Chronic sinusitis is given its name for a reason - it’s a long-lasting condition that can affect sufferers for months and even years. While it’s thought to affect a large number of people in the USA, it’s not always clear how someone has contracted chronic sinusitis or what they can do to treat it.
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What is chronic sinusitis?
Chronic sinusitis is a long-lasting inflammation, swelling, or infection in the nasal sinuses. Sinusitis is a common condition, but when it becomes chronic, it can be debilitating for people living with it. If someone has a sinus infection lasting longer than 12 weeks, or it comes back time and time again within a short period, it’s likely to be chronic sinusitis.
It’s important to distinguish chronic sinusitis from other types, like recurrent sinusitis, where infections repeatedly return, and acute sinusitis, which is shorter in duration but more intense. Understanding these differences can help ensure the right approach to treatment and care.
Recurrent sinusitis
Recurrent sinusitis differs from chronic sinusitis because it is typically a sinusitis infection that occurs four or more times in a year. This is different from chronic sinusitis because recurrent sinusitis comes and goes, affording the patient some form of relief at times.
Acute sinusitis
Acute sinusitis is the normal manifestation of a sinus infection and is typically what most people are first diagnosed with. It is most often caused by a common cold and without treatment or if other factors are at play, it could eventually manifest into recurrent or chronic sinusitis.
How long does chronic sinusitis last for?
Medical professionals will diagnose chronic sinusitis if a person has had a sinus infection that lasts more than 12 weeks. While three months doesn’t seem too long, some cases of chronic sinusitis can last for years and become difficult to manage without treatment - and sometimes even with treatment. Unlike recurrent sinusitis, chronic sinusitis, and its disruptive symptoms last much longer and without symptom-free intervals between episodes.
What causes chronic sinusitis?
Chronic sinusitis can be caused by a number of factors or conditions. The causes are typically those that block the airways, such as asthma, allergies, cystic fibrosis, and other similar conditions.
Infection
A whole host of bodily infections can affect the sinuses, from common colds to tooth infections. Both viruses and bacterial infections can have an impact on the sinuses and result in chronic sinusitis. People with weak immune systems can be more vulnerable to infections that cause chronic sinusitis as they are less able to fight off infections effectively.
If your doctor thinks a bacterial infection is to blame for your chronic sinusitis, they may prescribe antibiotics to fight off the infection. If it’s likely to be due to a viral infection, antibiotics will not help and instead, you might be offered nasal sprays or a course of other medications.
Inflammation
Sinus infections, allergies, and inflammatory conditions can all cause inflammation which can vary from moderate to severe in cases of chronic sinusitis. Inflammation can also happen when you breathe air that is high in pollution, you smoke, or you are around others who smoke. As inflammation is a leading symptom of chronic sinusitis, there are several treatment options available, including nasal sprays, drops, or nasal steroids.
Nasal polyps
In many cases of chronic sinusitis, nasal polyps are also present, and can sometimes be the cause of chronic sinusitis. Nasal polyps are small growths in the nasal cavity which are particularly common if you are also suffering from inflammation due to an infection, allergy, or asthma. Nasal steroid sprays are a common treatment option considered for chronic sinusitis with nasal polyps, as are antihistamines if the condition is caused by an allergy.
Deviated septum
Chronic sinusitis, in severe and rare cases, can result in a deviated septum for some patients. This is where the nasal septum inside the nose becomes crooked or off-center and is usually the result of an injury or birth defect. With chronic sinusitis and a deviated septum, antihistamines and nasal sprays can help, but surgery is most often the optimal solution to completely correct the issue with the septum. If the deviated septum is the cause of the chronic sinusitis, surgery may also help it to go away.
Scar tissue
Scar tissue can sometimes be a cause of chronic sinusitis. You may have scar tissue or adhesions from an incomplete sinus surgery, which can obstruct the sinus and cause fluids to build up, ultimately leading to chronic inflammation or chronic sinusitis. Sometimes, people are born with scar tissue too, which could result in chronic sinusitis.
Endoscopic sinus surgery is a common procedure used to treat chronic sinusitis caused by scar tissue or other blockages in the sinuses. A surgeon will look closely at the sinus tissues before removing the blockage which will remove the scar tissue and ease or end the chronic sinusitis symptoms.
