When Should I Worry About...

What Are the Signs of Chronic Sinusitis?

Jan. 22, 2024 - Katie McCallum

"It's just allergies."

We've all said it once or twice — perhaps more if you live in Houston, where allergy season can run year-round for some people. But ... are you sure it's just seasonal allergies?

Sinusitis causes similar nasal symptoms. Symptoms that, like allergies, can also either linger or come and go.

"A lot of people mistake sinusitis for allergies," says Dr. Omar Ahmed, an ENT doctor at Houston Methodist. "And if it is sinusitis, allergy treatments alone aren't going to fix the problem."

What's more, this sinus issue really should be dealt with in a timely manner. Not only can sinusitis symptoms greatly affect your quality of life, but prompt treatment also helps reduce the chance of it recurring or becoming chronic.

This means it's important to know the signs of sinusitis and what to do when symptoms won't go away.

What is sinusitis?

Your sinuses are small, air-filled cavities located in and around your nose. Surprisingly, their purpose isn't entirely clear. One of their known functions, though, is the production of mucus — which not only keeps the nose moist, but also helps trap any viruses, bacteria or allergens you may inhale.

When these mucus-producing cavities become swollen or infected, it's called sinusitis.

An infection is the most common culprit — a virus or bacteria penetrating the sinuses and causing inflammation. But anything that causes sinus swelling (like an allergen) or blocks the flow of mucus (such as growths in nasal tissue lining, called nasal polyps) can lead to sinusitis.

"Upper respiratory infections — typically caused by viruses — can turn into bacterial sinusitis if symptoms persist for longer than one week, and this is usually the most common cause of acute sinusitis," says Dr. Ahmed. "However, there are some cases where this can turn into chronic sinusitis, which can last months to years."

Allergies and other environmental factors, such as mold exposure, pollution and temperature changes, can all also lead to chronic sinusitis, causing increased swelling of the sinuses and even potentially development of nasal polyps.

What are the symptoms of sinusitis?

When the sinuses are swollen and inflamed or blocked by polyps, they're not able to drain mucus as well. This can come with uncomfortable consequences.

Sinusitis symptoms include:

  • Stuffy nose (nasal congestion)
  • Runny nose (nasal drainage)
  • Post-nasal drip
  • Pressure or pain around the nose, eyes and forehead
  • Loss of smell

These symptoms can last anywhere from a week to several months, depending on whether sinusitis is acute or chronic.

"Acute sinusitis is typically caused by viral infection and, like the common cold, resolves on its own in seven to ten days," explains Dr. Ahmed. "If it persists longer than that, we have to consider whether the infection may be bacterial."

It's why you'll want to consult your doctor about sinusitis symptoms that last longer than a week. Acute bacterial sinusitis can cause symptoms for several weeks, and antibiotics may be needed to help clear it. Left untreated, a bacterial sinus infection can linger longer than a month. Another reason to consult your doctor is that he or she can help rule out the other potential causes of sinusitis, such as nasal polyps or allergies — which are treated differently.

How do you know if you have chronic sinusitis?

Sinusitis is considered chronic when symptoms last longer than three months.

"Often times, people wait longer than this to come in for evaluation," says Dr. Ahmed. "They've gotten somewhat accustomed to dealing with it and only come in once their symptoms are really affecting their quality of life."

This usually happens when another trigger exacerbates swelling in the sinuses, such as another infection or irritating environmental factors, like pollution or humidity.

"For instance, a person living with untreated chronic sinusitis might find it to be manageable in the winter, but then the hot summer months come and symptoms get unbearable," says Dr. Ahmed. "Or vice versa. It's really dependent on the person."

How is chronic sinusitis treated?

Effectively treating chronic sinusitis starts with identifying the underlying cause of it.

"The first thing we do is look inside the nose and evaluate if there is truly sinusitis," says Dr. Ahmed. "If we see significant pus throughout the sinuses, we will assume there is a potential bacterial cause and we will start antibiotics. We also take a sample, and we sometimes change the antibiotic based on culture results."

If nasal polyps are present in the sinuses, oral and nasal steroids are the first-line treatment option. If neither infection nor polyps are present, other methods of easing inflammation or using a sinus rinse to clear out allergens may be recommended.

"Treatment is very dependent on the person and their specific situation," says Dr. Ahmed. "We might even recommend surgery in some cases. For instance, if sinusitis with nasal polyps fails to improve with steroids, removing the polyps is typically the next option. We can also use surgery to help open up the sinuses, so the passageways drain better and also allows for better access for topical intranasal medications."

At any rate, diagnosing and treating chronic sinusitis is important since untreated symptoms can greatly affect a person's life — shown to interrupt sleep, increase the risk of depression and anxiety and reduce productivity at home and work.

"Studies have examined quality of life metrics associated with chronic sinusitis and compared the results to the metrics of other major diseases, such as diabetes and heart failure," adds Dr. Ahmed. "What they've found is that severe chronic sinusitis actually has a worse impact on quality of life than even heart failure."

The bottom line: If symptoms like nasal congestion, post-nasal drip and facial pressure aren't going away, don't automatically assume it's just seasonal allergies. Be sure to get checked out so you can benefit from an accurate diagnosis and an effective treatment plan.

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