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Chronic Sinusitis

Last updated Dec. 10, 2019

Approved by: Krish Tangella MD, MBA, FCAP

Chronic Sinusitis affects the sinus cavities around the nasal passages, which gets swollen and inflamed, when attacked by a pathogenic microorganism.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Chronic Rhinosinusitis
  • Nasal Congestion due to Chronic Sinusitis

What is Chronic Sinusitis? (Definition/Background Information)

  • Sinuses are small air-filled spaces inside the cheekbones and forehead. Sinusitis is the inflammation of the sinuses caused by an infection due to microorganisms, like virus, bacteria, and fungus
  • When sinusitis develops quickly, over a short period of time, and lasts only for a short term, the condition is termed as Acute Sinusitis. When Acute Sinusitis does not get cured within a short period of time and lasts for more than 12 weeks, despite giving proper treatment, the condition is termed as Chronic Sinusitis
  • Chronic Sinusitis affects the sinus cavities around the nasal passages, which gets swollen and inflamed, when attacked by a pathogenic microorganism. Individuals experience difficulty in breathing through their nose, when affected by the condition
  • The condition is usually treated with antibiotics for bacterial infections, and antifungal medications for fungal infections

Who gets Chronic Sinusitis? (Age and Sex Distribution)

  • Chronic Sinusitis occurs worldwide and essentially any individual may be affected by the condition. But, generally young children and women are higher prone to Acute Sinusitis
  • Both genders and all races/ethnic groups are equally affected

What are the Risk Factors for Chronic Sinusitis? (Predisposing Factors)

The risk factors associated with Chronic Sinusitis include:

  • Hay fever and other allergic conditions
  • Congenital defects on the nasal passage, or other defects, such as crooked nasal septum or nasal polyps
  • Sensitivity to aspirin
  • Medical conditions, such as cystic fibrosis and chronic obstructive pulmonary diseases
  • Immune system disorders, such as immunoglobulin antibody deficiency, HIV, and AIDS
  • Smoking, history of asthma
  • Tumors in the nose
  • Previous injuries to the nose or cheeks
  • Individuals who have undergone certain medical procedures, like insertion of a nasogastric or endotracheal tube, for various health issues

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Sinusitis? (Etiology)

  • When an individual suffers from sinusitis, inflammation occurs in the mucous membranes of the nose, sinuses, and throat
  • The swelling blocks the sinus openings and does not allow mucus to drain properly, leading to facial pain and other symptoms, exclusive to sinusitis
  • The accumulated mucus in the blocked sinuses, create a moist environment, which helps infections to flourish

Chronic Sinusitis may be caused by:

  • A viral infection, like a common cold
  • Bacterial infection: All upper respiratory tract infections that usually last for more than 10-12 days are likely to be caused by a bacterium
  • Fungal infection: Fungal infection may also cause Chronic Sinusitis, especially when the individual has a weak immune system
  • Allergies, such as hay fever
  • Nasal polyps or tumors
  • Deviated nasal septum: When the wall between the nostrils is not straight (or is deviated), a sinusitis may occur easily due to poor drainage of mucus from the blocked nostrils
  • An infected tooth may lead to Chronic Sinusitis
  • When adenoids, located in the upper back part of the throat, get infected, it can lead to the disorder
  • Other diseases and medical conditions, like cystic fibrosis, GERD, immune system disorders, HIV, and AIDS can cause Chronic Sinusitis

What are the Signs and Symptoms of Chronic Sinusitis?

Sinusitis is termed as acute, when it lasts for 4-30 days and sub-acute, when it lasts for 4-12 weeks. Over 12 weeks, the condition is termed as Chronic Sinusitis, the signs and symptoms of which include:

  • Thick yellow, greenish discharge from the nose, or from the back of the throat
  • Nose is blocked or congested causing breathing difficulties
  • Pain, tenderness, and swelling around the eyes, cheeks, nose, and forehead
  • Pain in the upper jaw and teeth
  • Sense of smell and taste is reduced
  • Cough that is heavy during the night
  • Other symptoms may include: Ear pain, headache, sore throat, bad breath, fatigue, body aches, and fever

How is Chronic Sinusitis Diagnosed?

