Chronic sinusitis

DEFINITION

Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen — for at least eight weeks, despite treatment attempts.

Also known as chronic rhinosinusitis, this condition interferes with drainage and causes mucus to build up. If you have chronic sinusitis, it may be difficult to breathe through your nose. The area around your eyes and face may feel swollen, and you may have throbbing facial pain or a headache.

Chronic sinusitis may be caused by an infection, but it can also be caused by growths in the sinuses (nasal polyps) or by a deviated nasal septum. Chronic sinusitis most commonly affects young and middle-aged adults, but it also can affect children.

CAUSES

Common causes of chronic sinusitis include:

• Nasal polyps. These tissue growths may block the nasal passages or sinuses.
• Allergic reactions. Allergic triggers include fungal infection of the sinuses.
• Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
• Trauma to the face. A fractured or broken facial bone may cause obstruction of the sinus passages.
• Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases may result in nasal blockage.
• Respiratory tract infections. Infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, block mucus drainage and create conditions ripe for growth of bacteria. These infections can be viral, bacterial or fungal in nature.
• Allergies such as hay fever. Inflammation that occurs with allergies may block your sinuses.
• Immune system cells. With certain health conditions, immune cells called eosinophils can cause sinus inflammation.

SYMPTOMS

Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. At least two of the following signs and symptoms must be present for a diagnosis of chronic sinusitis:

• Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat
• Nasal obstruction or congestion, causing difficulty breathing through your nose
• Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
• Reduced sense of smell and taste

Other signs and symptoms can include:

• Ear pain
• Aching in your upper jaw and teeth
• Cough, which may be worse at night
• Sore throat
• Bad breath (halitosis)
• Fatigue or irritability
• Nausea

The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except they last longer and often cause more significant fatigue. Fever isn’t a common sign of chronic sinusitis, as it may be with acute sinusitis.

When to see a doctor

You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment.

Schedule an appointment with your doctor if:

• You’ve had sinusitis a number of times, and the condition fails to respond to treatment
• You have sinusitis symptoms that last more than seven days
• Your symptoms don’t get better after you see your doctor

See a doctor immediately if you have symptoms that may be a sign of a serious infection:

• Pain or swelling around your eyes
• A swollen forehead
• Severe headache
• Confusion
• Double vision or other vision changes
• Stiff neck
• Shortness of breath