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  • Writer's pictureDr. Koralla Raja Meghanadh

Chronic Sinusitis- symptoms, causes, and treatment

Updated: May 13

Chronic Sinusitis- symptoms, causes, and treatment

What is chronic sinusitis?

Chronic sinusitis is a stage of sinus infection that can last for a long time, sometimes for decades. A sinus infection that lasts more than 45 days is typically considered chronic sinusitis. Unlike acute sinusitis, which presents with more severe symptoms, chronic sinusitis usually has one to two symptoms with less severity. This is because in chronic sinusitis, the infection is present for a long period, and the body has adapted to it, reducing the number of complaints. Unfortunately, this may give the patient a false impression that the infection has been cured. In reality, it continues to linger and can spread to other parts, such as the voice box, ears, and lungs.

Chronic sinusitis is the third stage of sinusitis that occurs mostly when acute and subacute sinusitis is left untreated. Chronic sinusitis can become acute again whenever the balance between the infection and the body is disturbed. This stage is called "acute on chronic sinusitis." This can occur when a chronic patient’s immunity is lowered or if they are exposed to a cold or dusty environment or contracts another viral infection. In acute on chronic sinusitis, the number and severity of symptoms will increase, and the patient may experience new symptoms.

What causes chronic sinusitis?

Generally, when acute and subacute sinusitis is left untreated or partially treated, they progress into chronic sinusitis.

Viral infections, such as the common cold, are among the most common causes of sinusitis. While these infections usually resolve within a week, individuals with few underlying conditions may experience fluid stagnation in the sinuses, leading to sinusitis. Stagnant fluids create a breeding ground for bacteria, which can infect the sinus lining and cause sinusitis.

Symptoms of chronic sinusitis

Symptoms of chronic sinusitis:

  1. Runny nose

  2. Nasal congestion or blockage

  3. Headaches

  4. Facial pain

  5. A sensation of phlegm dripping from the back of the nose into the throat

  6. A frequent need to clear the throat

  7. Sore throat and throat pain

  8. Frequent cough attacks

The symptoms of sinusitis remain from the above list only. But, the number and intensity of these symptoms vary. During the acute stage, individuals will have 4 to 5 symptoms with high severity. While in the chronic stages, we will experience one to two symptoms with less severity.

Please read our "Sinusitis symptoms" article to learn more about the symptoms.

How serious is chronic sinusitis?

If left untreated, chronic sinusitis may result in complications affecting the voice box, lungs, and ears.

Complications of chronic sinusitis that can occur:

  1. Laryngitis (infection in the voice box)

  2. Bronchitis & Pneumonia (infection in the lungs)

  3. Otitis media are also known as middle ear infection (infection in ears)

Whenever our immune system is weakened, chronic sinusitis can transform into "acute on chronic sinusitis," which can affect our daily lives. Acute on chronic sinusitis has a separate set of complications.

To learn more, please read our article "Complications of Sinusitis".

How is chronic sinusitis diagnosed?

Generally, doctors diagnose chronic sinusitis using nasal endoscopy and CT scan.

With the help of nasal endoscopy, they can see mucoid discharge, nasal polyps, and yellow pus inside the nose, which will give them a basic understanding of the disease. If the pus appears green, it may indicate a prolonged infection caused by the bacteria called Pseudomonas aeruginosa. Nasal polyps are grape-like structures that are pale white and semi-translucent. These polyps block the nasal path and drainage path of the sinuses. Usually, we can see the nasal polyps in the late stages of sinusitis by just using a headlight. Mucoid discharge has a consistency like a thin string of gum.

CT scan is done to see if there are any anatomical anomalies in the sinus drainage pathway. This CT scan will also allow us to see the contents of the sinuses, like if they are filled with air, pus, fluids, or fungus.

Although an MRI is usually not required for sinusitis diagnosis, it may be needed if a doctor suspects any complications or tumors.

Chronic Sinusitis Treatment

The chronic sinusitis treatment could involve

  1. Antibiotics for gram-negative bacteria like macrolide and ciprofloxacin - 2 weeks to 6 months

  2. Anti-allergic medication in case of allergy

  3. Sinus Surgery

In chronic sinusitis, the initial step is to diagnose the underlying causes and the factors contributing to the condition. Once a thorough analysis has been conducted, treatment will begin. The primary approach to treating chronic sinusitis is to treat it with antibiotics. Usually, doctors don't start the treatment with surgery for chronic sinusitis. When treating a disease, if it is possible that medicines could be effective in curing it, doctors prioritize using antibiotics as the initial treatment option.

If sinusitis treatment is postponed, the effectiveness of antibiotics and other supportive medications may diminish. You are making it tougher to avoid sinus surgery by delaying the chronic sinusitis treatment. In addition, the duration of the antibiotic course will also increase as the disease advances.

In addition to antibiotics, other supportive medications such as antiallergics and decongestants may be prescribed if necessary to complement the antibiotic treatment.

However, we may require surgery if the patient fails to respond to medical treatment as expected. Moreover, surgery may also be considered if the patient experiences severe acute attacks, i.e., acute on chronic sinusitis, many times annually.

Antibiotics used for chronic sinusitis treatment

In chronic sinusitis, the bacteria are gram-negative. So, we treat it with antibiotics that act on gram-negative, like macrolide and ciprofloxacin.

These antibiotics should be given for two to six weeks for chronic sinusitis. But in some instances, chronic sinusitis treatment may extend beyond six months.

Surgery for chronic sinusitis

Doctors often treat chronic sinusitis with aggressive medication before choosing surgery. With proper medication, chronic sinusitis might be cured without surgery. However, suppose the patient experiences complications or does not respond well to medication. In that case, surgery is a possible treatment option. Whenever our immunity is down, the chronic will become acute on chronic sinusitis for a short duration. If a patient experiences five to six or more acute attacks, doctors may consider surgery an option.

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Can chronic sinusitis be cured?

Yes, chronic sinusitis can be cured with the right approach.

The standard treatment for chronic sinusitis involves taking antibiotics for 2 to 6 weeks, as a doctor prescribes. If there is no improvement in symptoms or if the condition worsens, a doctor may recommend surgery as an option.

How do you treat chronic sinusitis?

Chronic sinusitis is treated with antibiotics that target gram-negative bacteria for a period ranging from 2 to 6 weeks or, in some cases, up to 6 months. Since the bacteria causing chronic sinusitis are typically gram-negative, antibiotics are usually the first line of treatment prescribed by doctors. However, if there is no improvement even after taking antibiotics, surgery may be recommended as an alternative option. However, if the patient experiences worsening symptoms and disruption to their daily life due to multiple "acute on chronic" attacks, doctors may suggest surgery as a potential solution.

Will a CT scan show chronic sinusitis?

The answer is both yes and no. While a CT scan can reveal the presence of sinusitis, it cannot differentiate between acute and chronic sinusitis. Instead, the duration of symptoms is used to determine the diagnosis. A nasal endoscopy is typically the initial diagnostic tool used to examine for nasal polyps and discharges that can indicate sinusitis.

If the disease is long-standing, a CT scan is done to understand the condition. A CT scan shows anatomical anomalies in the sinus drainage pathways and the contents of the sinuses. The scan produces different visual cues based on the sinus contents. For instance, a sinus filled with air appears black, while fluid-filled sinuses show fluid level. If the sinus contains pus, it will appear as a greyish color. A fungal infection in the sinuses is indicated by grey and white-colored shadows inside.

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