The following tests may be conducted to diagnose Chronic Sinusitis:

Physical examination to check for:

  • Tenderness in the nose and throat
  • The healthcare provider may use a medical device to open the nose and apply medicines that constricts blood vessels in the nose. By doing so, the nose may be examined more closely
  • A light may be flashed inside the nose to check for inflammations, fluids, nasal polyps, and tumors

Other procedures include:

  • Nasal endoscopy: A tube is inserted into the nose using the aid of a fiber-optic light. This helps the physician check the inside of the nose very easily
  • Imaging studies: CT and MRI scans may show inflammation of the sinuses
  • Nasal and sinus cultures: If the sinusitis is caused by bacterial or fungal infections, then cultures may be performed to correctly diagnose the cause for the disease
  • Allergy test: An skin allergy test is conducted, when it is thought that sinusitis is caused by allergies

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Sinusitis?

The following complications may be the end-result of an attack of Chronic Sinusitis:

  • Severe asthma attack: Chronic Sinusitis can lead to severe breathing complications, like asthma
  • Meningitis: Infection may spread to the lining of the brain
  • Vision problems: Reduction in vision and blindness may result, if Chronic Sinusitis is not treated properly
  • Ear infection: Infection may spread to the ears and severe pain in the ears may be experienced

How is Chronic Sinusitis Treated?

Chronic Sinusitis does not need any special treatment if they are caused by viruses. Some basic self-care techniques are sufficient to manage the condition. For Chronic Sinusitis caused by other factors, the following measures may help:

  • Saline nasal spray may be sprayed into the nose several times, to clear the nasal passages
  • Use of decongestants that are available over-the-counter, in the form of oral medications, nasal sprays, and liquids
  • Nasal corticosteroids may provide relief and help by containing inflammation in the nose
  • Use of over-the-counter pain relievers, such as aspirin, acetaminophen, and ibuprofen
  • Antibiotics are used to treat sinusitis caused only by bacteria. An uninterrupted, full course of the medication, should be taken for 10-14 days
  • Anti-fungal medications for Acute Sinusitis caused by a fungal infection
  • Immunotherapy: If sinusitis is caused by allergies, then allergy shots like immunotherapy, may have to be administered, in order to control the symptoms

Surgical treatment measures:

  • Endoscopic sinus surgery is performed in extreme cases, when sinusitis cannot be controlled through other procedures and medications
  • A thin, flexible tube (with light) is used to navigate through the nasal passages and the cause of obstruction established
  • Using various other instruments, such obstructions are removed to relieve the nasal passage from the blockage
  • Widening the sinus passage may help in better and faster draining of the inflammations

How can Chronic Sinusitis be Prevented?

The following precautionary measures can be adopted to reduce the risk of acquiring Chronic Sinusitis:

  • Avoid close contact with individuals who suffer from cold
  • Frequent washing of hands with soap and water is recommended
  • Discuss the symptoms with the physician and manage them properly
  • Avoid going to places, which are polluted and overcrowded, especially during flu season
  • Avoid smoking
  • Use humidifier at home to add moisture to the indoor spaces

What is the Prognosis of Chronic Sinusitis? (Outcomes/Resolutions)

  • With correct diagnosis and prompt treatment, the prognosis is generally good
  • If left untreated, Acute Sinusitis may lead to unnecessary pain and suffering
  • In very rare cases, it may also lead to infection of the brain. In such cases, the prognosis may be poor

Additional and Relevant Useful Information for Chronic Sinusitis:

The following DoveMed website link is a useful resource for additional information:


What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 5, 2013
Last updated: Dec. 10, 2019