Turbinate hypertrophy
Turbinates are bony structures inside the nose that are covered by a special skin known as mucosa. They are responsible for filtering, warming, and moistening the air that is breathed in. Occasionally, allergies or infections can cause these turbinates to become inflamed, resulting in chronic sinusitis in some cases.
If the turbinates grow too big, they can block the nasal passages too. The underlying cause of turbinate hypertrophy will determine the course of treatments recommended, and they could include anything from antihistamines and steroid sprays to surgery.
Who is at greater risk for chronic sinusitis?
While anyone can suffer from chronic sinusitis, there are some people who are at a higher risk of getting it. Some of the risk factors that could increase your chance of getting chronic sinusitis include:
- Aging: Age-related changes can narrow the nasal passageways and reduce airflow, which may contribute to sinus problems like chronic sinusitis.
- Allergies: Reactions to allergens like pollen, dust mites, or mold can cause inflammation and swelling in the sinus tissues, leading to chronic sinusitis.
- Asthma: The airway inflammation associated with asthma can exacerbate or contribute to the development of chronic sinusitis.
- Environmental irritants: Exposure to pollutants like cigarette smoke or chemicals can irritate and inflame the sinus passages, increasing the risk of all types of sinusitis.
- Gastroesophageal Reflux Disease (GERD): Stomach acid reflux can irritate the upper airways and may play a role in causing or worsening chronic sinusitis.
- Structural blockages: Anatomic abnormalities such as nasal polyps or a deviated septum can obstruct sinus drainage, promoting infection and sinusitis.
- Weakened immune system: Individuals with compromised immune systems (e.g., from conditions like HIV or diabetes) are more prone to developing chronic sinusitis.
What are the symptoms of chronic sinusitis?
Chronic sinusitis can present itself with a number of different symptoms. The most common symptoms are tenderness and pressure around the nose, eyes, and forehead. Other symptoms include:
- Thick yellow or green mucus from your nose or postnasal drip
- Stuffy nose
- Toothache
- Cough
- Headache, particularly a headache that makes your face hurt
- Tiredness
- Ear pain
- Loss of taste and/or smell
- Bad breath
When the sinuses are swollen and inflamed or blocked by polyps, mucus drainage is not as effective which can be uncomfortable and even cause pain. You should consult your doctor if symptoms persist as you may need to try alternative treatment options. Your healthcare professional can also help rule out other potential causes, such as nasal polyps or allergies which may need a different course of treatment.
How do you know if you have chronic sinusitis?
A person with chronic sinusitis is usually diagnosed by their doctor, typically because they have had sinusitis symptoms lasting longer than 12 weeks. Unfortunately, some people become so used to living with sinusitis that they don’t realize it’s a chronic condition and only seek medical help when the symptoms are affecting their quality of life. It’s important to always monitor your symptoms and log them to ensure you get the treatment you need to treat your condition.
What happens if you leave chronic sinusitis untreated?
Sometimes, chronic sinusitis will go away on its own, but there are also cases where people suffer from it for many months and even years. If you live with chronic sinusitis for a long time without treatment, there can be several consequences:
- Spread of infection: If left untreated, a sinus infection can spread to other parts of the body, including the bones (osteomyelitis), spinal fluid (meningitis), brain (abscess), and eyes (orbital cellulitis), potentially causing severe complications.
- Loss of smell: Chronic or severe sinusitis may lead to a permanent or temporary loss of the sense of smell (anosmia), which can significantly impact a person’s quality of life.
- Sinus mucocele: A mucocele is a hardened mass that can form in the sinuses due to chronic blockage. Although usually benign, it can cause discomfort and pressure, and if it becomes infected, surgical removal may be necessary.
- Sinus thrombosis: In rare cases, the body may develop a blood clot (thrombosis) in the sinuses, usually as a protective mechanism against infection. While uncommon, this can restrict blood flow to the brain, eyes, and surrounding nerves, causing serious damage. Even more rarely, sinus thrombosis can occur without any infection.
