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  • Dr. Koralla Raja Meghanadh

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

Updated: Jan 23

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. 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.

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

Suppose an individual doesn't get treated or partially treated in the acute stage, i.e., within 15 days of the symptoms. In that case, the severity of symptoms subsides, 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.

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.

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.

Dr. K. R. Meghanadh

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