Chronic sinusitis is inflammation of the lining of the sinuses, the air-filled spaces in the bones of the face around the nose and the eyes, that lasts twelve weeks or more despite treatment. Unlike acute sinusitis, which appears after a cold and clears within weeks, here the lining stays swollen and inflamed, the drainage openings of the sinuses block, and the symptoms become part of daily life: a permanently blocked nose, thick discharge that runs down the throat, pressure and heaviness in the face, a reduced sense of smell and tiredness. Many people get used to the situation and manage it with sprays and repeated antibiotics without the problem being solved. It is worth seeing an ENT specialist when the symptoms last more than three months, when the sense of smell is affected, when there have been more than three or four episodes of sinusitis in a year, or when a proper course of medical treatment has not helped.
What happens in the sinuses in chronic inflammation
The sinuses are lined with a membrane that produces mucus and moves it with tiny hairs towards small drainage openings that lead into the nasal cavity. When the lining is swollen for a long time, these openings block, mucus collects, oxygen in the cavity falls, and the environment suits ongoing inflammation. The inflammation itself increases the swelling, and so a cycle forms that is hard to break without treatment aimed at the root of the problem.
Medicine today distinguishes between two main types: chronic sinusitis with polyps and chronic sinusitis without polyps. Polyps are benign, soft, translucent growths of the swollen lining that grow from the sinuses into the nasal cavity and block it. They are not cancerous, but they are linked to a particular type of inflammation, sometimes together with asthma and aspirin sensitivity, and they call for a different treatment approach.
What causes chronic sinusitis
- Untreated allergic rhinitis, which causes permanent swelling of the lining.
- An anatomical structure that narrows the drainage openings: a deviated septum, enlarged turbinates or air cells that block the passage.
- Nasal polyps.
- Asthma, which often accompanies chronic inflammation of the upper airways.
- Sensitivity to aspirin and anti-inflammatory drugs, which appears together with polyps and asthma.
- Smoking and exposure to air pollution and occupational dust.
- Reflux that reaches the throat and the nose.
- Inflammation arising from the root of a tooth in the upper jaw.
- Diseases that affect the cilia or the immune system, which are rarer.
How chronic sinusitis is recognised
There are four main signs: congestion or blockage of the nose, thick discharge from the nose or into the throat, pressure or pain in the face, and a reduced sense of smell. The diagnosis requires at least two of them for twelve weeks, together with evidence of inflammation on examination of the nose or on imaging. These symptoms are often joined by a chronic cough, mainly at night and in the morning, bad breath, a dull headache, pressure in the ears, disturbed sleep and tiredness that affects daily function.
A reduced sense of smell is particularly typical of sinusitis with polyps, and sometimes it is the first symptom people notice, when food loses its taste. Severe facial pain on its own, without congestion and without discharge, usually comes from migraine or another type of headache rather than the sinuses, even when it is felt around the forehead and cheeks.
What you can do at home
Saline nasal rinses, once or twice a day, are the most effective home treatment: they clear mucus and discharge, reduce swelling and improve the action of the cilia. Use boiled and cooled water or distilled water only, and keep the device clean. Over-the-counter steroid nasal sprays reduce the inflammation when used continuously, not only during flares. Decongestant sprays give short relief but cause rebound congestion when used for more than a few days, so they are not suitable for a chronic condition.
Alongside this it is important to treat allergy when it is present, stop smoking, keep the air humid in winter and drink enough. When these steps are not enough after a few weeks, it is time for a work-up.
When to see an ENT specialist
It is worth booking a visit with a private ENT specialist in Modi’in in these situations:
- Congestion, discharge or facial pressure that lasts more than twelve weeks.
- A reduced or lost sense of smell, especially when it persists.
- Three or four episodes of acute sinusitis a year, each needing antibiotics.
- A proper course of rinses and steroid spray for eight to twelve weeks that has brought no improvement.
- Blockage on one side of the nose only, or repeated nosebleeds.
- Sinusitis alongside poorly controlled asthma or aspirin sensitivity.
- Regular snoring, sleep disturbance or a chronic cough that accompany the congestion.
- A suspected source in a tooth of the upper jaw.
