CHRONIC SINUSITIS: Types, Symptoms, Risk Factors, Diagnosis, Prevention


What are SINUSES?

The sinuses are hollow pockets in the skull that houses air pockets. There are four groups of sinuses which are located between the eyes and behind the forehead, nose, and cheekbones.

These are –





What are the functions of SINUSES?

The sinuses in the human skull help in —

1) Reducing the weight of the skull;

2) Dampening pressure;

3) Humidifying and warming inspired air;

4) Absorbing heat and insulating the brain;

5) Helps in aiding in the resonance of the sound; and

6) Increasing the olfactory surface area.

What is Sinusitis?

If you have ever felt an aching pain, swelling, traumatic pull, or pressure around your eyes and nose after suffering from cold or allergies, then probably you might be facing sinusitis, commonly called a sinus infection.

And this infection has no age limit for it can affect right from children to older adults.

Sinusitis is an inflammation of the mucus lining of the sinuses that can cause them to get blocked. This results in the absorption of the air of the sinuses resulting in the filling of the sinuses with fluid.

We know now that sinusitis is a result of a cold……..But how exactly does it work?

Naturally, the function of the sinuses is to remove the secretions of the nose and sinuses thus keeping them safe from bacteria and viruses.

Sometimes, a cold or exposure to allergens can cause too much mucus to form. This mucus buildup can become very thick and sticky and encourage bacteria and other germs to build up in the sinus cavity, eventually leading to a sinus infection or SINUSITIS.

When the noses or the sinus tissues get infected by a cold, instead of cleaning the mucus from the sinuses, the mucus gets collected in them. As a result this excess mucus further block the sinus openings and arrest their functioning. Thereby, this mucus pool inside the sinus cavity becomes just adequate of a nidus for bacterial infection, and hence the bacterial population increases because of which the infection keeps getting severe.

What are the RISK FACTORS for Sinusitis?

Anyone can develop sinusitis or a sinus infection. However, certain health conditions and risk factors can increase the chances.

The potential risk factors for sinusitis are:

    • DEVIATED NASAL SEPTUM – When the septum, that is the flexible nasal cartilage that divides the nose into two halves is not straight, it forms one wide nasal passage and the other narrow which causes blockage of the nose.
    • Benign sinonasal nasal masses such as NASAL POLYPS
  • COLD and other upper respiratory tract infections which can be caused by viruses, bacteria, or fungi
  • HYPERSENSITIVITY or ALLERGIES to certain allergens like mold, pollen, etc that causes cold and other nasal infections.
  • Any previous or ongoing illness or medication can lead to sinus as a symptom or side effect.

Certain other practices that can trigger and aggravate sinusitis are:-

  • Smoking in adults
  • Feeding infants, while they are lying down, can also lead to sinus.
  • A weakened immune system
  • CYSTIC FIBROSIS, which causes thick mucus to build up in your lungs and other mucous membrane linings
  • Dental infection



1) Blockage of the nose

2) Mucus from the nose moving down the throat also known as POST NASAL DRIP

3) Pressure and pull around the eyes, nose, and forehead
The headache usually comes upon waking, gradually increases and reaches its peak at about mid-day, and then starts subsiding (also known as OFFICE HEADACHE).

4) Ethmoidal pain, which may be aggravated by movements of the eyeball, is localized over the bridge of the nose, and deep to the eyes.

5) Wet cough with thick yellow or green mucus –
Cough may remain throughout the day and maybe more at night.

6) Dizziness

7) Fever

8) Bad breath

9) Severely stoning headache which increases on bending or stooping down

10) Decreased sense of smell (aka HYPOSMIA)

11) Loss of sense of smell (aka ANOSMIA)

12) Swelling or Puffiness around the eyes

13) There may be facial pain, or dental and gum pain (especially in maxillary sinus involvement). Pain may be aggravated by stooping, coughing, or chewing.


1. Acute Rhinosinusitis (< 4 weeks duration)

– Acute Viral Rhinosinusitis (VRS)
– Acute Bacterial Rhinosinusitis (ABRS)

2. Subacute Rhinosinusitis (4–12 weeks duration)

3. Chronic Rhinosinusitis (> 12 weeks duration)
a. With Nasal Polyps
b. Without Nasal Polyps

4. Recurrent Acute Rhinosinusitis
(3 episodes in 6 months
4 or > 4 episodes of acute rhinosinusitis in 1 year)


  • Imaging tests. Various imaging tests can be used in making a diagnosis.

–> An X-RAY (specifically in Occipitomental view or WATER’s view) provides a simple image of the sinuses.

–> A CT SCAN of PARANASAL SINUSES (in coronal, axial, and sagittal views) provides a complete 3-D picture of the sinuses.

–> An MRI uses powerful magnets to create images of the nose and paranasal sinuses and is most useful when fungal sinusitis such as Mucormycosis or Black fungus of sinuses is suspected.

  • Nasal endoscopy. The doctor may also use an ENDOSCOPE that passes through your nose, to directly visualize the inside of your nasal passages, nasal septum, turbinates, and nasopharynx.
    The doctor may also obtain a sample of pus from the nose for culture testing during this procedure.
    Culture testing can detect the presence of viruses, bacteria, or fungi.
  • Allergy tests. An ALLERGY TEST like SKIN PRICK TEST identifies environmental factors that may cause an allergic reaction.


