Richmond’s Sinus and Allergy Specialists

Chronic Sinusitis

Do I have Chronic Sinusitis?

If you have had nasal congestion and drainage for more than 3 months, you may have chronic sinusitis.  The primary symptoms are nasal congestion, stuffiness, mouth breathing, and snoring.  Nasal blockage often results in loss of taste and smell. Pain and fever are less commonly seen in chronic sinusitis than in acute infections.  Chronic sinusitis causes swelling and drainage in the nose, which can best be seen during an endoscopic examination by an ENT specialist (otolaryngologist).

You should see a specialist if any of the following last 3 months or longer:

  • Thick or discolored nasal discharge
  • Nasal congestion or obstruction
  • Facial pain, pressure or fullness
  • Decreased sense of smell

What is Chronic Sinusitis?

Chronic sinusitis is an inflammatory condition of the nose and sinuses (the air-containing spaces around the nose and eyes) lasting longer than three months. By definition, patients have at least two of the symptoms listed above, plus evidence of pus, polyps or swelling on examination.Typically, an otolaryngologist (ENT specialist) will examine your nose with a tiny nasal endoscope that allows the specialist to look for mechanical obstruction, redness, swelling, and sinus drainage.  If previous antibiotics have failed, a culture of the sinus drainage may guide further therapy.  The diagnosis can also be confirmed by demonstration of mucosal thickening on a sinus CT scan. At Richmond ENT, we can perform a CT scan in the office on your first visit, and review the results with you within 60 seconds.

Read more about diagnosis of sinusitis

Is it Serious?

Chronic sinusitis can be a debilitating illness that affects not only nasal function, but also impairs overall quality of life to a degree as great as or greater than chest pain, back pain, heart failure or emphysema. Chronic sinusitis affects about one out of every seven adults and peaks during the productive work years between the ages of 20 and 60. Direct expenses for office visits and medications in the United States are approximately $4.3 billion per year. 1

What Causes Chronic Sinusitis?

Although an episode of acute bacterial sinusitis can linger into a chronic condition, other causes of chronic sinusitis include nasal obstructions, allergies, bacterial biofilms, fungi, and immunologic abnormalities.  Anatomic variation and allergic swelling can contribute to sinus blockage. Blockage of sinus openings allows stagnant mucous to accumulate, and create a place for bacteria and fungi to grow. The use of antibiotics selects for resistant strains of bacteria and fungi. Bacteria also have the capacity to organize into multicellular colonies called biofilms, which function much like a microscopic coral reef – slowly growing and building a protective structure that protects the bacteria while supplying nutrients. The presence of bacteria and fungi can stimulate immunologic reactions that cause further swelling and damage to the sinus membranes.

Read more on the following causes of chronic sinusitis:

How do I Treat Chronic Sinusitis?

Chronic sinusitis is much more difficult to treat than acute bacterial sinusitis.  You may have been sick for months and may have received several courses of antibiotics.  Over time, the bacteria become immune to the antibiotics, and you may become allergic to certain antibiotics.  Steroids tend to be the most helpful medicine for chronic sinusitis, as they reduce the swelling that causes nasal and sinus blockage.  Despite aggressive medical management, many patients with chronic sinusitis require surgical cleaning of their sinuses.  New techniques such as balloon sinus dilation make it possible to wash out the sinuses under local anesthesia in the office. Most patients have very little pain and return to work the day after balloon dilation.

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1 Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31.