Chronic Sinusitis: Symptoms, Diagnosis, Causes & Treatment

Chronic sinusitis is characterized by inflammation of the sinus membranes caused by infections (bacterial, viral or fungal), allergies, anatomical abnormalities (such as a deviated septum), inadequate or excessive use of antibiotics, or a weakened immune system.

With chronic sinusitis, symptoms usually last more than 12 weeks, and may include facial pain in the face that worsens when lowering the head, a stuffy or runny nose, the presence of yellow-green or bloody phlegm, or a cough that worsens when lying down.

The treatment of chronic sinusitis is guided by a family doctor or ENT specialist, and generally involves irrigating the nose with saline solution and using medication like antibiotics, antihistamines or corticosteroids, (although these generally depend on the cause of the inflammation). In some cases, surgery to drain accumulated mucus and/or correct changes in the nasal septum or remove nodules may be advised,

Common symptoms

The main symptoms of chronic sinusitis are:

• Stuffy or runny nose
• Yellowish or greenish phlegm
• Nose bleeds
• Chronic cough, which worsens when lying down
• Post-nasal drip, which is when phlegm runs down the throat
• Stuffy nose, which makes it difficult to breathe through the nose
• Facial pain or headache, which worsens when you lower your head or lie down
• Sensation of pressure inside the head
• Decreased sense of smell and taste
• Constant bad breath
• Ear or throat pain
• Dizziness
• Excessive tiredness

The symptoms of chronic sinusitis last for over 12 weeks and can occur after one or several episodes of acute sinusitis, which additionally presents with fever, body aches and intense nasal discharge.

Sinusitis caused by allergies or presenting in people with a history of allergies or rhinitis can also lead to asthma attacks, an itchy nose or throat, or worsening of symptoms when in contact triggering substances, like dust.

Confirming a diagnosis

Chronic sinusitis is diagnosed by an ENT specialist or family doctor through an evaluation of the patient's symptoms and a palpation of the nasal sinuses (to determine whether pain and sensitivity are present).

The doctor may also order tests to confirm the diagnosis, such as a CT or MRI of the nasal cavities or sinuses, and a nasal endoscopy, to evaluate the interior of the nasal sinuses. These tests help to identify whether there are other causes for the chronic sinusitis, such as nasal polyps, a deviated septum or tumors.

Other tests that may be ordered by the doctor are laboratory analysis of nasal secretions, to assess the presence of microorganisms such as bacteria or viruses, or an allergy test, to identify whether the sinusitis is triggered by allergies,

Possible causes

Symptoms of chronic sinusitis persist for over 12 weeks, and are usually related to infections (viral, fungal or bacterial) or allergies. Some factors can increase the risk for developing chronic sinusitis include:

• Incorrect treatment for acute sinusitis
• Using antibiotics incorrectly, unnecessarily, or repeatedly
• Respiratory tract infections, such as colds
• Anatomical abnormalities, such as deviated septum, nasal polyps, hypertrophy of the nasal turbinates
• Severe or poorly controlled asthma or allergic rhinitis
• GERD
• Weakened immunity, which can occur in patients with HIV or patients who use corticosteroids chronically, for example
• Uncontrolled diabetes
• Cystic fibrosis
• Dental infections
• Otitis media
• Frequent exposure to pollutants, such as cigarette smoke

In addition, conditions like primary ciliary dyskinesia or Kartagener syndrome can also increase the risk for developing chronic sinusitis.

Treatment options

To treat chronic sinusitis, the ENT specialist or family doctor may prescribe medications or treatments such as:

• Antibiotics, like amoxicillin/clavulonate, azithromycin or levofloxacin. These are only used in cases of bacterial infections and are generally done for 2 to 4 weeks.
• Mucolytics and decongestants, such as ambroxol, to reduce the thickness of secretions and facilitate their elimination.
• Anti-inflammatories or corticosteroids, such as nimesulide or prednisone, help reduce inflammation and local swelling.
• Antihistamines, such as loratadine, which are indicated for cases triggered by allergies.
• Nasal corticosteroids, such as budesonide, fluticasone or mometasone, which help to combat inflammation and allergies in the respiratory tract;
• Nasal irrigation with saline solution or salt and water preparations. Check out our step-by-step guide on how to perform a nasal irrigation.
• Nebulization with water vapor or saline solution to thin-out secretions.

Nasal decongestants containing naphazoline or oxymetazoline, for example, may also be prescribed by the doctor in some cases. These should be done with caution, however, for a maximum of 3 to 5 days. Prolonged use may cause a rebound effect, which may worsen the symptoms of chronic sinusitis. Read more about sinusitis medications that your doctor may consider.

When is surgery indicated?

Surgery for chronic sinusitis aims to treat the natural drainage channels of the nasal sinuses by widening them or removing obstructions. Facilitating natural drainage can help prevent mucus build-up, which often leads to the growth and spread of fungus and bacteria.

These procedures can also be combined with the correction of a defect in the nose anatomy, which may also be impeding recovery of chronic sinusitis. Some corrective surgeries include correction of the septum, removal of the adenoids or reduction in the size of the turbinates (which are the spongy tissues inside the nose).

Natural treatments

Inhaling steam from plants such as eucalyptus or chamomile can also help to relieve symptoms. This a safe intervention to use while undergoing medical or prescribed treatment. Check-out other natural treatments for sinusitis that you can use to compliment your treatment plan.

Possible complications

When not properly treated and managed, chronic sinusitis can worsen over time and lead to the build-up of secretions in the sinuses. This can form an abscess, while also causing the spread of the inflammation or infection to organs that are close to the nasal cavities, like the eyes or the brain.

The infection can also trigger asthma attacks, (especially in children), pneumonia, or even reach the bloodstream and cause a generalized infection.