1) Nasal Decongestion

The following can be done to reduce the nasal congestion –

    To help relieve the feeling of pain and pressure from sinusitis, apply a WARM CLOTH to the affected area such as the face or forehead several times a day.
  • Perform a NORMAL SALINE NASAL WASH to help clear the thick and sticky mucus from the nose.
    Drink plenty of water and juice to stay hydrated and help thin the mucus.
  • Use a HUMIDIFIER in the bedroom to add moisture to the air.
    Steam inhalation can be done to decongest the nose.
    (Eucalyptus+Campor+Menthol) capsules such as Karvol plus can be added to the steam inhalation. It helps in thinning the mucus and clearing out the blocked nose, provides relief from pain and breathing difficulties, relieves infection and local irritation caused due to cold, and prevents worsening of respiratory tract infections.

2) Medical Management

Medical management includes the use of –


–> A 28-day antibiotic course is used along with a nasal steroid spray (NSS), which may be
combined with a short course of tapering dose of oral steroids, before the case is considered for surgery.

–> The Nasal Steroid Spray (NSS) like Fluticasone/Mometasone/Budesonide is tapered and started again if symptoms recur.

–> Culture directed topical antibiotics can be used:
a. Mupirocin, 5 g in 45 ml saline, as nasal irrigation in cases of Staph. aureus.
b. Gentamicin, 80 mg in 500 ml saline, as nasal irrigation, in cases of Pseudomonas.

–> Saline nasal douching daily before NSS helps in some refractory cases.
One to three tablespoons of saline (1–2 teaspoons of salt and 1 teaspoon of baking soda per 1 quarter of water) should be used per sitting. They help to keep the nose free from viscid secretions and also remove the superficial infection.

–> Antiallergics to manage the Allergy (if present) —
a. Topical antihistamines
b. Anticholinergics (for eg. Ipratropium)
c. Leukotriene modifier (for eg. Montelukast, Zafirlukast, and Zileuton) may be helpful in some cases.

–> Nasal decongestants like Xylometazoline or Oxymetazoline relieve nasal obstruction and improve sinus ventilation. Excessive and longtime use is avoided because it may lead to rhinitis medicamentosa and affect mucociliary clearance.


  • ESS

ESS or Endoscopic sinus Surgery –

When the patient fails to respond to the above-mentioned medical management, then surgical management of sinusitis is advised to the patient.

By surgical management of sinusitis, I mean ESS which is ENDOSCOPIC SINUS SURGERY.

In antibiotic failure patients where a CT scan is positive for sinusitis, endoscopic sinus surgery (ESS) is considered.

Massive polyps are usually not cured with antibiotics and recurrence usually occurs after surgery.

Long-term NSS and oral steroids in the postoperative period do prevent or delay the recurrence of nasal polyps.

With endoscopic sinus surgery, not just all the paranasal sinus lesions but the associated Deviated Nasal Septum can also be managed successfully.

Balloon sinuplasty –

It’s a newer technique of treating sinusitis where the ENT surgeon will insert a small, balloon-tipped catheter into the sinus passages. Under imaging guidance, they ensure the catheter is in the right location and slowly inflates the balloon. The balloon inflation widens your sinus openings and passages. Once this is complete, the balloon is deflated and the catheter is removed.

Because the surgeon doesn’t have to cut out any nasal or sinus tissues as done in ESS, the recovery time of the patient is usually shorter with balloon sinuplasty.

However, not all people with chronic sinusitis are good candidates for the Balloon sinuplasty procedure. If there are nasal polyps that are also blocking the sinus openings, Balloon Sinuplasty is NOT advised for such patients.


As sinusitis can develop after a cold, the flu, or a nasal allergy, following a healthy lifestyle and reducing the exposure to germs and allergens can help prevent this inflammation of the sinuses.

So what should you do to reduce the risk of sinusitis, you can:

  • One should get a FLU VACCINE every year.
  • Eat NUTRITIOUS FOODS, such as fruits and vegetables.
  • WASH HANDS regularly.
  • One should limit exposure to allergens such as chemicals, pollens, and other irritants.
  • Take ANTIALLERGICS to treat allergies and colds.
  • One should try to avoid exposure to people with active respiratory infections, such as a cold or the flu.
  • Avoid SUDDEN TEMPERATURE CHANGE. (for example, one should not come from hot sunny weather directly in front of the air conditioner)



This blog including information, content, references, and opinions is for informational purposes only.

The Author does not provide any medical advice on this platform.

Viewing, accessing, or reading this blog does not establish any doctor-patient relationship.

The information provided in this blog does not replace the services and opinions of a qualified medical professional who examines you and then prescribes medicines.

And if you have any questions of medical nature, please refer to your doctor or the qualified medical personnel for evaluation and management at a clinic/hospital near you.

The content provided in this blog represents the Author’s own interpretation of research articles.

Leave a Reply

Your email address will not be published. Required fields are marked *