Ferrell Duncan Clinic Allergy and Immunology


Sinusitis, Chronic

What causes chronic sinusitis?

In chronic sinusitis, the membranes of both the paranasal sinuses and the nose are thickened because they are constantly inflamed. Most experts now use the term "chronic rhinosinusitis" to describe this condition, and they also recommend that the condition be divided into rhinosinusitis with or without nasal polyps. Nasal polyps are grape-like growths of the sinus membranes that protrude into the sinuses or into the nasal passages. Polyps make it even more difficult for the sinuses to drain and for air to pass through the nose.

The causes of chronic sinusitis are largely unknown. The condition often occurs in people with asthma, the majority of whom have allergies. It is possible that constant exposure to inhaled allergens that are present year-round, such as house dust mites, pets, mold (a kind of fungus), and cockroaches cause chronic inflammation of the nose and the sinuses.

An allergic reaction to certain fungi may be responsible for at least some cases of chronic sinusitis; this condition is called "allergic fungal sinusitis." At least half of all people with chronic rhinosinusitis do not have allergies, however.

Most health experts believe that chronic rhinosinusitis is not an infectious disease (like acute sinusitis). If you suffer frequent episodes of acute sinusitis, however, you may be prone to develop chronic rhinosinusitis. Other causes of chronic rhinosinusitis may be an immune deficiency disorder (for example, primary immune deficiency disease or HIV infection) or an abnormality in the quality of mucus produced by the respiratory system (cystic fibrosis).

Another group of people who may develop chronic sinusitis are those with significant anatomic (structure) variations inside the nose, such as a deviated septum, that lead to blockage of mucus.

What are the symptoms of chronic sinusitis?

One of the most common symptoms of sinusitis is pain, and the location depends on which sinus is affected.

  • If you have a pain in your forehead over the frontal sinuses when you are touched, your frontal sinuses may be inflamed.
  • If your upper jaw and teeth ache, and your cheeks become tender to the touch, you may have an infection in the maxillary sinuses.
  • If you have swelling of the eyelids and tissues around your eyes, and pain between your eyes, you may have inflammation of the ethmoid sinuses that are near the tear ducts in the corner of your eyes. Ethmoid inflammation also can cause a stuffy nose, a loss of smell, and tenderness when you touch the sides of your nose.
  • If you have earaches, neck pain, and deep achiness at the top of your head, you may have infection in the sphenoid sinuses, although these sinuses are less frequently affected.

Most people with sinusitis have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.

In addition to the pain, people with sinusitis frequently have thick nasal secretions that are yellow, green, or blood-tinged. Sometimes these secretions, referred to as post-nasal drip, drain in the back of the throat and are difficult to get rid of. Also, sinusitis is strongly associated with nasal symptoms such as a stuffy nose, as well as with a general feeling of fullness over the entire face.

Less common symptoms of sinusitis can include:

  • Tiredness
  • Decreased sense of smell
  • Cough that may be more severe at night
  • Sore throat
  • Bad breath
  • Fever

How is chronic sinusitis diagnosed?

Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and goes away without treatment.

Your healthcare provider can usually diagnose sinusitis by noting your symptoms and doing a physical examination, which includes examining your nasal tissues. If your symptoms are vague or persist, your healthcare provider may order a computed tomography (CT) scan, a form of X-ray, to confirm that you have sinusitis.

Laboratory tests your healthcare provider may use to diagnose chronic sinusitis include:

  • Blood tests to rule out conditions associated with sinusitis, like an immune deficiency disorder
  • A sweat test or a blood test to rule out cystic fibrosis
  • Tests on the material that is inside your sinuses to detect bacterial or fungal infection
  • Biopsy of the membranes (linings) of the nose or sinuses to determine the health of the cells lining these cavities

How is chronic sinusitis treated?

Healthcare providers often find it difficult to treat chronic sinusitis successfully. The two main forms of treatment, nasal steroid sprays and long courses of oral antibiotics, alone or in combination, have not been rigorously tested in chronic sinusitis. Scientists need to do more research to determine what the best treatment is.

Many healthcare providers also recommend using saline (saltwater) washes or sprays in the nose to help remove thick secretions and allow the sinuses to drain.

If you have severe chronic sinusitis, your healthcare provider may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.


When medicine fails, surgery may be the only alternative for treating chronic sinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. During surgery, which is usually done through the nose, the surgeon:

  • Enlarges the natural opening of the sinuses
  • Removes any polyps
  • Corrects significant anatomic deformities that contribute to the obstruction

Most people have fewer symptoms and better quality of life after surgery. In a substantial number of people, however, problems can recur after surgery, sometimes even after a short period of time.

In children, surgeons can sometimes eliminate sinus problems by removing adenoids (tissue in the back of the throat) that obstruct the nasal-sinus passages.

How can chronic sinusitis be prevented?

There are no methods that have been scientifically tested and proven to prevent acute or chronic sinusitis. However, your healthcare provider may recommend a variety of measures that may provide you with some benefit.

  • Keep your nose as moist as possible with frequent use of saline (salt) sprays.
  • Avoid very dry indoor environments and use a humidifier, if necessary. But be aware that if you have allergies to molds, house dust mites, or cockroaches, a humid environment may also create problems.
  • Avoid exposure to irritants, such as cigarette and cigar smoke or strong odors from chemicals.
  • Avoid exposure to anything you're allergic to. If you have not been tested for allergies and you are getting frequent sinus infections, ask your healthcare provider to give you an allergy evaluation or to refer you to an allergy specialist.
  • Avoid long periods of swimming in pools treated with chlorine, which irritates the lining of the nose and sinuses.
  • Avoid water diving, which forces water into the sinuses from the nasal passages.

You may find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head, blocking your sinuses or the eustachian tubes in your ears. As a result, you might feel discomfort in your sinuses or middle ear during the plane’s ascent or descent. Some health experts recommend using decongestant nose drops or sprays before a flight to avoid this problem.

Reference: The National Institute of Allergy and Infectious Disease

Last updated April 20, 2017