- Nasal congestion, pain, and pressure that lasts over 3 months could be chronic sinusitis.
- Viruses, allergens, and respiratory or immune conditions can raise your risk of chronic sinusitis.
- Treatments your doctor may suggest include decongestants, steroids, nasal irrigation, and biologics.
Sinusitis is a condition where your sinuses become swollen and inflamed. This condition can be acute or chronic. Acute sinusitis generally clears up within about a month, but if your symptoms last longer than 12 weeks, you have chronic sinusitis.
The right treatment can help you get some relief from its symptoms — but treatment is also important because it lowers your risk of complications, such as permanent loss of smell, decreased productivity at school or work, and depression.
Read on to learn the symptoms of chronic sinusitis, as well as your options for treatment and tips to prevent it.
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Symptoms of chronic sinusitis
Your sinuses are passages behind your nose. They produce fluids that drain out of your nose to help keep it clean and free of microbes like bacteria.
With sinusitis, these passages become swollen, filled with fluid, and irritated.
People with chronic sinusitis typically have ongoing sinus pressure symptoms, such as headache and pain around the face, says Dr. Eugene Chio, an otolaryngologist with the Ohio State University Wexner Medical Center. These symptoms persist even with treatment, Chio says.
You may also feel generally tired or unwell, or experience other symptoms, including:
- A runny nose with yellow or green mucus that might drip down your throat
- Pain, pressure, or a feeling of fullness on your face
- A blocked nose or difficulty breathing through your nose
- Pain around your teeth
- A reduced sense of smell
- Painful, stuffy ears
- Bad breath
Possible causes of sinusitis include:
- Viruses, bacteria, and fungi: Rhinoviruses, influenza, staphylococcus aureus, and anaerobic bacteria can all cause chronic sinus inflammation. Fungi like Aspergillus and Candida can also cause fungal chronic sinusitis, but this is more common if you have immunosuppressive conditions like diabetes or HIV.
- Allergies: If you're allergic to inhaled allergens like dust mites, pollen, and mold, coming into contact with them can leave your sinuses swollen and inflamed.
- Toxins: Cigarette smoke (both first- and secondhand smoke) and other airborne irritants — such as ammonia, formaldehyde, and carbon monoxide — can irritate your sinuses.
- Improper drainage from your sinuses: Foreign objects, nasal polyps, a deviated nasal septum, or any swellings inside your nose can prevent drainage. The resulting fluid buildup in your nose can lead to chronic sinusitis.
- Ciliary dysfunction: Cilia are tiny hair-like structures in your nose and nasal passages that guide the flow of fluids downward and outward. Damaged cilia — which can result from smoking and vaping — may cause a buildup of fluid that leads to inflamed sinuses.
- Prolonged use of tubing: Having a tube in your nose for feeding or breathing can increase your risk of sinusitis because the tube obstructs and irritates your nose. Similarly, being on oxygen therapy for an extended period can dry and irritate your nasal passages.
Risk factors for chronic sinusitis
Your sinusitis may be more likely to become chronic if you have any of the following:
- Regular exposure to toxins, allergens, and air pollution: Harmful fumes and air pollution leave your sinuses little time to recover, which can mean they're constantly inflamed. Pets can also increase your risk of chronic sinusitis, especially if you have allergies, says Dr. Gary Snyder, a board-certified otolaryngologist in private practice.
How to get a diagnosis
If you have symptoms that suggest chronic sinusitis, it's best to make an appointment with a doctor as soon as possible — especially if you experience symptoms that point to a spreading infection, such as:
- Worsening symptoms
- Severe symptoms such as a severe headache, pain around your face, or a high fever
- Difficulty seeing or blurred vision
Your doctor will ask about your symptoms and how long you've had them. They'll also examine your face, ears, nose, throat, and chest for signs of swelling and tenderness.
To confirm a diagnosis of chronic sinusitis, your doctor may recommend some tests, including:
- Aeroallergen allergy testing: This can help your doctors identify any allergens irritating your sinuses.
- CT scan: This imaging test can help detect any swelling, fluid collection, or inflammation in your sinuses.
- Nasal endoscopy: This test allows your doctor to look into your sinuses for signs of swelling and inflammation. They can also take a sample of the fluids for a culture to identify any bacteria present.
- Sinus biopsy: If there is any tissue or mass in your sinuses, your doctor may take a small portion of it to determine the cause and best treatments.
Treatment of chronic sinusitis
Chronic sinusitis can't always be cured, but treatment will often help ease your symptoms.
Your doctor will try to pinpoint the cause, treat any infections, and suggest treatments to relieve nasal swelling and irritation, such as:
- Allergen avoidance: This involves identifying allergies that could be causing your symptoms and making a plan for you to avoid them.
- Pain relief: Your doctors may prescribe pain relievers like ibuprofen, aspirin or acetaminophen to relieve pain around your face, teeth, and ears. If you have aspirin-exacerbated respiratory disease (AERD), they may recommend alternatives such as acetaminophen and hydrocodone.
