17700 Chronic Sinusitis

Overview

Chronic sinusitis is a long-term swelling of the sinuses, which are the small air-filled spaces behind your forehead, cheeks, and eyes. When the lining stays swollen for 12 weeks or longer, it can cause blocked nasal passages, facial pain, and other bothersome symptoms. It is more than a lingering cold — it is a condition that often needs ongoing care.

Yes, chronic sinusitis is one of the most common chronic conditions seen in GP practices. Many people live with it for months or years, and it is a leading reason for visits to a family doctor.

It can affect anyone, but it is more common in adults. You are more likely to get it if you have allergies, asthma, a deviated septum, nasal polyps, or a weak immune system. People who smoke or are around secondhand smoke are also at higher risk.

Symptoms

Common symptoms

• Constant stuffy or blocked nose
• Thick yellow or green mucus from the nose or down the back of the throat
• Pain, pressure, or a dull ache in the face, often around the eyes, cheeks, or forehead
• Reduced sense of smell or taste
• Headache that is worse when leaning forward
• A cough that gets worse at night
• Bad breath or a bad taste in your mouth
• Feeling tired, low, or unwell

Symptoms in children

• Similar symptoms to adults, such as a blocked nose and facial pain
• Irritability or fussiness
• Mouth breathing, especially at night
• Snoring or noisy breathing
• Trouble feeding in infants due to a blocked nose

Symptoms in older adults

• Less typical symptoms, so the condition may be missed
• More fatigue or low energy
• Pressure or congestion may be mild or absent
• Confusion or a change in behaviour in some frail older adults
• Falls or unsteadiness can occasionally be linked to feeling unwell

Causes

Main causes

• Inflammation from a viral infection that never fully clears
• A bacterial infection that develops on top of an existing cold or congestion
• Allergies that cause ongoing swelling in the nasal passages
• Nasal polyps, which are soft, non-cancerous growths in the nose
• A deviated septum, meaning the wall dividing the nose is crooked

Risk factors

• Allergic rhinitis (hay fever) or asthma
• Smoking or being around secondhand smoke
• Frequent colds or respiratory infections
• A weakened immune system from conditions or medicines
• Dental infection in the upper teeth
• Acid reflux that reaches the nose and throat

When to see a doctor

See a doctor urgently if:

• Call your local emergency number if you have any of the emergency signs listed above, such as a high fever with a severe headache, eyelid swelling, or trouble breathing.
• Contact your GP or out-of-hours service the same day if you have a very high temperature, severe facial pain, or worsening symptoms after 10 days.

Book a routine appointment if:

• Make an appointment if your nasal symptoms last longer than 10 days.
• See your doctor if you have had four or more episodes of sinusitis in a year.
• Visit your GP if you have a decreased sense of smell, a persistent cough, or facial pain that does not go away.

Diagnosis

Your doctor will ask about your symptoms, how long they have lasted, and what makes them worse. They will look at your face and inside your nose. In most cases, no special tests are needed to start treatment.

Tests that may be done

• A small, flexible camera with a light (endoscope) inserted into your nose to see the sinus openings.
• A CT scan to get detailed images of your sinuses, if the diagnosis is unclear or symptoms are severe.
• Allergy tests if allergies are thought to be a cause.
• A swab from your nose may be taken if a bacterial infection is suspected.

What to expect at your appointment

Your GP may start treatment based on your history and exam. If symptoms do not improve, you may be referred to an ear, nose, and throat (ENT) specialist. They may repeat tests or try different treatment approaches.

Treatment

The goal of treatment is to reduce swelling, clear mucus, and treat any underlying cause. It often begins with home care and a trial of medicines. Surgery is considered only when other treatments have not worked or if a blockage needs to be corrected.

Self-care at home

• Use a saline (salt water) rinse or spray to wash out mucus and allergens from your nose.
• Breathe in steam from a bowl of hot water or a warm shower to loosen mucus.
• Place a warm, damp cloth over your face to ease pressure.
• Drink plenty of fluids to keep mucus thin.
• Rest and sleep with your head slightly raised.
• Avoid smoke, strong perfumes, and known allergens.

Medical treatments

Your doctor may recommend a prescription nasal spray containing a corticosteroid to reduce inflammation. Over-the-counter saline sprays are also used to keep the nose moist. Antibiotics are only prescribed if a bacterial infection is confirmed, not for most viral cases. In some situations, a short course of oral steroids or allergy medicines may be suggested. Always ask your doctor or pharmacist for advice before using any medicine.

When is surgery considered?

Surgery is not the first option. It may be considered if you have nasal polyps that do not shrink with medicines, a structural problem like a deviated septum, or blocked sinus openings that cause repeated infections. Surgery usually aims to widen the openings so that mucus can drain more easily.

Living with this condition

Living with chronic sinusitis can feel exhausting, but small daily habits can make a big difference. Rinsing your sinuses with saline, using steam, and staying hydrated are simple tools you can do at home. Keep your doctor informed if symptoms change or become harder to manage.

Lifestyle tips

• If you smoke, try to quit. Your GP can help.
• Avoid being around smoke, dust, or strong chemicals.
• Use a humidifier in dry rooms, especially in winter.
• Wash your hands often to reduce the chance of colds.
• Try to sleep enough and manage stress.
• Keep windows closed during high pollen days if you have allergies.

Diet and exercise

Drink enough water, but a balanced diet can help your immune system. Regular light exercise, like walking, can help clear your nose and boost your mood. There is no special diet proven to cure sinusitis, but eating well supports your overall health.

Mental health and emotional wellbeing

Living with a chronic condition can be draining. You may feel frustrated, embarrassed about a stuffy nose or bad breath, or low because of fatigue. These feelings are normal. It is important to talk to your doctor about how the condition is affecting your mood, and to reach out to friends, family, or a counsellor.

Prevention

Chronic sinusitis cannot always be prevented, but you can reduce how often you get symptoms. Controlling allergies, avoiding colds, not smoking, and staying away from irritants are the most helpful steps.

Vaccines

Staying up to date on recommended vaccines, such as the flu and pneumonia vaccines, may help prevent respiratory infections that can trigger sinusitis. Ask your doctor what vaccines are right for you.

Screening programmes

There is no routine screening for chronic sinusitis. However, if you have long-term allergies or recurrent sinus infections, see your doctor regularly for a check-up.

Complications

If left untreated

• Repeated acute sinus infections that keep coming back
• The infection spreading to nearby areas, such as the eye or the brain (rare but serious)
• Nasal polyps or worsening of existing polyps
• Sleep problems that lead to daytime tiredness
• Reduced quality of life from constant pain and congestion

Long-term outlook

The outlook for chronic sinusitis is generally good. Most people find a combination of treatments that works for them, even if it takes time. With the right care and patience, you can manage the condition and enjoy a good quality of life.

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