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4 Stages of Sinusitis - Acute, Chronic, Subacute, Acute on Chronic

Updated: May 28

Dr. K. R. Meghanadh

Acute | Subacute | Chronic | Acute on Chronic

Stages of sinusitis - acute, subacute, chronic, acute on chronic

How Sinusitis starts?

For a person to get sinusitis, they must have a few underlying problems like -

  1. allergies

  2. anomalies in the structures like sinus opening and drain paths of sinuses that are responsible for draining infected fluids

  3. low immunity towards bacteria by birth

When people with the above conditions are infected with common viral infections like the common cold, swelling in the nose structures can occur, resulting in the stagnation of the fluids in the sinuses. These stagnated fluids will be responsible for hosting bacteria that can infect the sinus walls causing sinusitis. The chances of getting sinusitis will decrease drastically if the common cold is treated with proper medication under a doctor's guidance.

Read our article "causes of a sinusitis infection," where we clearly describe how each of the three factors mentioned above can contribute to sinusitis.

Stages of Sinusitis

There are four stages of sinusitis and they are

  1. Acute

  2. Subacute

  3. Chronic

  4. Acute on chronic

Sinusitis is a condition that develops in stages. It begins with an acute stage, progresses to a subacute stage, and eventually becomes chronic. The chronic stage is the longest-lasting and typically has milder symptoms that persist over time. However, if a person's immunity weakens or develops another infection, the chronic stage may progress to a more severe stage with additional symptoms. This stage is known as acute on chronic sinusitis.

Acute sinusitis

As mentioned earlier, most sinus infections start with common viral infections like the common cold. These viral infections usually subside within 5 to 7 days. In this period, the stagnation can begin due to swelling of nasal structures, and bacteria grow in these fluids. The bacteria can affect the skin lining of the sinuses resulting in sinusitis.

Due to sinusitis, common cold symptoms worsen. These symptoms can be -

  1. Nose block

  2. Running nose

  3. Headache

  4. Fever

  5. Loss of smell

  6. Congestion or redness of the eyes

  7. Phlegm coming from the back of the nose into the throat

  8. Recurrent attacks of cough

Unlike the common cold, these symptoms can hinder the patient's daily life due to their severity. The worsening of these symptoms indicates that symptoms are turning from viral to bacterial, i.e., infection is turning into acute bacterial sinusitis or acute sinusitis.

So, in zero to five days, the symptoms were for the flu, and in six to fifteen days, the symptoms belonged to acute sinusitis. If the individual takes proper treatment religiously within fifteen days, this sinusitis is more likely to get cured, and all the symptoms should disappear. If the acute sinusitis treatment is partial, the intensity of the symptoms will decrease.

Subacute sinusitis

Subacute sinusitis is a stage that can occur when acute sinusitis is only partially treated or left untreated. The subacute stage will continue for about one month, i.e., from the 15th day of the infection to the 45th day.

Although the decrease in symptoms will give a false notion that the disease has subsided, the chance of progressing to chronic gets higher with this stage. With the start of this stage onwards, doctors may want to do a minor surgery as a part of the treatment, and the number of tests done as a part of diagnosis compared to acute also increases.

It is common for doctors and online articles to group the acute and subacute stages of sinusitis. However, it is essential to recognize significant differences in the approaches used for diagnosis and treatment between these stages. Therefore, distinguishing between acute and subacute sinusitis can be crucial for effectively managing and resolving the condition.

Chronic sinusitis

After 30 days of subacute sinusitis, i.e., after 45 days of infection, it turns into chronic sinusitis. In chronic sinusitis, the number of symptoms decreases to one or two with lesser severity and is not at all troubling the patient.

Here an equilibrium between the bacteria and immunity is reached. The symptoms are only reduced, deceiving the patient. A compromise between infection and immunity is achieved, but the disease does not reduce internally.

As the symptoms have subsided, patients have the wrong notion that the sinusitis is in control and come to terms with the existing symptoms. But, internally, the infection has not decreased, and there is a potential risk of it spreading to the voice box, ears, and lungs.

You can read about the complications of sinusitis here.

Acute on Chronic sinusitis

Whenever a chronic sinusitis patient goes into colder weather, the nasal mucosa slightly swells, adding to the other sinusitis factors. Already partially blocked openings or drainage pathways will be blocked more or get blocked. When the total blockage happens, the bacteria grow more, and the symptoms will increase, similar to acute sinusitis. This stage is called "acute on chronic" sinusitis. Both the number and severity of the symptoms will also increase in acute on chronic sinusitis. The patient can experience new symptoms.

This stage can happen whenever a chronic patient moves to a cold or dusty environment or if they get another viral infection.

Many attribute acute on chronic sinusitis to food like ice creams or cool drinks, but it depends mainly on the environment or viral infections and not on foods.

Written by

Dr. K. R. Meghanadh


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 prescribed by a doctor. If there is no improvement in symptoms or if the condition worsens, a doctor may recommend surgery as an option.

What is the difference between sinusitis and acute sinusitis?

The main difference between sinusitis and acute sinusitis is that acute sinusitis is just one stage of sinusitis. Acute sinusitis is the first stage and typically lasts for the first 15 days. Acute means very severe, so in the acute stage, the number and severity of the symptoms are more compared to future stages. Due to lack of proper treatment, acute progresses to subacute sinusitis, which will last for one month, followed by chronic sinusitis. In both subacute and chronic, the number and severity of symptoms will decrease gradually. But, if a chronic patient gets into cold weather or gets another viral infection, this chronic can move into a stage called "acute on chronic" sinusitis, where the symptoms will increase, like in acute or even more.

Knowing which stage of sinusitis we are in is essential, as the diagnosis and treatment will depend on it.

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.

What is the longest sinus infection?

Chronic sinusitis is the longest sinus infection. Dr. K. R. Meghanadh, our author, has seen patients with chronic sinusitis for as long as 40 years. It is not uncommon to see people suffering from chronic sinusitis for decades. Whenever a sinus infection lasts for more than 45 days, it turns into chronic. Chronic sinusitis is caused when the acute and subacute sinusitis is left untreated or partially treated. Even though chronic sinusitis persists for several months or even years, we can cure it with proper treatment.

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