Chronic sinusitis is inflammation of the paranasal sinuses lasting more than 12 weeks.
Diagnosis is initially clinical. Nasal endoscopy may show inflammation, purulent discharge, oedema, or frank polyps.
Initial medical treatment includes nasal saline irrigation and topical intranasal corticosteroids. Oral antibiotics, oral corticosteroids, antihistamines, and leukotriene receptor antagonists may also be considered.
Computed tomography is needed if initial medical treatment fails.
Functional endoscopic sinus surgery is very effective for patients unresponsive to medical treatment.
Chronic sinusitis is inflammation of the paranasal sinuses lasting more than 12 weeks. Symptoms include facial pressure, rhinorrhoea, postnasal drainage, congestion, and general malaise. Chronic sinusitis is divided into 2 groups, with and without polyps, which have slightly different treatment regimens. This topic discusses chronic sinusitis in the absence of polyps. For more information on nasal polyps, including diagnosis and management, please see the BMJ Best Practice topic: Nasal polyps.
History and exam
Key diagnostic factors
- presence of risk factors
- facial pain/pressure
- nasal obstruction
- nasal discharge/postnasal drip
Other diagnostic factors
- dental pain
- ear pain/pressure
- ciliary dysfunction
- aspirin sensitivity
- allergic rhinitis
- airway hyperreactivity/asthma
- previous sinus surgery
- severe mid-septal deviations
- concha bullosa deformity
- paradoxically bent middle turbinates
- foreign bodies
- craniofacial anomalies
- granulomatosis with polyangiitis
- history of asthma
1st investigations to order
- anterior rhinoscopy
- nasal endoscopy
Investigations to consider
- sinus CT
- sinus MRI
- nasal/sinus cultures
- allergy testing
patients with continued symptoms despite medical therapy
- Acute sinusitis
- Allergic rhinitis
- Allergic fungal sinusitis
- Rhinitis 2020: A practice parameter update
- European Position Paper on rhinosinusitis and nasal polyps 2020
Sinusitis (acute)More Patient leaflets
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