- Steroids: Using nasal steroid sprays can help reduce pain, swelling, and inflammation around your nose. Your doctor may prescribe oral steroids to reduce inflammation.
- Nasal irrigation: This involves using a salt and water solution to flush out any fluid and dirt from your nasal passages.
- Antihistamines: These drugs can help treat allergies and reduce symptoms like swelling, runny nose, and congestion.
- Decongestants: These drugs may reduce swelling around your nose and help you breathe more easily.
- Antibiotics: If your doctor thinks you have a bacterial infection, they may prescribe antibiotics for several days to clear it.
- Biological drugs: Prescription drugs like dupilumab, which are designed to act like your body's natural antibodies, can help reduce inflammation and congestion in your sinuses.
- Surgery: A balloon sinuplasty or endoscopic sinus operation may help restore drainage and remove swellings in your nose A balloon sinuplasty involves placing a small balloon in your nose to enlarge your sinuses and help them drain fluid more efficiently. Endoscopic sinus surgery involves removing obstructions in your sinuses.
Your care team may recommend a combination of treatments to help you get the most relief.
If you feel uncomfortable and find it difficult to breathe at home, these remedies may offer some relief:
- Inhale steam: Warm, moist air may improve your breathing and help mucus drain out. You can do this by placing hot water in a bowl and bending over it with a towel over your head to inhale the steam for as long as you can tolerate, typically about 30 seconds at a time. Alternatively, you can close your bathroom door and windows and run a hot bath. Stay in the bathroom to inhale the steam for a few minutes.
- Use a humidifier: Running a humidifier in your home can also add moisture to the air and help relieve congestion and other symptoms. Check out the best humidifiers we've tested.
- Try a warm compress: Applying a warm compress to your nose and face may provide some relief. You can make a compress by dipping a clean towel in warm water, squeezing it to remove excess liquid, and holding it to your face until it's no longer warm.
- Drink plenty of fluids: Warm drinks like warm water, lemon water, or herbal tea can improve your breathing and keep you hydrated. Experts recommend women drink about 91 ounces of fluid per day, and men drink about 125 fluid ounces. It's best to avoid alcoholic or caffeinated drinks, though, since they can make it harder to rest or stay hydrated.
- Eat spicy soups: Older research suggests chicken soup may help reduce inflammation. This may be due to the fact that herbs and spices used to make chicken soup contain antioxidants and anti-inflammatory agents that help you feel better. Spices like clove, garlic, black pepper, coriander, and ginger have proven anti-inflammatory effects, too.
- Eat fruits and vegetables: Fruits and vegetables rich in antioxidants and anti-inflammatory compounds called polyphenols may help relieve inflammation. Examples include grapes, berries, broccoli, onions, red cabbage, oranges, and lemons. The CDC recommends adults eat about five cups of fruits and vegetables each day.
- Embrace rest and sleep: Sleep helps your body heal and recover. Experts recommend getting seven to nine hours of sleep each night — but don't worry if you find yourself sleeping even more when sick.
Things that can worsen symptoms
While your sinuses are inflamed, try to avoid anything that can worsen your symptoms, such as:
- Blowing your nose too hard: Blowing with too much force may damage blood vessels in your nose, making the swelling and irritation even worse. It can also cause nosebleeds.
- Picking your nose: This can introduce more germs or allergens to your sinuses and worsen infection and inflammation.
- Inhaling fumes or chemicals: Fumes from cleaning products, pesticides, exhaust fumes, air fresheners, or candles can irritate your sinuses even further. Even ingredients that may seem helpful, like menthol, eucalyptus, and other essential oils, can worsen your symptoms.
- Traveling while sick: Airplane travel can expose your sinuses, ears, and throat to increased pressure and worsen your symptoms considerably. Even long car or train trips can make you breathe dry air and increase your discomfort.
- Overusing nasal sprays or decongestants: Using nasal sprays for more than seven days can lead to rebound congestion and make your symptoms worse.
Preventing chronic sinusitis
These tips can help lower your risk of chronic sinusitis:
- Practice good hygiene: Proper handwashing and the use of hand sanitizers can reduce the number of microbes that get to your face and nose.
- Avoid spending time with people who have colds or runny noses: Colds are contagious, and since they can inflame your sinuses and lead to chronic sinusitis, try to keep your distance from people who are ill — or wear a mask and encourage them to wear one, too.
- Get vaccinated: Being vaccinated against respiratory viruses like the flu, pneumonia, and COVID-19 can reduce your risk of developing viral sinusitis from these conditions, not to mention lower your risk of severe symptoms if you do contract these illnesses.
Chronic sinusitis causes prolonged inflammation of your sinuses, which can lead to pain, discomfort, fever, and ongoing congestion. But the right treatment can help reduce your symptoms or even clear them altogether.
If you experience symptoms that suggest chronic sinusitis, such as a runny nose, blocked sinuses, and pain around your face that just won't go away, making an appointment with a healthcare professional is an excellent next step.
Your doctor can help you identify possible causes, suggest strategies to get relief, and offer guidance on avoiding complications.