Overview
Chronic sinusitis is inflammation of the sinuses (air-filled cavities in the facial bones) lasting longer than 12 weeks. Recurring and persistent sinus problems despite treatment significantly reduce quality of life.
Approximately 12% of adults experience chronic sinusitis. Mucus drainage is impaired, allowing bacteria and fungi to grow.
Symptoms
For a diagnosis of chronic sinusitis, 2 or more of the following symptoms must last at least 12 weeks:
- Nasal congestion
- Thick, discolored (yellow-green) nasal discharge
- Postnasal drip
- Facial fullness, pressure, or pain (especially in the forehead, around the eyes, cheeks)
- Decreased sense of smell and taste
Accompanying symptoms:
- Ear pain or pressure
- Chronic cough (especially at night)
- Sore throat, hoarseness
- Bad breath
- Fatigue, weakness
- Headache
- Toothache (upper teeth)
- Low-grade fever
Causes
- Nasal polyps (mucosal swelling)
- Septum deviation (deviated nasal bone)
- Allergic rhinitis (hay fever)
- Recurrent upper respiratory infections
- Fungal infections
- Dental infections
- Immune system disorders
- Cystic fibrosis
- Asthma
- Aspirin sensitivity
Risk Factors
- Asthma
- Allergic rhinitis
- Weak immune system
- Nasal structural problems
- Smoking or secondhand smoke
- Air pollution
- Frequent chemical/irritant exposure
- Dental infections
- Reflux
- Frequent upper respiratory infections
Complications
- Increased asthma attacks
- Vision problems (orbital cellulitis, blindness)
- Meningitis (rare)
- Brain abscess (very rare)
- Bone infections
- Thrombosis (cavernous sinus thrombosis)
- Permanent loss of smell
- Decreased quality of life
When to See a Doctor
- If symptoms last more than 10 days
- If they do not respond to antibiotic treatment
- If there is severe facial pain, fever, or vision problems
- Frequently recurring sinusitis
- If sleep is disrupted
Emergency situations:
- Swelling or redness around the eye
- Blurred vision, double vision
- Severe headache
- Change in consciousness
- Neck stiffness
- High fever
Diagnosis and Treatment
Diagnosis:
- Detailed ENT examination
- Endoscopic nasal examination
- Sinus CT (definitive diagnosis)
- Allergy tests
- Fungal or bacterial culture
- Immune tests (when needed)
Treatment:
1. Medication:
- Nasal corticosteroids (mometasone, fluticasone — main treatment)
- Nasal saline irrigation
- Oral corticosteroids (short-term)
- Antibiotics (for bacterial infection, 2-3 weeks)
- Antihistamines (if allergic)
- Leukotriene antagonists
- Decongestants (short-term)
- Biological agents (for resistant polypoid sinusitis)
2. Surgery (in cases unresponsive to medication):
- Functional endoscopic sinus surgery (FESS)
- Balloon sinuplasty
- Polyp surgery
- Septum surgery
Prevention
- Avoid upper respiratory infections
- Pay attention to hand hygiene
- Do not smoke; avoid secondhand smoke
- Avoid air pollution
- Stay away from allergy triggers
- Keep your home humid (dry air irritates sinuses)
- Regularly perform nasal saline irrigation
- Get your vaccines (flu, pneumococcal)
- Take care of your dental health
- Manage your stress
- Drink plenty of water