Some people may also simply continue to experience the original symptoms of chronic sinusitis, which include:
- Congestion or constant green mucus for months
- Headache
- Postnasal drip
- Sinus infection and/or sore throat
- Facial pain or pressure around the nose, eyes, and above the cheeks
- Loss of smell and/or taste
- Fever
- Fatigue
Reasons your sinusitis keeps coming back
If you’ve been suffering from chronic sinusitis, or recurrent sinusitis that keeps coming back, there could be a few reasons for this. Understanding why your chronic sinusitis isn’t going away or keeps coming back is essential for finding the right treatment.
You don’t have an accurate diagnosis
For those diagnosed with sinusitis and undergoing treatment, it’s important to seek medical attention if an infection lasts for a long time, treatment isn’t working, or the pain becomes unbearable. Medical professionals may conduct a comprehensive examination of the nose and sinus passages to evaluate the correct diagnosis and cause of your symptoms. In some cases, a previous diagnosis of a sinus problem may be inaccurate and the symptoms may have been caused by another issue.
Excessive inflammation of the nasal passages
A key symptom of sinusitis is inflammation of the nasal passages, but this can often lead to excessive inflammation in more areas than just the nasal passages and behind the cheekbones. Many people with sinusitis will also experience throat discomfort resulting from post-nasal drip. This can make it difficult to reduce the inflammation and unfortunately result in sinusitis recurring or turning into chronic sinusitis.
To reduce excessive swelling and reduce the chance of your sinusitis from returning, you could try:
- Inhaling steam (a hot shower is great for this)
- Using a nasal-specific saline solution to flush the nasal passages a few times a day
- Avoiding smoking cigarettes or inhaling second-hand smoke
- Using an air purifier and humidifier, especially while sleeping to moisten the passages
- Taking a shower at night to flush allergens from the day out of your sinuses
- Drinking lots of fluids like hot teas, especially herbal teas designed to support breathing, sinus pressure, and/or allergies
- Avoiding outdoor activities that over-expose you to pollen
- Taking care of your immune system by eating well (try an anti-inflammatory diet), getting plenty of rest, and managing stress
A previous nasal fracture
Nasal bones are the most commonly broken bones in the body and often heal well on their own. However, sometimes nasal fractures can cause inflammation and lead to recurrent or chronic sinusitis. If you think this may be the cause of your sinusitis, you should consult your medical professional.
Abnormal growths or other anatomical abnormalities
The body is a complex system and sometimes symptoms do not relate to the underlying cause. Seemingly out of nowhere, tissues can thicken, cells can excessively multiply causing tumors, or small issues that didn’t cause problems in the past can begin to cause you trouble. All of this can lead to sinusitis symptoms and even chronic sinusitis if not diagnosed and properly managed.
How to treat chronic sinusitis
There are a variety of chronic sinusitis treatments available depending on the root cause of the condition and personal circumstances. Some treatments include steroids, nasal sprays, and surgery. Most treatments and medications for chronic sinusitis focus on easing inflammation and improving symptoms.
Looking to explore new treatment options? Clinical trials offer an excellent opportunity to access innovative therapies. Discover everything you need to know about clinical trials and how to participate in our comprehensive guide.
What are the signs that chronic sinusitis has cleared up?
If you’ve been using medication or another form of treatment for chronic sinusitis, you may be wondering when you’ll start feeling better. When chronic sinusitis clears up, people often notice a significant reduction in symptoms such as facial pressure or pain, mucus discharge, and nasal congestion. Many people also find it easier to breathe and they may experience a return to their sense of smell and taste.
Preventing chronic sinusitis
While difficult to live with, chronic sinusitis can be prevented in some cases. Whether you’ve never experienced chronic sinusitis or you’ve treated it recently and want to avoid it coming back, there are some of the ways you can reduce your risk of getting chronic sinusitis:
- Protect your health by avoiding getting too close to people you know are fighting colds or other infections, and always wash your hands with soap and water.
- Manage any allergies you have by working with your healthcare provider to keep symptoms under control with appropriate treatments.
- Avoid cigarette smoke and polluted air as these can irritate the lungs and nasal passages.
- Use a humidifier if you have dry air in your home as this can add moisture and prevent sinusitis infections.
Can clinical trials help with chronic sinusitis?
Clinical trials are designed to research new treatments and innovations for a variety of health conditions, illnesses, and diseases. Chronic sinusitis benefits greatly from clinical research. While there are many treatment options available, not all of them are effective for everyone, especially those who have suffered from the condition for years and have not been successful with other treatments.
