Overview of Rhinosinusitis

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Rhinosinusitis is a common disorder related to inflammation of your nasal passages and sinus cavities. About 1 out of every 7 people experience rhinosinusitis every year, particularly if there are other risk factors such as smoking, asthma, dental problems, a weakened immune system, swimming, or rapid changes in air pressure (such as occurs with air travel or scuba diving). Most cases of rhinosinusitis are caused by allergies or infection.

Rhinosinusitis is divided into four categories depending on how long the illness lasts:

  • Acute rhinosinusitis: Symptoms last less than four weeks
  • Subacute rhinosinusitis: Symptoms last four to 12 weeks
  • Chronic rhinosinusitis: Symptoms last longer than 12 weeks
  • Recurrent rhinosinusitis: Four or more episodes per year.

Acute sinusitis is most often the result of an upper respiratory tract infection. Chronic sinusitis is associated with allergies, nasal polyps, deviated septum, or even an undiagnosed fungal infection (most often in immunocompromised people).

Symptoms

Symptoms of rhinosinusitis are similar regardless of the duration or cause, and may include:

  • Runny nose
  • Postnasal drip
  • Nasal congestion
  • Sinus pain or pressure
  • Headache
  • Toothache
  • Loss of smell
  • Halitosis (bad breath)

Unlike adults, children with rhinosinusitis will typically have a cough.

Because not all of the symptoms are experienced in the nose or sinuses, your dentist or optometrist may be the first person to spot them and refer you to an otolaryngologist (an ear, nose, and throat specialist).

If left untreated, chronic rhinosinusitis can lead to other more serious complications, including sleep apnea and nasal polyps.

Diagnosis

Your healthcare provider will likely not perform any tests beyond their general assessment for rhinosinusitis. This can usually be diagnosed based on the history of your symptoms and physical exam findings.

If your healthcare provider suspects an infection, a nasal or sputum culture and possibly a CT scan may be ordered to identify the cause and extent of the infection. This can help with the selection of the appropriate antibiotic.

If your healthcare provider believes that your rhinosinusitis is related to allergies, you will likely be referred to an allergist for a thorough evaluation of your allergies. In order to achieve maximal relief, you will need to avoid allergens that are causing your symptoms.

Treatment

Treatment for rhinosinusitis varies and is usually based on the duration and severity of symptoms. If your healthcare provider's evaluation suggests that the infection is bacterial, antibiotics will be prescribed. Antibiotics will not be given for infections caused by viruses since antibiotics will have no effect on these infections.

Many of the symptoms related to rhinosinusitis can be managed using over-the-counter pain relievers (like acetaminophen or ibuprofen), decongestants (like pseudoephedrine), nasal irrigation, or topical steroids.

Allergic rhinosinusitis may be treated with antihistamines like Claritin, Zyrtec, or Allegra.

Nasal decongestants are commonly used to help reduce inflammation in your nasal passages. Since many decongestants are now available over-the-counter it is common to self-medicate with these drugs before seeing a healthcare provider.

It is important to avoid the overuse of nasal decongestants, such as Afrin (oxymetazoline) or Neo-Synephrine (phenylephrine hydrochloride), which can lead to rebound congestion and nasal spray addiction.

A Word From Verywell

Chronic sinusitis is commonly self-diagnosed incorrectly by people who believe that they are experiencing seasonal allergies. Similarly, people with migraines have been known to incorrectly treat themselves for symptoms of sinusitis.

To this end, it is important to receive a proper diagnosis from a qualified healthcare provider if your symptoms are severe, persistent, recurrent, worsening, or interfering with the quality of your life.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Aring AM, Chan MM. Acute rhinosinusitis in adults. AFP; 83(9):1057-1063.

  2. Cleveland Clinic: Center for Continuing Education. Sinusitis.

  3. Piromchai P, Kasemsiri P, Laohasiriwong S, Thanaviratananich S. Chronic rhinosinusitis and emerging treatment options. Int J Gen Med. 2013;6:453-464. doi:10.2147/IJGM.S29977

  4. American Academy of Allergy, Asthma, & Immunology. Patients self-medicating: persistent rhinitis overuse decongestant nasal sprays.

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.