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What Is Chronic Rhinosinusitis?
Chronic rhinosinusitis is ongoing inflammation of the lining of the nose and sinuses. Symptoms generally last for at least 12 weeks, although they may improve and return over time. This form of chronic sinusitis can affect adults and children. It may occur with nasal polyps, which are soft growths in the nasal passages, or without them.
Symptoms
Symptoms of Chronic Rhinosinusitis
- Nasal obstruction or congestion
- Reduced sense of smell
- Facial pressure or pain
- Postnasal drainage
- Thick nasal discharge
- Cough, especially at night
- Bad breath
Symptoms of chronic rhinitis and rhinosinusitis persist or recur for at least 12 weeks and can range from mild to severe. People with nasal polyps often have prominent congestion and reduced smell, while people without polyps may have more facial pressure or drainage. Unlike a short-term chronic sinus infection, chronic disease is not necessarily caused by an active infection.
Causes
Causes of Chronic Rhinosinusitis
Swelling of the nasal and sinus lining can narrow the openings that normally drain mucus. Trapped mucus and poor airflow may then keep the area inflamed, creating a cycle of congestion and drainage problems. Chronic rhinosinusitis is not always caused by an active bacterial infection, so antibiotics are not appropriate for every flare.
- Nasal polyps can block drainage pathways and contribute to long-lasting inflammation.
- Allergic or nonallergic inflammation can keep the nasal lining swollen.
- A deviated septum or other structural blockage can interfere with sinus drainage.
- Asthma-related airway inflammation may occur alongside sinus inflammation.
- Immune disorders can make sinonasal inflammation more persistent or recurrent.
- Other inflammatory conditions may affect the nose and sinuses as part of a broader disease process.
Risk Factors
Risk Factors for Chronic Rhinosinusitis
Medical factors
Asthma, allergies, nasal polyps, structural nasal differences, immune disorders, and other inflammatory conditions can increase the likelihood of persistent rhinosinusitis. These factors may require medical assessment rather than self-management.
Environmental factors
Tobacco smoke, air pollution, and workplace irritants can worsen nasal inflammation. Poorly controlled allergies or nasal inflammation may also increase flares, although avoiding these factors cannot prevent every case.
Some risk factors, such as smoke exposure and uncontrolled allergies, can be addressed with support from a clinician. Structural differences, asthma, immune disorders, and nasal polyps may need medical evaluation and targeted treatment. Having one or more risk factors does not mean that chronic rhinosinusitis will definitely develop.
Complications
Complications of Chronic Rhinosinusitis
- Sleep disruption can result from congestion, coughing, or difficulty breathing through the nose.
- Reduced smell can affect enjoyment of food and awareness of odors.
- Asthma symptoms may worsen when upper-airway inflammation is poorly controlled.
- Repeated acute flares can cause episodes of more intense pain, pressure, or discharge.
- Ongoing symptoms can affect concentration, mood, daily activities, and overall quality of life.
Seek urgent care
Watch for serious warning signs
Rarely, infection can spread around the eye or into the skull. Seek urgent medical care for vision changes, eye swelling, a severe headache, confusion, a stiff neck, or rapidly worsening illness.
Diagnosis
How Chronic Rhinosinusitis Is Diagnosed
Clinicians diagnose chronic rhinosinusitis using at least 12 weeks of compatible symptoms plus objective evidence of inflammation in the nose or sinuses. Evidence may be found during a nasal examination, nasal endoscopy, or imaging such as a CT scan. This approach helps distinguish chronic disease from short-term infections and other causes of congestion.
Medical history and examination
| Test or evaluation | What it assesses | When it may be used |
|---|---|---|
| Clinical history and examination | Symptoms, duration, and visible nasal findings | Initial evaluation |
| Nasal endoscopy | Deeper nasal passages, drainage, and polyps | Persistent or unclear symptoms |
| CT scan | Sinus anatomy, inflammation, and blockage | Unclear diagnosis or treatment planning |
| Additional testing | Allergy, immune, or related conditions | Selected patients with suggestive features |
Treatment & Management
Chronic Sinusitis Treatment and Management
First-line chronic sinusitis treatment usually focuses on reducing inflammation and improving drainage. Saline nasal rinsing may clear mucus, but use distilled, sterile, or previously boiled and cooled water with a clean device. Intranasal corticosteroids may reduce swelling, while treating allergies or asthma and avoiding smoke or other irritants can help control symptoms. Use medicines as directed by a clinician.
Additional medical treatments
Selected patients may need short courses of other medicines, such as antibiotics when a clinician identifies a bacterial flare or oral corticosteroids for particular inflammatory problems. Biologic therapy may be considered for some people with severe nasal-polyps disease that remains uncontrolled despite standard treatment. Endoscopic sinus surgery can be an option when symptoms and objective inflammation persist despite appropriate medical treatment. Surgery improves access for drainage and topical treatment, but ongoing medical care may still be needed afterward.
Prevention
Can Chronic Rhinosinusitis Be Prevented?
- Avoid tobacco smoke and known irritants when possible.
- Control allergies and asthma according to an individualized treatment plan.
- Follow prescribed nasal sprays or other maintenance treatment consistently.
- Use distilled, sterile, or boiled and cooled water for saline irrigation.
- Clean and dry saline-rinse equipment as directed.
- Attend follow-up visits when symptoms persist or flare repeatedly.
These steps may reduce flares and help limit worsening, but prevention is not guaranteed. Structural, genetic, immune, and inflammatory factors can contribute even when a person avoids known triggers and follows treatment carefully.
Outlook and Prognosis
Outlook and Prognosis
Symptoms often improve when treatment is used consistently, but they may return and require adjustment over time. The outlook depends on factors such as nasal polyps, asthma, allergies, structural blockage, and response to treatment. Chronic sinusitis is often manageable, although some people need long-term nasal treatment, specialist care, or surgery followed by continued medical therapy.
When Should You See a Doctor
When Should You See a Doctor?
- Symptoms lasting 12 weeks or longer should be assessed.
- Repeated sinus flares may need evaluation for chronic inflammation or contributing conditions.
- Reduced smell that persists or worsens should be discussed with a clinician.
- Persistent nasal blockage warrants an examination, especially when it affects sleep.
- Ongoing facial pressure or pain should be evaluated when usual care does not help.
- Symptoms that do not improve with usual care may require diagnosis review or specialist treatment.
Urgent warning signs
Get urgent medical help
Eye swelling or vision changes, severe headache, confusion, stiff neck, facial swelling, or rapidly worsening illness may indicate a serious complication and should be assessed promptly.
