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Chronic sinusitis

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Your sinuses are hollow spaces within the bones of your face, behind and above your nose. They humidify and warm the air you breathe, aid your sense of smell, and improve the sound of your voice. They also make mucus, which cleans and moisturizes your nasal passages.

Inside your sinuses are tiny hairs, called cilia, which constantly sweep mucus out of your sinuses and into your nose and throat. Your sinuses drain into your nose through small openings called ostia. When the ostia become blocked, mucus backs up in your sinuses.

When your sinuses can't drain, microorganisms such as viruses and bacteria can multiply and cause infection. Infection causes swelling, which makes it even harder for your sinuses to drain.

Common causes of sinus blockage, which can lead to chronic sinus infections, are:

  • Respiratory tract infections. Infections in your respiratory tract — most commonly, colds — can inflame and thicken your sinus membranes, impeding mucus drainage and creating conditions ripe for bacteria growth.

  • Allergy. Your immune system may mistake harmless elements such as pollen, pet dander or dust mites as violent attackers, and fight back. The results of this battle mimic signs and symptoms of a cold — stuffy nose, itchy eyes, cough — and may cause congested sinuses. Seasonal allergies may increase your risk during distinct times of the year. If you have allergies to dust mites or pets, your symptoms could appear and reappear at seemingly more random times. Fungi also can cause a specific type of chronic sinusitis called allergic fungal sinusitis.

  • Nasal or sinus obstructions. Nasal polyps, small growths that resemble grapes, can obstruct the passages from your sinuses to your nose, making proper drainage difficult. The size and shape of the opening between your sinuses and nasal cavity also may obstruct sinus drainage.

Other causes of chronic sinusitis include:

  • Lack of antibodies called immunoglobulins in your immune system

  • Cystic fibrosis, which causes your body's secretions to become thick and sticky in your sinuses as well as in your lungs

  • Trauma, such as a fractured facial bone, which may obstruct one or more of your sinus cavities

When to seek medical advice

Typically, people have several episodes of acute sinusitis before developing chronic sinusitis. If you've had sinusitis a number of times and the condition doesn't respond to treatment, or if your infection has lasted more than 3 months, ask your doctor if you might have chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist.

Chronic sinusitis can increase the frequency and severity of asthmatic flare-ups in people with asthma and in people who have asthma-like reactions to aspirin and related medications such as ibuprofen. If you experience wheezing or shortness of breath, or if you're concerned about possible aspirin allergy, see your doctor for additional tests.

Screening and diagnosis

Chronic sinusitis can be difficult to diagnose because the symptoms may be very similar to colds or allergies. Provide your doctor with as much detail about the type and duration of your symptoms as possible.

Your doctor may recommend allergy skin tests to determine whether allergies are causing your sinusitis. Allergy skin tests are safe, involve little if any discomfort and usually can be done in about 25 minutes.

These procedures help in diagnosing chronic sinusitis:

  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.

  • Imaging. Images taken using a computerized tomography (CT) scan can show details of your sinuses and nasal area, including a deep inflammation or infection that may be difficult to detect using an endoscope.

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