Chronic Sinusitis

Chronic Sinus Infections

Chronic sinusitis is often caused by inflammation and blockage due to physical obstruction such as a deviated septum, misformed bone or cartilage structures such as the nasal conchae (turbinates), or blockage by nasal cysts or polyps. © ADAM

Chronic sinusitis is a common condition that quite a few of us will experience at some point. While not necessarily serious, it's a pain -- literally. Symptoms of chronic sinusitis include nasal irritation, runny nose, post nasal drip, nasal congestion and sinus pressure or pain that lasts more than 12 weeks. The diagnosis of chronic sinusitis requires signs of inflammation of the sinuses on a CT scan of the sinuses or by direct visualization by nasal endoscopy.

Types of Chronic Sinusitis

There are a number of different types of chronic sinusitis, including:

  • chronic infectious sinusitis
  • chronic hyperplastic eosinophilic sinusitis
  • allergic fungal sinusitis
  • aspirin exacerbated respiratory disease

Sometimes chronic sinusitis is linked to the development of nasal polyps. Also, the presence of allergic white blood cells, called eosinophils, also help to characterize what type of sinusitis you may have. The presence or absence of nasal polyps and eosinophils also help to determine the types of treatments that are used to treat the chronic sinusitis. Often people with any type of chronic sinusitis also struggle with short-term bouts of acute sinusitis.

Chronic Infectious Sinusitis

Chronic infectious sinusitis means you have a long-term bacterial infection. People with chronic infectious sinusitis show large amounts of neutrophils within the sinuses, which suggest that bacteria are present.

The presence of these bacteria may cause stimulation of the immune system and worsening inflammation within the sinuses.

What leads to the persistent infection? Chronic infectious sinusitis may be caused by blockage of the normal drainage sites of the sinuses, from either an anatomical malformation of the sinuses (such as septal deviation or concha bullosa), or from inflammation of the nasal passages (such as from allergic rhinitis or a viral respiratory tract infection).

Treatment of chronic infectious sinusitis typically involves the use of oral antibiotics as well as topical nasal corticosteroid sprays (and sometimes short courses of oral corticosteroids) and nasal saline washes. If these therapies are not helpful, sinus surgery is often required.

Chronic Hyperplastic Eosinophilic Sinusitis

Chronic hyperplastic eosinophilic sinusitis (CHES) is caused more by inflammation of the sinuses rather than by bacterial infection. Nasal polyps are often found in people with CHES, especially in people who also have asthma. Most people with CHES have positive allergy testing to environmental allergens such as pollens, molds, pet dander and dust mites. The presence of bacteria or mold within the sinuses of people with CHES acts as allergens as well, further worsening the sinus inflammation.

Treatment of CHES is best accomplished with the use of nasal saline washes, often with the addition of topical antibiotics (such as mupirocin) added to the saline. Treatment of allergic inflammation of the nasal passages and sinuses, with topical nasal corticosteroid sprays, montelukast (Singulair), and short courses of oral corticosteroids, are very effective for people with CHES.

Sinus surgery is sometimes required, but does not replace the need for anti-inflammatory medications to control CHES.

Allergic Fungal Sinusitis

Allergic fungal sinusitis (AFS) is caused by an allergic reaction to fungus (or mold) living within the sinuses. AFS results in symptoms of nasal congestion, decreased sense of smell, a peanut buttery nasal discharge, and the formation of nasal polyps. The swelling within the sinuses can be so severe with AFS that bone can be destroyed and nerves damaged, often resulting in visual problems, such as double vision.

The diagnosis of AFS is made when a person allergic to fungus is found to have fungus and eosinophils in samples removed during sinus surgery. Treatment of AFS usually involves sinus surgery followed by the use of oral and topical corticosteroids to maintain control of the disease. Allergen immunotherapy (allergy shots) against the fungus to which the person is allergic can also be helpful for the treatment of AFS.

Aspirin Exacerbated Respiratory Disease

People with aspirin exacerbated respiratory disease (AERD) experience chronic sinusitis, asthma and aspirin allergy. The chronic sinusitis is usually severe, involves all of the sinuses, and involves nasal polyps. The most common symptom is a decreased sense of smell, and asthma may be severe and difficult to control. People with AERD may also experience a severe asthma attack if aspirin or another non-steroidal anti-inflammatory drug (NSAID) is taken.

Sinus surgery usually only gives temporary relief, as the chronic sinusitis in people with AERD rapidly recurs, and the need for multiple sinus surgeries is common. Allergies play little to no role in the inflammation caused by AERD. The treatment of AERD usually involves sinus surgery followed by aspirin desensitization, which improves the symptoms of chronic sinusitis and asthma. Other treatments include montelukast (Singulair), zileuton (Zyflo), topical nasal corticosteroids and occasional short courses of oral corticosteroids.

Read more about the diagnosis and treatment of sinusitis.


Hamilos DL. Chronic Rhinosinusitis: Epidemiology and Medical Management. J Allergy Clin Immunol. 2011;128:693-707.

Payne SC, Borish L, Steinke JW. Genetics and Phenotyping in Chronic Sinusitis. J Allergy Clin Immunol. 2011; 128:710-20.

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