Chronic Sinusitis

Overview

What is chronic sinusitis?

Chronic sinusitis is a long-lasting sinus inflammation (swelling) and infection. It can linger over a period of time, typically longer than 12 weeks. The sinuses are four paired cavities (spaces) in the head. These spaces are connected by narrow channels. The four spaces are named for the bones they are near: ethmoidal, sphenoidal, frontal and maxillary. The sinuses make thin mucus that drains out of the channels of the nose. This drainage works as a filtration system, keeping the nose clean and free of bacteria.

The sinuses can become infected when they are blocked and filled with fluid. This is called sinusitis. There are several kinds of sinusitis: acute, subacute, chronic and recurrent. Unlike chronic sinusitis, acute sinusitis typically lasts only a few days, but can last up to four weeks, before going away with minimal or no treatment. Chronic sinusitis may require different types of treatment. Surgery is sometimes needed in severe cases of chronic sinusitis that do not respond to other methods.

Chronic sinusitis is different than recurrent sinusitis because chronic sinusitis symptoms never really go away for long periods of time. In recurrent sinusitis, you have 4 or more bouts of sinusitis in one year, but you also have symptom-free periods in between.

What is the difference between sinusitis and rhinitis?

The “-itis” means that we are talking about inflammation, swollen tissue. Sinusitis is swelling in the sinuses. Rhinitis is swelling in the nose. In reality, these usually happen at the same time, so chronic sinusitis is pretty much the same as chronic rhinosinusitis.

Symptoms and Causes

What causes chronic sinusitis?

Chronic sinusitis can be caused by several factors. These include:

  • Blocked airways from asthma or allergies or from conditions such as cystic fibrosis.
  • Infections, which can be bacterial, viral or fungal.
  • Abnormal nose structures, such as a deviated septum (the line of cartilage and bone down the middle of the nose is crooked or off to the side).
  • Polyps (growths).
  • A weak immune system.

What are the symptoms of chronic sinusitis?

Symptoms of chronic sinusitis may include:

  • Tenderness or pressure in the face (particularly around the nose, eyes and forehead).
  • Post nasal drip (mucus drips down the throat).
  • Nasal discharge (thick yellow or green discharge from nose) or a stuffy nose.
  • Toothache, ear pain and/or headache.
  • Cough.
  • Tiredness.
  • Ear pain.
  • Loss of the senses of taste and smell.
  • Halitosis (bad breath).

The combination of symptoms and the fact that they last for such a long period of time can make you miserable. You'll probably have trouble sleeping through the night and may have dark circles under your eyes.

Diagnosis and Tests

How is chronic sinusitis diagnosed?

Chronic sinusitis is diagnosed when symptoms of a sinus infection have continued for more than 12 weeks. In some cases, your doctor may use an endoscope (a small and flexible tool that allows the doctor to see inside your nose and sinuses).

A CT scan or MRI could also be used to look for structural issues. Structural problems usually include a deviated nasal septum (the nose is shifted to the side) or polyps (growths).

In very few cases, your provider might order a biopsy to see if the infection has spread. Biopsies involve taking tissue or bone samples to example under the microscope.

How can you tell the difference between chronic sinusitis and other issues, like migraine headaches?

You probably can’t tell the difference between all of these things. So, in cases where you have a constant headache, or facial pain, or tooth pain, you should call your healthcare provider to get a diagnosis. This is especially true if you have tried different therapies and have not been able to find relief. Your primary healthcare provider might even find it difficult to diagnose you properly and might suggest you see a specialist. This would be an otolaryngologist, commonly called an ear, nose and throat (ENT) doctor.

Management and Treatment

How is chronic sinusitis treated?

Chronic sinusitis is not usually caused by a bacterial infection, but it can be. If your healthcare provider really thinks that you have a bacterial infection, they might give you a prescription for something like amoxicillin. Antibiotics only help for bacterial infections. Other ways to treat non-bacterial chronic sinusitis include:

  • Avoiding triggers (usually related to allergies and environmental factors).
  • Using intranasal corticosteroid sprays and leukotriene antagonists (to reduce inflammation) or antifungal medication (rarely) to get rid of a fungus.
  • Treating the underlying condition, such as allergies, asthma, and/or immune deficiency conditions, with medications such as topical antihistamine, or steroid, sprays or antihistamine pills.
  • Having surgery (typically to correct structural issues like a deviated nasal septum or to remove polyps or fungal balls). Fungal balls are clumps of fungal infection that block sinuses.
  • Having a procedure called balloon sinus ostial dilation, which inserts a balloon into a sinus cavity to open it further and make more room.

Can chronic sinusitis be cured?

Chronic sinusitis symptoms can be cured. However, you will probably have to use more than one therapy.

Is chronic sinusitis dangerous?

This condition is rarely life-threatening, but it can be dangerous at times. Infections can spread beyond the sinuses into your bones, brain or spine.

Prevention

How do I prevent chronic sinusitis?

You may be able to prevent infections and chronic sinusitis if you:

  • Treat the underlying conditions behind chronic sinusitis, like asthma and allergies.
  • Avoid allergens such as animal dander, dust, pollen, smoke and mold that trigger swelling in the sinuses.
  • Quit smoking if you do smoke and avoid any secondhand smoke.
  • Wash your hands thoroughly with soap and water.
  • Rinse your nasal passages with saline solution, either purchased or with a neti pot. (This is a small item that is filled with sterile water and salt. You pour, or gently squeeze, the water into one side of your nose and it comes out the other.)
  • Eat healthy foods, stay hydrated and exercise regularly to stay healthy overall.
  • Use a humidifier to keep nasal tissues moist.

Living With

When should I call my healthcare provider about chronic sinusitis?

Call your doctor if your symptoms last for a long period of time (several weeks) despite treatment or if you are in pain. You should also call if you have a stiff neck, swollen eyes, and a problem with your vision or mental changes.

Remember, your health is your business. You do not have to put up with feeling ill for long periods of time. Pay attention to how long you have sinus symptoms because this is something that your care provider will ask you. Keep track of things that you have done to make yourself feel better. If medications are prescribed, make sure you store them and take them as instructed.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy