What Is Chronic Sinusitis?

Sinuses are interconnected, hollow spaces located in the skull that connect to the nasal passages. They help filter the air we breathe and act as another level of immune defense. Sinuses are lined with soft tissue and have a light layer of mucus that keeps them moist and healthy.

When working properly, the sinuses drain mucus regularly. Chronic sinusitis interferes with that. It occurs when the sinuses become inflamed and blocked for 12 weeks or longer, despite treatment. This can make it difficult to breathe freely, sleep well, and even think clearly.

Chronic sinusitis is treatable. At University of Utah Health, our fellowship-trained rhinologists are experts who specialize in managing nasal and sinus problems. They can diagnose chronic sinusitis and provide personalized treatment, including non-surgical therapies and, if needed, endoscopic sinus surgery. They participate in clinical research and clinical trials including studies that explore new treatments for chronic sinusitis.

Chronic Sinusitis Causes

Experts don’t always know why some people develop chronic sinusitis and others don’t. You may be more likely to develop this condition if you have:

  • allergies,
  • asthma,
  • an underlying condition, such as cystic fibrosis,
  • a family history of chronic sinusitis, or
  • nasal polyps (soft, painless, noncancerous growths on the lining of the nose or sinuses).

Bacterial infections do not cause chronic sinusitis, but some people with chronic sinusitis develop persistent bacterial infections.

man with sinus pain

Chronic Sinusitis Symptoms

Common symptoms of chronic sinusitis include:

  • difficulty breathing through your nose,
  • difficulty sleeping due to breathing discomfort,
  • increased mucus in your sinuses and nose,
  • inflammation (swelling) in your nose (nasal congestion),
  • loss of smell and taste,
  • pain in your ears, upper jaw, and teeth, and
  • post-nasal drip (when mucus drains down the back of your throat).

Other symptoms can include:

  • fatigue,
  • headaches, and
  • sore throat.
The symptoms of acute sinusitis are similar to those of chronic sinusitis but only last for a short time.

When to Seek Treatment

If you experience symptoms of sinusitis for more than 10 days, consider making an appointment with your primary care provider. Your provider may recommend treatments such as:

  • antibiotic medication,
  • decongestant medication,
  • rest, and
  • rinsing your sinuses with a saline solution.

If your symptoms persist, you may need to make an appointment with a specialist, such as a rhinologist. Rhinologists at U of U Health are experts in diagnosing and treating chronic sinusitis.

In rare situations, chronic sinusitis can cause symptoms that need immediate medical attention. These occur when a bacterial infection develops in the sinuses and spreads to other parts of your body. If you experience loss of vision, confusion, or dizziness along with sinusitis symptoms, call your primary care provider right away.

What to Expect at Your First Appointment

During your first appointment with a rhinologist, the goal is to learn more about your symptoms and medical history to create a personalized treatment plan.

Your doctor will talk with you about:

  • your symptoms and how long you have been experiencing them,
  • what treatments you have already tried, and
  • any underlying conditions you have that may be making your symptoms worse.

Your doctor may want to do tests before deciding what treatment to recommend. These tests can occur during your first visit and may include:

  • doing a nasal endoscopy (this involves using a thin tube with a small camera and light to view inside your nose and sinus passages),
  • doing blood tests, and
  • testing a small mucus sample.

Some tests may be ordered separately and take place at a later time. These include:

Non-Surgical Treatments for Chronic Sinusitis

After all the test results are available, the rhinologist will talk to you about a treatment plan. This can happen during your first appointment or during a follow-up conversation.

The first line of treatment will likely involve non-surgical therapies to control the inflammation, reduce symptoms, and improve your quality of life. This is sometimes referred to as “appropriate medical management” and may include:

  • flushing your sinuses with a saline solution,
  • using a nasal spray that contains a corticosteroid (anti-inflammatory) medication or adding this medication to your saline rinse,
  • using oral steroid medication, and
  • using oral antibiotic medication.

Most people with chronic sinusitis experience relief with these non-surgical treatment options. Some people need additional non-surgical therapies due to an underlying condition. For example, people with allergies may need to see an allergy specialist.

woman using nasal spray

Chronic Sinusitis Surgery

If appropriate medical management isn’t successful, the next step may be to have endoscopic sinus surgery. This surgery opens up blocked sinuses so that they can drain better and you have better access for anti-inflammatory medicine to reach your sinuses more easily.

Surgery alone is not a cure. You will need to use nasal sprays or irrigations that contain anti-inflammatory medication as directed by your doctor. As a result of the surgery, more of the medicine will reach your affected sinuses, which will provide more symptom relief. 

Endoscopic sinus surgery: what to expect

The care team will let you know what to expect and how to prepare for your surgery. If you take blood thinners or certain supplements, you will need to stop for two weeks before surgery. The rhinologist may have you take antibiotic, anti-inflammatory, or steroid medications before tor after the surgery takes place.

Endoscopic sinus surgery is minimally invasive and usually done as an outpatient procedure. Patients with other health problems, such as sleep apnea or heart disease, may need to stay at the hospital overnight.

During surgery, the surgeon will access your sinuses using endoscopes inserted into your nose. The surgeon may:

  • remove polyps that are causing blockages,
  • open inflamed sinuses to create more space for drainage and better access for medication, or
  • guide a small balloon into your sinuses and inflate it gently to clear the passageways.

Endoscopic sinus surgery doesn’t require any external incisions. You won’t have any visible signs of the surgery, such as puffy eyes or swelling. You may experience some pain or discomfort for the first few days after surgery, but over-the-counter pain relievers should provide relief.

After endoscopic sinus surgery

For the first few days after surgery, you will need to rinse your sinuses with a saline solution to keep them clean. The care team will teach you how to do this.

You’ll have a follow-up appointment with your rhinologist about a week after the surgery. The doctor will view your sinuses using an endoscope to make sure everything is healing well. After this appointment, you can gradually resume your normal activities. You will typically begin using anti-inflammatory nasal sprays on a regular schedule. This will help keep your symptoms well-controlled.

Living with Chronic Sinusitis

Thanks to appropriate management, the majority of people with chronic sinusitis experience significant improvement in their symptoms. Patient-specific care and ongoing management of this chronic disease process are the keys to the best outcomes.

Making an Appointment with a Rhinologist

Referrals are welcome but not necessary when making an appointment with a rhinologist at U of U Health. To make an appointment, call 801-587-8368 or use our online form. Our team will verify your insurance coverage before your visit. If you have had medical tests related to your condition, we will request the results from your provider. Our goal is to make your visit as efficient and helpful as possible.