Chronic sinusitis is inflammation of the paranasal sinuses lasting more than 12 weeks.
Diagnosis is initially clinical. Nasal endoscopy may show inflammation, purulent discharge, edema, 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, rhinorrhea, 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
- 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
Raj Sindwani, MD, FACS, FRCS
Section Head of Rhinology, Sinus, and Skull Base Surgery
Head and Neck Institute
Cleveland Clinic Foundation
RS is an author of a number of references cited in this topic.
Christopher Roxbury, MD
Rhinology and Endoscopic Skull Base Surgery
Section of Otolaryngology - Head and Neck Surgery
Department of Surgery
University of Chicago Medicine & Biological Sciences
CR declares that he has no competing interests.
Dr R Sindwani and Dr C Roxbury would like to acknowledge Dr J Antisdel, a previous contributor to this topic.
Ryland P. Byrd, Jr, MD
James H. Quillen College of Medicine
East Tennessee State University
RPB declares that he has no competing interests.
Thomas Sanford, MD
Assistant Professor of Otolaryngology - Head and Neck Surgery
St Louis University School of Medicine
TS declares that he has no competing interests.
Ozgur Yigit, MD
Istanbul Training and Research Hospital
OY declares that he has no competing interests.
Christos Georgalas, MD, PhD, DLO, FRCS (ORL-HNS)
Academic Medical Center
CG declares that he has no competing interests.
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