Chronic sinusitis is swelling (inflammation) of the air-filled spaces (sinuses) behind the forehead, cheeks, and eyes, which continues for a long time or keeps coming back.

See also: Sinusitis

The sinuses are openings in the bones around the nose. Four pairs of sinuses connect to small openings in the nose area. Normally, air passes in and out of the sinuses, and mucus and fluid drain from the sinuses into the nose.

Sinusitis is usually due to allergies or infection. When sinusitis keeps coming back or continues for a long period of time, it is considered chronic.

Causes of chronic sinusitis include:

• Blockage in the nose from allergies, nasal polyps, nasal tumors, or a deviated nasal septum
• Dental infections such as tooth abscess
• Allergy to the aspergillus species of fungus

Chronic sinusitis is much less common than acute sinusitis. Acute sinusitis often occurs with upper respiratory infections. Chronic sinusitis may produce less severe symptoms than acute sinusitis, but it can damage the tissues of the sinuses.

Symptoms may last for 3 months or more.

• Chronic fatigue
• Cough
• Facial pain around the eyes or in the forehead or cheeks
• Headache (in the front of the head or around the eyes)
• Nasal congestion
• Nasal drainage (yellow, yellow-green, thick)
• Pain in the roof of the mouth or teeth

The health care provider will examine you and tap lightly on your face over your sinuses. This method is called percussion. It may reveal tenderness in the area.

Normal sinuses glow when light shines directly onto them. (See also: Transillumination). If sinusitis is present, the sinuses will not glow when your doctor shines a light onto them.

Other tests that may be done include:

• CT scan of the sinuses
• MRI of the sinuses
• Sinus x-rays

These imaging tests may show the sinuses to be filled with fluid or reveal thickening of sinus tissues.

The goal of treatment is to cure the infection and make symptoms go away.

Antibiotics may be given if the infection is caused by bacteria. Antibiotic treatment usually takes 3 - 4 weeks.

Pills taken by mouth that help relieve a stuffy nose (oral decongestants) are sometimes used. Nasal sprays (topical steroids) may help relieve symptoms of chronic sinusitis that are due to allergies.

Over-the-counter painkillers (analgesics) may be used to control pain.

Surgery to clean and drain the sinuses may be needed. Surgical repair of a deviated septum or nasal obstruction may prevent chronic sinusitis from coming back.

Chronic sinus infections can usually be cured, but may need treatment over a long period of time.

Chronic sinusitis tends to come back, especially if conditions such as nasal blockages are not treated.

• Abscess forms, including (rarely) brain abscess
• Chronic sinusitis comes back
• Infection spreads to area around the eye, possibly causing vision damage or blindness
• Infection spreads to the bones of the face (osteomyelitis)
• Infection spreads to the brain (meningitis)

Call for an appointment with your health care provider if you develop symptoms of chronic sinusitis. Also call if acute sinusitis symptoms do not improve with treatment.

Using decongestants when you have an upper respiratory infection may reduce your risk of developing sinusitis. However, decongestant nasal sprays should only be used for short periods of time, or they can make congestion worse. This is called rebound congestion or rhinitis medicamentosa.