Chronic sinusitis: treatment, symptoms and how long it lasts

The NHS says a pharmacist or GP may prescribe steroid nasal sprays or drops to reduce the swelling in the sinuses, which you might need to take for a few months, and antihistamines if an allergy is causing symptoms. It says antibiotics are rarely needed.

CKS advises, for chronic sinusitis, avoiding allergic triggers, stopping smoking (and avoiding passive smoking), practising good dental hygiene and avoiding underwater diving if there are prominent symptoms. It also says good control of associated allergic rhinitis or asthma is likely to benefit sinusitis symptoms. It suggests considering saline nasal irrigation and, for adults, a course of up to 3 months of an intranasal corticosteroid, such as mometasone or fluticasone, especially if there is an allergic cause.

CKS says that in adults the diagnostic symptoms are nasal blockage, obstruction or congestion, or nasal discharge, with facial pain or pressure and/or a reduction or loss of the sense of smell. In children they are nasal blockage or discharge, with facial pain or pressure and/or cough.

The NHS lists other features of sinusitis in general.

• Pain, swelling and tenderness around the cheeks, eyes or forehead.

• A blocked or runny nose, and a reduced sense of smell.

• Green or yellow mucus from the nose.

• A headache, toothache, bad breath, a cough or a feeling of pressure in the ears.

• Snoring at night and sounding nasal when you speak.

• In young children, irritability, difficulty feeding and breathing through the mouth.

The NHS describes sinusitis as swelling of the sinuses, small empty spaces behind the cheekbones and forehead that connect to the inside of the nose. The swelling stops mucus draining into the nose and throat properly, making you feel blocked up.

Most sinusitis is short-lived. The NHS says it usually clears up on its own within 4 weeks. CKS classifies it as chronic when symptoms last 12 weeks or longer, and describes primary and secondary types, further divided by whether the disease is on one side or both and by its underlying mechanism. Chronic sinusitis traditionally includes forms with and without nasal polyps.

Because several different problems can sit behind long-lasting symptoms, how long chronic sinusitis lasts varies. CKS says to consider specialist referral if there has been no improvement in 6 to 12 weeks of treatment, and the NHS says ENT referral may be needed after 3 months.

CKS says chronic sinusitis is a complex disease with several variants. It lists these predisposing factors, and notes that acute sinusitis is usually triggered by a viral infection of the upper airways.

• Smoking and other causes of impaired ciliary (hair-like cell) function, such as cystic fibrosis.

• Asthma and chronic obstructive pulmonary disease (COPD).

• Allergic rhinitis.

• Nasal polyps, and the combination of asthma, nasal polyps and aspirin or NSAID intolerance.

• Immune problems (immunocompromise).

• Anatomical variations that obstruct drainage, though CKS says the evidence shows a generally small effect.

• Occupational exposures and living in rural areas, which are associated with a higher prevalence.

The NHS suggests getting plenty of rest, drinking plenty of fluids, taking painkillers such as paracetamol or ibuprofen, avoiding things that trigger allergies, not smoking, and cleaning your nose with a salt water solution.

For the salt water rinse the NHS says to boil about 570ml (1 pint) of water and let it cool, mix in 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda, wash your hands, then sniff a small amount into one nostril at a time over a sink, breathing through the mouth and letting it pour back out. It says to repeat up to 3 times a day, making a new solution each time. CKS notes that for adults saline irrigation is safe and effective, and advises against baby shampoo or hypertonic saline.

The NHS says sinusitis is common after a cold or flu, and if you have a high temperature or do not feel well enough to do your normal activities it advises staying at home and avoiding contact with other people until you feel better. Chronic sinusitis, however, is described by CKS as persistent inflammation of the upper airways with several possible causes, including allergy, polyps and anatomy, rather than as an infection that spreads between people.

CKS says diagnosis of chronic sinusitis requires a combination of symptoms and objective evidence of inflammation of the nose and sinuses. A GP starts with your history and an examination. In secondary care, CKS lists nasal endoscopy to document inflammation and polyps, CT imaging to rule out complications or tumours and confirm the diagnosis, allergy testing and tests of immune function.

If nasal polyps are the cause, the NHS says a GP can usually tell by looking inside your nose, and that polyps are usually treated with steroid nose drops or a spray.

The NHS says a GP may refer you to an ENT specialist if you still have sinusitis after 3 months of treatment, keep getting sinusitis or only have symptoms on 1 side of your face. CKS lists further reasons for referral: immune problems, symptoms that significantly affect quality of life, a suspected allergic or immunological cause, a structural problem causing obstruction, polyps or asthma complicating management, or doubt about the diagnosis.

An ENT specialist may recommend surgery for some people. The NHS calls surgery for chronic sinusitis functional endoscopic sinus surgery (FESS). It is carried out under general anaesthetic, and the surgeon can widen the sinuses either by removing some of the blocked tissue or by inflating a tiny balloon in the blocked sinuses and then removing it. The NHS says that after surgery for nasal polyps it is common for polyps to grow back, usually within a few years, so a steroid nasal spray may still be needed.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you are very unwell, painkillers do not help or symptoms get worse, or you have a weakened immune system, for example because of chemotherapy. Call 111 for advice about a child under 5.

CKS says hospital admission is needed for severe systemic infection, signs of sepsis, complications around the eye (such as swelling of the eyelid or cellulitis, a displaced eyeball, double vision or newly reduced vision), complications inside the skull (such as swelling over the forehead bone, signs of meningitis or severe frontal headache) or reduced consciousness. It also says persistent one-sided symptoms such as nasal obstruction, discharge, nosebleeds, crusting or facial swelling need an urgent suspected cancer pathway referral.

On the NHS, care usually begins with a pharmacist or GP, who can prescribe nasal sprays and review allergy and asthma control. ENT referral, nasal endoscopy and CT scans are arranged if treatment does not work, and sinus surgery is carried out by ENT surgeons.

Some people see a private ENT specialist to have nasal endoscopy or imaging sooner. The assessment and operations are the same. It helps to take a record of previous treatments and ask what the expected benefit of surgery is for your pattern of symptoms.