Sinusitis stages - acute, chronic, subacute, acute on chronic

Updated: 5 days ago

Dr. K. R. Meghanadh


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.


Read our article "causes of a sinusitis infection," where we clearly describe how each of the three factors mentioned above can contribute to 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 this time frame of fifteen days, this sinusitis is more likely to resolve, and all the symptoms should disappear. If the treatment is partial, the intensity of the symptoms will decrease.


Subacute sinusitis

If an individual doesn't get treated or partially treated in the acute stage, i.e., within15 days of the symptoms, then the severity of symptoms subside, pushing the disease to the next stage called subacute sinusitis.


This stage will continue for about one month, i.e., from the 15th day of the infection to the 45th day of the infection.


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 infection is not reduced 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 can spread to the voice box, ears, and lungs.



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 totally 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. New symptoms can be experienced by the patient.


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 mostly on the environment or viral infections and not on foods.


Dr. K. R. Meghanadh

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