Chronic sinusitis

Also known as chronic rhinosinusitis (CRS)

Chronic sinusitis is an ongoing inflammatory condition of your nasal passages and sinuses. The symptoms last for 3 months or more.

Key points

  1. Sinusitis occurs when your sinuses cannot drain properly. It causes a heavy, full feeling in your head that can be painful and uncomfortable.
  2. Acute sinusitis normally gets better on its own within 1 to 3 weeks, but when symptoms persist for 3 months or more, it is called chronic sinusitis.
  3. Chronic sinusitis is treated with medications, surgery, non-surgical treatments or a combination of these.
  4. There are things you can do to help prevent you getting chronic sinusitis.

What causes chronic sinusitis

The sinuses are tiny air spaces in your cheeks and forehead and around your eyes. They are lined with a thin membrane that makes mucus, which drains out through your nose. Sometimes the lining becomes inflamed or infected, making it harder for the mucus to drain properly, and the sinuses become blocked.

Chronic sinusitis usually results from a sinus inflammation that lasts for more than 3 months.

Things that can increase your risk of getting chronic sinusitis are:

  • asthma and allergies such as hayfever
  • nasal polyps (swellings in the linings of the nose or sinuses)
  • deviated septum (where the wall between your nostrils has been displaced sideways by an injury)
  • smoking including passive smoking
  • ongoing exposed to irritant chemicals or fumes 
  • regular use of some nasal decongestants
  • dental disease.

What are the symptoms of chronic sinusitis?

The main symptoms of chronic sinusitis are usually a blocked nose (nasal obstruction) and reduced sense of smell.

You may also:

  • have a headache that becomes worse when you lean forward
  • have a tender and painful feeling face
  • have a sore throat, nausea or coughing
  • have sore ears or teeth
  • feel generally tired
  • puffy eyes
  • bad breath
  • not be able to smell or taste things normally.

Unlike sinusitis, chronic sinusitis does not cause a fever.

How is chronic sinusitis diagnosed?

Your doctor can diagnose chronic sinusitis by reviewing your medical history, completing an examination and conducting some tests such as a CT sinus scan.

How is chronic sinusitis treated?

Often treating the underlying cause will help to improve your symptoms. This may mean treating your asthma, allergies, or dental disease, or quitting smoking. If the cause relates to the structure of your nose and nasal passages such as nasal polyps, a deviated septum, narrow nasal passages, or tissue thickened by years of infection, then it may involve treating this. You can try the following things to relieve your symptoms:

  • Saline rinses done every day can keep mucus loose, remove secretions, reduce post-nasal drip and rinse away allergens and irritants. Buy a sinus rinse bottle or pot from your pharmacy and make a saline solution of ½ teaspoon salt, ¼ teaspoon baking soda and ¼ teaspoon sugar dissolved in 250 mL (1 cup) of warm water. Read more about saline nasal sprays, drops and rinses.
  • Steroid nasal sprays can help to reduce inflammation of your sinus linings, reduce mucus production and help shrink any polyps that may be present. They have the advantage of delivering the medicine right where it is needed. Read more about steroid nasal sprays.
  • Pain relief medication such as paracetamol or ibuprofen are not ongoing treatments and should only be used when necessary for the shortest possible time.
  • Antihistamines especially ones that are less likely to make your drowsy (like loratadine) can be helpful in preventing allergy and consequently relieving your sinus symptoms, if allergy is the cause. They can dry and thicken secretions and make it hard to drain, so they are not suitable for everyone.
  • Antibiotics may be needed if the inflammation leads to a sinus infection. You may need to take them for several weeks.

Surgical Treatment

If maximal medical treatments do not help, you may be offered endoscopic sinus surgery. There are several options: 

  • Functional endoscopic sinus surgery (FESS)
    This involves a surgeon inserting an endoscope into the nose through which they can see what is blocking drainage of your sinuses and remove any tissue that is causing the blockage. This is often all that is needed to improve sinus drainage and ventilation and help to restore normal function to the sinuses.
  • Balloon catheter dilation of paranasal sinus ostia
    This involves a surgeon pushing a small balloon through a flexible tube in the nostril, into the blocked sinus. By inflating the balloon, blocked areas are pushed to the sides, the balloon is deflated and removed, leaving a sinus drainage channel that can drain properly again. 
  • Nasal surgery 
    Some people have a deviated septum between the left and right nostrils. This can be secondary to an injury or something you are born with. Others have extra large nasal turbinates. Nasal surgery to correct these problems can be helpful.

How can I prevent chronic sinusitis?

If you develop acute sinusitis, you can take steps to help prevent it from becoming chronic, including:

  • saline rinses
  • drinking plenty of water
  • inhaling steam when you’re in the shower
  • propping your head up with a higher pillow when you’re sleeping
  • blowing your nose gently
  • only taking antihistamines if your sinusitis is caused by allergies
  • only using nasal decongestants for a day or two as using them for too long can make the problem worse.

Learn more

Sinusitis NHS Choices UK
Acute and Chronic Sinusitis: Treatments and Home Remedies WebMD
Sinusitis Choosing Wisely, American Medical Association
Patient education: Chronic rhinosinusitis (Beyond the Basics) UptoDate

References

  1. Antibiotic Guide: choices for common infections BPAC, 2017
  2. Adult sinusitis: plain language summary American Academy of Otolaryngology, 2015
Credits: Editorial team. Last reviewed: 26 Apr 2018