Several clinical trials studying chronic sinusitis are currently underway to understand more about this condition. Some are focused on medications or innovative treatments, while others seek to establish new treatment options for specific groups, for example, children with cystic fibrosis and chronic sinusitis.
A Phase II clinical trial evaluating the efficacy and safety of a bioresorbable nasal implant is in progress. The implant delivers a corticosteroid (mometasone furoate) over six months to reduce inflammation and improve symptoms. The trial is suitable for patients who have not undergone surgery but are unresponsive to conventional treatments, with results expected in 2024.
Another ongoing clinical trial is studying the use of Dupilumab (Dupixent), an injectable biologic, in patients with chronic sinusitis without nasal polyps. Dupixent has already been approved for treating chronic rhinosinusitis with nasal polyps, and this study explores expanding its use.
Should you participate in a clinical trial for chronic sinusitis?
Enrolling in a clinical trial for chronic sinusitis can be a valuable option, especially if other treatments have not been effective or if you are interested in contributing to medical research. Clinical trials offer participants the opportunity to access cutting-edge treatments for chronic sinusitis that are not yet available to the public, potentially providing early relief from symptoms through novel medications or therapies.
In addition to trying new treatments, participants receive close and personalized medical supervision, with continuous monitoring from healthcare professionals who specialize in chronic sinusitis. This level of individualized care is often more extensive than what is typically available outside of a clinical trial setting.
Moreover, participating in a clinical trial helps advance scientific knowledge, contributing to the development of improved treatment options for future patients. Beyond the personal benefits of participating in a clinical trial, many find it empowering to play an active role in their healthcare journey while helping pave the way for better treatments for others.
Living with chronic sinusitis
Living with chronic sinusitis sometimes means individuals need to adapt their daily lives. For example, you might need to organize your day differently to manage your energy levels, or even consider flexible work arrangements for more severe symptoms. Open communication with your workplace is important for understanding and potentially enabling workplace adjustments. Taking short breaks, creating a comfortable work environment, and engaging in stress management techniques can all help a person live with chronic sinusitis more comfortably.
Seeking support from family, friends, or support groups is important too. Regular physical activity, balanced meals, and staying hydrated are integral to managing symptoms of chronic sinusitis. If you’re undergoing treatment, you need to ensure your medication is consistently managed and you have regular consultations with your doctor.
While living with chronic sinusitis can be uncomfortable, depending on your symptoms and the cause, you may also experience a number of other complications that can make day-to-day activities harder. It’s important to note that serious complications of chronic sinusitis are rare, but they can happen. Some rare complications include vision problems if a sinus infection spreads to an eye socket, and serious infections such as meningitis, cellulitis, or osteomyelitis.
Conclusion
Although chronic sinusitis is typically diagnosed after someone has experienced symptoms for 12 weeks, it is possible for some people to live with the condition for many years, especially if they are not undergoing treatment to resolve symptoms. While many treatments and prevention strategies are available, they do not work for everybody, which makes clinical trials for chronic sinusitis all the more important.
FAQs
Is there a difference between sinusitis and rhinitis?
Sinusitis is inflammation that occurs inside your sinuses, leading to infection, while rhinitis is when a reaction occurs that causes nasal congestion, a runny nose, sneezing, and itching. Most types of rhinitis are caused by inflammation and are associated with symptoms in the eyes, ears, or throat. Rhinitis is also commonly experienced during certain times of the year, while chronic sinusitis is not always seasonal. While both conditions cause nasal inflammation, they are not the same.
What’s the difference between chronic sinusitis and recurrent sinusitis?
Chronic sinusitis is different from recurrent sinusitis because chronic sinusitis symptoms don’t go away for long periods. Recurrent sinusitis is a condition that causes symptoms for a while, resolves, and then comes back again.
Can chronic sinusitis cause fatigue and depression?
Chronic sinusitis can cause fatigue and depression in some cases, as do many chronic conditions. The prolonged discomfort of chronic sinusitis can cause sleep issues, stress, and ultimately depression which is often more of a risk in people who already have mood disorders or depression. Once a person feels depressed, they may find life to be more bleak and difficult to manage, including sinusitis symptoms. This is when it is imperative to consult with medical professionals to get the appropriate treatment.