What Is Chronic Sinusitis?

Chronic sinusitis (sinus infection) is sinus inflammation lasting three months or longer. Your sinuses are hollow spaces in your cheekbones, around your eyes, and behind your nose. These areas are moist with mucus that help filter, warm, and moisten the air you breathe. Inflammation and infection can occur if something prevents the mucus from draining properly.

This article will help you identify the symptoms of chronic sinusitis and learn about its causes, diagnostic procedures, and treatment options.

Chronic Sinusitis Symptoms

The primary indicator of chronic sinusitis is the duration of symptoms. If you experience sinusitis symptoms for three months or more, it’s considered chronic. General symptoms of sinusitis include the following:

• Stuffy and runny nose
• Headache or sinus pain felt behind the eyes
• Toothaches or tenderness in your face
• Sore throat or postnasal drip
• Fever
• Cough (may get worse at night)
• Bad breath
• Loss of smell

You may only have a few of these symptoms. Loss of smell can also be a symptom of COVID-19. Even if you do not think you have been exposed, take a COVID-19 test to ensure you are negative.

Causes

The possible causes of chronic sinusitis are the same as acute sinusitis (which lasts four weeks or less) or subacute sinusitis (which lasts one to three months). They include:

• Colds and allergies cause mucus buildup, which leads to blocked sinuses that can become inflamed or infected.
• Nasal polyps are noncancerous tissue growths inside the nasal passages. Over time, they can block nasal passages, leading to mucus buildup and infection.
• A deviated septum occurs when the cartilage between the nostrils is crooked. This can impact the function of the nasal passages and lead to chronic sinusitis.

Certain lifestyle behaviors, environmental factors, and health conditions can increase your risk of developing chronic sinusitis:

• Smoking
• Chronic allergies or hay fever
• Changes in altitude (air travel or scuba diving)
• Weakened immune system
• Children attending daycare
• Cystic fibrosis
• Poorly functioning cilia (tiny hairs that move mucus out of the nose and lungs)

Diagnosis

Typically, a physical examination is enough for a provider to diagnose you with acute sinusitis. They will look inside your nose for polyps, shine a light against your sinuses to look for inflammation, or tap over a sinus cavity to check for infection.

If you suspect you have chronic sinusitis, a healthcare provider may recommend further testing to make a diagnosis. These tests include:

• Nasal endoscopy: A provider uses a flexible tube with a light and camera at the end to look at the sinuses up close.
• Computed tomography (CT) scan: This imaging method uses a series of X-rays to create a cross-sectional view of the sinuses.
• Magnetic resonance imaging (MRI): This type of imaging checks for tumors or fungal infections.

Other tests for chronic or repeated sinusitis include:

• Allergy testing
• Immune function tests, including a blood test for human immunodeficiency virus (HIV)
• Ciliary function test
• Nasal culture
• Cystic fibrosis sweat test
• Nasal culture
• Nasal cell analysis (cytology)

How Do You Treat Chronic Sinusitis?

Depending on the severity of your chronic sinusitis, a healthcare provider will prescribe medication or recommend surgery. Chronic sinusitis will require medication and, in some cases, surgery. Medicines for chronic sinus infection may include:

• Nasal saline irrigation (sinus flush) is a way to rinse your nasal passages with a saltwater solution to mimic the function that the built-up mucus would otherwise do—warming and filtering the nasal passages.
• Nasal corticosteroid sprays, such as Flonase (fluticasone), reduce nasal inflammation and improve sinus symptoms.
• Oral corticosteroids, such as Rayos (prednisone), also reduce inflammation but are given by mouth and absorbed into your bloodstream rather than applied directly to the nasal passages.
• Antibiotics, like Zithromax (azithromycin), treat sinusitis caused by bacteria. They are not effective for sinus infections caused by allergies or a virus.
• Sinus surgery is considered when all other treatment options have been ineffective.

Prognosis

Chronic sinusitis usually resolves with self-care or medical treatment. If you experience repeated episodes or symptoms are not get better within three to four weeks, you should be examined for other conditions, such as nasal polyps or allergies.

The following are rare complications of chronic sinusitis:

• Skin infection around the eye
• Meningitis (inflammation of the tissue that protects the brain and spinal cord)
• Bone infection
• Abscess

Summary

Chronic sinusitis is an inflammation of the sinus passages that lasts three months or longer. Signs of chronic sinusitis include stuffy nose, headache or pain behind the eyes, cough, toothaches, loss of smell, and fever. Most cases of chronic sinusitis can be treated at home with over-the-counter medications. If symptoms don't resolve after treatment, or you experience vision changes or a headache not relieved by painkillers, call your healthcare provider immediately.