Sinusitis is a condition where the nasal passages or sinuses become inflamed. This can happen due to infections, allergies, or other irritants. Usually, sinusitis goes away on its own within a week or two. However, if sinusitis persists for longer than that, it is considered chronic sinusitis. Chronic sinusitis can lead to some serious complications if left untreated.
What is sinusitis?
The sinuses are hollow cavities in the bones surrounding the nose. There are four pairs of sinuses: maxillary, frontal, ethmoid, and sphenoid. Each sinus is lined with a mucous membrane and connects to the nasal cavity via small openings called ostia. The main functions of the sinuses are to warm, humidify, and filter air entering the lungs. The sinuses also produce mucus to trap dust, pathogens, and other particles from entering the body.
When the sinuses become inflamed due to irritation, allergies, or infection, it is known as sinusitis. This inflammation causes the sinuses to swell and prevents them from draining properly. As a result, mucus and fluids build up, causing congestion, pressure, and pain in the face and head. Some common symptoms of sinusitis include:
- Facial pain, pressure, or fullness
- Nasal congestion and blockage
- Thick, discolored nasal drainage
- Loss of smell and taste
- Headache
- Fatigue
- Cough
- Sore throat
- Bad breath
There are two main types of sinusitis:
- Acute sinusitis – Lasts less than 4 weeks. Usually caused by a viral infection.
- Chronic sinusitis – Lasts 12 weeks or longer. Can be caused by frequent acute sinusitis infections that don’t fully resolve.
Causes and Risk Factors
Some of the most common causes and risk factors for chronic sinusitis include:
- Allergies – Allergic rhinitis can trigger chronic inflammation in the sinuses.
- Asthma – The chronic inflammation associated with asthma makes the sinuses more vulnerable.
- Nasal polyps – These noncancerous growths can obstruct sinus drainage.
- Deviated septum – An off-center septum can block sinus drainage.
- Respiratory infections – Chronic sinus infections, cold, flu, etc.
- Immune deficiencies – Conditions that impair immunity like HIV/AIDS.
- Environmental factors – Smoking, air pollution, chemicals.
- Poor mucociliary clearance – Conditions like cystic fibrosis impair mucus drainage.
If acute sinusitis is not properly treated and resolved, it can often lead to chronic sinusitis. Frequent antibiotic overuse for acute sinusitis may also damage sinus tissues over time, making the condition worse.
Complications of Untreated Chronic Sinusitis
Leaving chronic sinusitis untreated for too long can result in a number of worrisome complications. Some potential complications include:
- Persistent infections – Chronic sinus infections that don’t respond to antibiotics.
- Nasal polyps – Noncancerous polyps may obstruct sinus drainage.
- Loss of sense of smell – Inflammation can damage olfactory nerves.
- Facial pain – Constant sinus pressure can lead to pain in sinus areas.
- Headaches – Drainage and pressure from infected sinuses.
- Dental problems – Sinusitis may contribute to dental pain, decay.
- Eyelid swelling – Blocked tears ducts can cause swollen eyelids.
- Vision problems – Swelling around eyes may press on optic nerves.
- Ear infections – Blocked Eustachian tubes link sinusitis with ear infections.
- Sleep apnea – Sinus congestion and inflammation narrow airways at night.
- Fatigue – Chronic infections drain energy and disrupt sleep.
Two of the most severe complications that can arise from untreated chronic sinusitis are sinus infections spreading to the eyes or brain. Let’s look at these in more detail:
Spread to the Eyes (Orbital Complications)
If a sinus infection persists and is not drained, the infection can spread to the bones and tissues around the eyes. This can rapidly develop into an emergency condition called orbital cellulitis. Orbital complications can include:
- Eyelid swelling, redness, or drooping
- Vision changes or loss
- Bulging of the eye
- Double vision
- Severe eye pain and headache
These orbital complications are considered a medical emergency. If not treated urgently, it can lead to permanent vision damage or blindness. Prompt IV antibiotics and surgery may be needed to treat the infection and prevent it from destroying delicate eye structures.
Spread to the Brain (Intracranial Complications)
Another rare but extremely dangerous complication is when a severe sinus infection penetrates into the bones of the skull and affects the brain. Potential intracranial complications include:
- Meningitis – Infection and swelling of the membranes surrounding the brain.
- Brain abscess – Pocket of pus that forms within the brain tissue.
- Epidural abscess – Infection between the skull and lining of the brain.
- Encephalitis – Brain inflammation that can damage nerves.
- Osteomyelitis – Infection of the frontal bone of the skull.
If sinusitis spreads to the brain, it can be life-threatening. Urgent diagnosis via CT scan and treatment with IV antibiotics are needed to cure the infection before it causes brain damage, seizures, coma, or death.