Swelling and redness around the eye, double or blurred vision, a sudden severe headache with a high fever, a stiff neck or confusion are emergencies that need an immediate visit to the emergency room.
What the ENT specialist checks
The visit begins with a detailed conversation about the duration and nature of the symptoms, the treatments tried, allergies, asthma, smoking and other conditions. The doctor then examines the nasal cavity, usually also with a thin endoscope with a camera that shows the drainage openings, the lining and any polyps, as well as the ears, the throat and the neck.
As needed, the doctor refers you for a CT scan of the sinuses, which shows the degree of inflammation in each sinus, the anatomy and the blockages, and is essential before any decision about surgery. When allergy is suspected, the doctor refers you for an allergy work-up, and when there is asthma or aspirin sensitivity a lung specialist or an allergist is involved. A culture of the discharge is needed only in certain cases.
How chronic sinusitis is treated
Medical treatment is the foundation and continues for a long time. It includes high-volume saline nasal rinses, a daily steroid nasal spray or drops, and treatment of allergy when it is present. In flares with signs of bacterial infection antibiotics are given, sometimes for longer than usual. When there are polyps, a short course of oral steroids shrinks them and restores smell, but the effect is temporary. In recent years biological treatments by injection have been added for severe cases with polyps; they target the inflammation itself and are meant for people who have not been helped by surgery and standard treatment.
When full medical treatment over several months is not enough, or when there is a clear anatomical blockage, endoscopic sinus surgery comes up for discussion. In the operation, which is performed through the nostrils without external incisions, the drainage openings are widened, polyps and diseased tissue are removed, and the septum is straightened if needed. The surgery does not cure the tendency to inflammation but opens the way for rinses and sprays to reach every sinus, so medical treatment continues after it. The decision is made after a CT scan and a conversation about the benefits, the risks and the expectations.
Why it is worth a work-up rather than continuing to suffer
Chronic sinusitis affects quality of life no less than other chronic diseases: poor sleep, tiredness, reduced concentration, lost enjoyment of food and repeated courses of antibiotics. An orderly work-up makes it possible to identify the type and the cause, to tailor treatment that targets the root of the problem and not only the symptom, and to save years of partial treatment. If hearing or ear pressure is also troubling you, read our article on sudden hearing loss and why it is urgent.
At EliteMed in the Ayala 360 complex in Modi’in you can book a visit with an ENT specialist without a referral, and the consultation can be held in English. The information here is general and does not replace an examination and advice from a doctor.
Frequently asked questions
What is the difference between acute and chronic sinusitis?
Acute sinusitis usually appears after a cold, lasts up to four weeks and mostly clears on its own or with short treatment. Chronic sinusitis lasts twelve weeks or more, with congestion, discharge, facial pressure or reduced smell, and results from ongoing inflammation of the lining and blockage of the drainage openings, so its treatment is different and longer.
Are nasal polyps dangerous?
Nasal polyps are benign growths of swollen lining and are not cancerous. They cause blockage, a reduced sense of smell and ongoing inflammation, and need treatment and follow-up. A polyp on one side only, especially with bleeding, requires a more careful work-up by an ENT specialist to rule out other causes.
Do antibiotics cure chronic sinusitis?
Not usually. Antibiotics treat a bacterial flare, but the underlying problem in chronic sinusitis is inflammation of the lining and blockage of the drainage openings, so the main treatment is nasal rinses, nasal steroids and treatment of the cause, and in suitable cases surgery. Repeated courses of antibiotics without a work-up do not solve the problem.
Do I need a CT scan before seeing an ENT specialist?
No. The doctor decides whether imaging is needed after the conversation and the examination of the nose, and refers you for a CT scan mainly when medical treatment has not helped, when an anatomical blockage or polyps are suspected, or before planning surgery. It is worth bringing the results of any previous tests to the visit.
Does surgery solve the problem for good?
Endoscopic sinus surgery opens the drainage openings and removes polyps and diseased tissue, and it improves the symptoms considerably in most people who have it. It does not remove the tendency to inflammation, so rinses, steroid spray and follow-up continue after it. In people with polyps and asthma, the polyps may return over the years and need further treatment.