the area around the eyes may be tender or painful due to swelling.

Chronic sinusitis can be caused by infections, allergies, polyps, nasal fractures, etc., and usually occurs secondary to allergies and colds. Sinusitis commonly resolves in 10 days and requires no antibiotics in most cases, but if it persists for more than 12 weeks, then it results in chronic sinusitis. Some symptoms that you might experience include problems smelling or tasting foods or drinks, discoloured coloured mucus dripping from the nose, nasal passage getting blocked by dry or hard-bitten mucus, the mucus leaking down to the back of the throat, headaches, nausea, vomiting, fatigue etc. Visit your healthcare provider if these symptoms don’t subside with over-the-counter medications or with home remedies. Your healthcare provider will diagnose you based on the symptoms you experience by physically examining your nose and by running a few tests like allergy tests, nose swabs and image analysis. Once your healthcare provider confirms the diagnosis, you will be started on treatment with medications and, in rare cases, with surgery. Try reducing your chances of getting chronic sinusitis by quitting smoking, getting underlying conditions like allergies and asthma treated and washing your hands regularly to avoid getting any infection. 

References

  1. Kwon E, O’Rourke MC. Chronic sinusitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Feb 14]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441934/ 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Alaa Soliman

Pediatrician, Medical interpreter, Research & Development Specialist, and Medical/Health Professional Writer

I believe in the importance of Health awareness and discussing behavioral factors like healthy nutrition, physical activity, stress management, and positive social connections. When people realize the hazards of certain lifestyle habits, they know the importance of making changes. Healthy behaviors can make changes to a more balanced life and decrease the risk and spread of diseases.

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