What you need to know about chronic sinusitis

Chronic (long-term) sinusitis, also known as chronic rhinosinusitis, refers to inflammation of the linings of the nose and sinuses that persists for more than 12 weeks. Surveys suggest that up to five to 25 people in every 100 may be suffering from chronic sinusitis in the UK. 

Here we’ll look at the symptoms of chronic sinusitis as well as what causes it, how it is diagnosed and what treatments are available. 

Symptoms of chronic sinusitis

Common symptoms of chronic sinusitis include a blocked nose (congestion) and bright yellow or green discharge from your nose. Discharge from your nose may run out of your nostrils (rhinorrhea) or may run down the back of your nose into your throat (post-nasal drip). 

You may also experience an uncomfortable feeling of pressure in your face, especially in your cheeks, forehead and around your eyes, a foul smell in your nose and a reduction in your ability to smell and/or taste. 

It is important to note that facial pain is not the main symptom of chronic sinusitis but is a common symptom of acute sinusitis; in the case of acute sinusitis, facial pain usually gets better with a course of antibiotics. 

Risk factors for chronic sinusitis

Acute sinusitis is caused by an infection, such as a common cold, the flu or COVID-19. In some cases, chronic sinusitis can subsequently develop. 

Your risk of developing chronic sinusitis is higher if you smoke, have a deviated septum or are exposed to high levels of environmental or occupational pollutants. Occasionally, exposure to certain aggressive bacteria or fungi (due to inappropriate antibiotic use) or dental procedures can cause chronic sinus infections — this is usually associated with a putrid or nasty smell within your nose. 

Diseases that increase levels of inflammation in your body or are associated with altered mucus or mucus clearance also increase your risk of chronic sinusitis. Your risk is especially high if you have cystic fibrosis, primary ciliary dyskinesia or the rare blood vessel disorder granulomatosis with polyangiitis (GPA), previously known as Wegener’s granulomatosis.

Diagnosing chronic sinusitis

If you’re concerned that you have chronic sinusitis, see your GP. They will diagnose your condition based on your medical history and symptoms, that is, whether you have experienced nasal congestion and yellow or green nasal discharge, with or without facial pressure and loss of smell or taste, for more than 12 weeks. 

They may refer you to an ENT surgeon if more in-depth investigations are needed. Your ENT surgeon will investigate whether or not you have allergies that could be causing your sinusitis and will also perform a nasal endoscopy. 

This involves passing a thin, telescope-like tube with a camera and light on the end into your nose to examine your sinus cavities. This will allow them to look for nasal polyps or other structural abnormalities, as well as direct evidence of discharge from your sinuses. 

Depending on the results of your nasal endoscopy, your ENT surgeon may recommend a CT scan to determine which of your sinus cavities are involved and to what extent, so they can better advise you on your treatment options. 

Treating chronic sinusitis

Unlike acute sinusitis, it is not recommended to treat chronic sinusitis with a course of antibiotics as this is not an effective treatment. The exception to this advice is if your chronic sinusitis is caused by a tooth infection, which will need treatment with antibiotics. 

Chronic sinusitis is usually treated with nasal saline flushing and nasal steroid sprays — these treatments are only effective if applied consistently and as instructed by your doctor. 

You may also need treatment for several weeks or even months with a type of antibiotic called macrolides, which modulates your immune system and helps reduce inflammation. If these treatments aren’t effective your doctor may recommend sinus surgery to unblock your sinuses. 

If the cause of your chronic sinusitis is a local issue, such as a tooth infection or a deviated septum, these underlying causes will be treated; for example, a deviated septum can be resolved with surgery. 

Complications of chronic sinusitis

If the inflammation caused by chronic sinusitis spreads to other parts of your body, you may experience complications. Your sinus cavities are situated between your eyes, airway and brain, and consequently, infection can spread to any of these areas.

If infection spreads to your eyes or your brain and pus starts to collect there, you will need surgery to remove the pus to help resolve the infection. Eye infections can lead to permanent vision loss, while brain infections can be life-threatening. 

In rare cases, chronic sinusitis can lead to chronic infection of the bones of the face (osteomyelitis), causing the bone to gradually be destroyed. Consequently, instead of discharge leaking through your nose, it will leak through part of your skin. 

How to reduce your risk of chronic sinusitis

Certain factors that influence your risk of chronic sinusitis are hard to control, for example, living in an urban area, which consequently exposes you to high levels of pollution. However, other factors can be controlled, such as leading a healthy lifestyle (ie exercising regularly and following a healthy, balanced diet) to help support a strong immune system. 

If you have a condition that causes your immune system to become overactive, it is important to follow the treatment advice of your doctor. This will reduce your risk of developing chronic sinusitis.