Diagnosing Chronic Sinusitis
If you have had sinus congestion, pain, or other symptoms persist for 12 weeks or longer, see your doctor for an evaluation. Chronic sinusitis can often be mistaken for allergies or colds, so a proper diagnosis is key.
To diagnose chronic sinusitis, your doctor will:
- Ask about your symptoms and how long you’ve had them.
- Examine your nose, throat, and sinuses for swelling.
- Tap and press on your face to check for sinus tenderness.
- Use a flashlight to look for nasal polyps or discharge.
- Order imaging tests – CT scan or MRI of sinuses.
- Take a nasal culture to test for bacteria, fungi, or viruses.
- Check for allergies using skin or blood tests.
- Examine nose and throat with an endoscope.
Based on your test results, your doctor can confirm a diagnosis of chronic sinusitis and check for any complications. Prompt treatment will then be recommended.
Treating Chronic Sinusitis
Treatment for chronic sinusitis aims to clear out sinus congestion, control infection and inflammation, and keep sinuses functioning and draining properly. Typical treatments may include:
- Antibiotics – Used to cure bacterial infections causing chronic sinusitis.
- Oral steroids – Help reduce sinus inflammation and swelling.
- Nasal steroid sprays – Reduce inflammation and mucus production.
- Nasal saline irrigation – Rinsing with salt water helps clear sinus congestion.
- Decongestants – Temporarily relieve congestion and pressure symptoms.
- Antihistamines – Block allergic reactions and postnasal drip.
- Surgery – To enlarge sinus openings or remove polyps or obstructions.
It’s important to take all prescribed medication as directed. You may need to use steroid nasal spray daily for several months after other acute symptoms resolve. Proper medication use helps prevent recurrence of chronic sinus infections.
For patients who don’t improve with medication, surgery may be recommended. The most common surgery is functional endoscopic sinus surgery (FESS). This uses a small scope and camera to enlarge sinus openings, remove polyps, or clear out infected tissue. Balloon sinuplasty is another option that gently restructures sinus tissues without removing any.
After surgery, saline irrigation is critical for keeping sinuses clean while they heal. Antibiotics, steroid spray, and other medication may still be required short-term. Most patients see significant improvement in symptoms after surgery for chronic sinusitis.
Preventing Chronic Sinusitis
Once you have chronic sinusitis, it can be an ongoing battle to keep symptoms under control. To help prevent acute sinusitis from turning into a chronic problem, try these prevention tips:
- Treat colds, allergies, and sinus infections early and aggressively.
- Use nasal steroid sprays as prescribed to calm inflammation.
- Rinse sinuses daily with saline spray or irrigation.
- Avoid cigarette smoke and air irritants that trigger symptoms.
- Use a humidifier to keep nasal passages moist.
- Take decongestants sparingly to avoid rebound swelling.
- Get regular exercise to support immune defenses.
- Drink plenty of fluids to keep nasal secretions thin.
Seeing an allergist can also help you identify and manage environmental triggers that contribute to sinus problems. Keeping symptoms under control when they first appear may help prevent acute sinusitis from becoming a chronic issue.
When to See a Doctor
You should see a doctor right away if you have sinus congestion and pain that persists beyond 10-14 days or keeps returning. Other reasons to get prompt medical care include:
- Symptoms get significantly worse instead of improving.
- You develop a high fever, headache, or swelling around the eyes.
- Thick, colored nasal discharge, especially yellow, green, or brown.
- Symptoms interfere with sleep, work, or other activities.
- Over-the-counter sinus medications don’t provide relief.
Chronic sinusitis requires prescription medication and possibly surgery to cure infections, open sinus drainage, and prevent complications. Leaving this condition untreated allows inflammation and congestion to worsen over time. See an ear, nose and throat (ENT) specialist if you suspect you have chronic sinusitis.
Conclusion
Chronic sinusitis develops when acute sinus infections are not resolved and keep recurring over a period of 12 weeks or longer. This chronic inflammation can lead to persistent facial pain, headaches, congestion, and recurrent infections.
If chronic sinusitis remains untreated, more worrisome complications can occur including vision loss, meningitis, brain abscess, and life-threatening infections around the eyes or brain. That’s why it’s critical to see a doctor for proper diagnosis and treatment if acute sinusitis does not improve.
To cure chronic sinusitis, a combination of prescription antibiotics, steroid medications, saline irrigation, and surgery may be required. Careful use of medication and prevention tips can help keep the condition from returning once the sinuses have healed.
Don’t hesitate to get medical help if sinus problems become a chronic issue. Prompt and effective treatment can help avoid many of the most dangerous complications linked to long-lasting sinusitis.