FAQs Chronic Sinusitis - Disease & Symptoms

When inflammation of the nasal mucosa extents to the mucosa of the sinuses located right above the nose, the consensus term of (rhino)sinusitis is used. Typical symptoms of (rhino)sinusitis are facial pain or pressure, smell dysfunction and nasal secretions dripping into the throat, in addition to the classical rhinitis symptoms of nasal blockage and nasal secretions. When these symptoms are present for more than 12 weeks, (rhino)sinusitis is addressed as chronic. Chronic (rhino)sinusitis can present with or without nasal polyps and currently is it still unclear why some chronic (rhino)sinusitis patients develop nasal polyps and others do not. 

Chronic (rhino)sinusitis with nasal polyps runs in families but also chronic (rhino)sinusitis without nasal polyps has been observed in family members, strongly suggesting that a hereditary (=genetic) factor contributes to the disease. However, studies in identical twins showed that both siblings will not necessarily develop nasal polyps, which emphasizes the additional and important role of non-hereditary, environmental factors. 

Sinuses are air-filled cavities covered by mucosal linings within the bones of your face and skull. The nose and sinuses are important for filtering, heating and moistening the air you breathe through your nose. This important function protects your lungs. Sinus cavities may also contribute to voice resonance. Furthermore, a gas (nitric oxide or NO) is produced inside the sinuses which protects against sinus infections, improves removal of secretions from the sinuses and increases the uptake of oxygen in the lungs. 

Around 10% of the population in Europe has chronic (rhino)sinusitis. This roughly equals the population of Spain. In some areas the percentage of affected people is even higher.

In general, this is a chronic disease that cannot easily be cured, however patients sometimes have long periods of well-controlled disease. The treatment aims primarily to control patient's symptoms. Other goals are to reduce mucosal inflammation, to establish sinus drainage of secretions and to reduce sudden worsening of symptoms. Usually the disease becomes less severe after 60 years of age.

Lifestyle factors like smoking, work-related exposure to certain agents (or irritants) and air pollution may affect chronic (rhino)sinusitis. Inhaled pollutants like cigarette smoke cause irritation to the airways and hinders clearance of secretions from nose and sinuses. Moreover, cigarette smoke increases the likelihood of getting airway infections, makes it more difficult to breathe through the nose, and reduces the sense of smell. Chronic (rhino)sinusitis is also associated with acid reflux from the stomach, which some patients have without noticing. It is advised to avoid high intake of coffee, alcohol or acidic drinks such as sodas or juices. 

Many patients with chronic (rhino)sinusitis remember a prolonged infection of the nose caused by a virus or bacteria as the triggering event of their chronic illness. Infections inflame and thicken the sinus membranes and hinder removal of secretions from the sinuses. This swelling and inflammation sometimes last long after an infection. However, inflammation, which is the major cause of chronic (rhino)sinusitis, can also be caused by many other factors acting together at different stages of the disease. Sometimes chronic (rhino)sinusitis is caused by local allergic reactions to certain bacteria and fungi. The inflammation of the sinuses can also influenced by the presence of nasal polyps or related medical conditions such as asthma, aspirin sensitivity and immune system disorders. In conclusion, bacteria and viruses can play a role both during initiation and modulation of the disease, but additionally, other environmental and hereditary factors contribute to the disease.

The importance of allergy as a contributing factor to chronic (rhino)sinusitis is not fully understood. Allergic disease is associated with asthma and allergic patients get severe and recurrent chronic (rhino)sinusitis more often. Year-round allergies to for example moulds and dust mites seem to occur more often in patients with chronic (rhino)sinusitis than seasonal allergens such as pollen. Allergy seems to be more important in the Asiatic than the European population for chronic (rhino)sinusitis. 

Chronic (rhino)sinusitis is a broad diagnosis that includes different inflammatory diseases, further classified based on the presence of nasal polyps. Although not fully understood, it is usually caused by a combination of different factors that contributes to development of the disease. In chronic (rhino)sinusitis there is a malfunctional interplay between individual patient characteristics (including genes) and several environmental factors. Hypotheses as to causes include immune system disorders, airway disease like asthma, allergies, inhaled pollutants like cigarette smoke, local allergic reaction to substances produced by certain bacteria and fungi and -seldom- anatomical variation in the nose and sinuses.

Different factors contribute to the development and severity of chronic (rhino)sinusitis. Although smoking or infections may be associated the disease, many other factors contribute to chronic (rhino)sinusitis. Lifestyle with excessive intake of alcohol, coffee or soft drinks, as well as stress, can cause stomach acid reflux, and this can in some cases be related to chronic (rhino)sinusitis. Heavy stress and inadequate sleep may also weaken your immune system. In addition, structural abnormalities such as a highly deviated nasal septum, may also contribute to the blockage of mucus inside the sinuses and the development of chronic (rhino)sinusitis.  

A prolonged cold is caused by a sudden (delete) virus infection and is different from chronic (rhino)sinusitis. Many patients with chronic (rhino)sinusitis remember an infection of the nose as the first event of their chronic illness. A prolonged cold can result in swollen membranes inside the nose and sinuses with symptoms such as nasal blockage, runny nose and reduced sense of smell. However, in case of chronic (rhino)sinusitis, the symptoms need to be present for at least 12 weeks in a row. In addition, confirmation of sinus disease is needed by nasal endoscopy (looking with a camera inside the nose) and/or a CT scan. 

Chronic (rhino)sinusitis is characterized by the presence of two or more of the following key symptoms, one of which should be either: nasal blockage (having difficulty breathing through your nose) and/or discoloured and thick discharge from the nose or down into the throat (called post-nasal drip); with or without: facial pain/pressure or reduction of smell. Some patients also experience ear or teeth pain, bad breath, sore throat, irritability and lack of energy.

When looking into the nose, the doctor may find mucous membranes to be swollen, red and signs or irritation. When examining further inside the nose with endoscopy, the doctor may also find polyps or secretions from sinus openings. When looking into the mouth and throat, the doctor may see discoloured and thick secretions that has come from the back of the nose down into the throat. There may also be clinical signs of complications caused by chronic (rhino)sinusitis, such as swelling and redness around one eye. 

Chronic (rhino)sinusitis can present with or without nasal polyps and currently it is still unclear why some patients develop nasal polyps and others do not. The main characteristic of nasal polyps is the large quantity of fluid in between the cells of the sinuses (oedema) with the presence of inflammatory cells inside this fluid. Among the inflammatory cells, eosinophils are prominent in about 80% of Caucasian polyps associated. In non-Caucasian polyps as well as in polyps from patients with cystic fibrosis, increased numbers of neutrophils (other type of inflammatory cells) are observed, which is also detected in patients suffering from chronic (rhino)sinusitis without nasal polyps.

Classical nasal polyps that are seen in conjunction with chronic (rhino)sinusitis do not develop into malignant tumors. However, other types of polyp-like structures can be present in the nasal cavity that might be or turn into malignant tumors. Therefore it is of the utmost importance that nasal polyps are adequately examined and followed up by means of nasal endoscopy and if necessary, by different types of scans. Extra vigilance is needed in case of one-sided symptoms, nasal bleedings, deformations of the face and severe pain.

Alcohol intolerance is seen in several patients with chronic (rhino)sinusitis. It causes congestion of the nose and sinuses, but is not due to an allergic reaction.

Smoking is a major factor causing irritation in the lungs, but also the nose and the nasal sinuses. This is true for all people who smoke, but in patients with chronic (rhino)sinusitis this irritation can be much more severe.  Stop smoking is very important and takes the irritation factor away. Otherwise medical treatment with nasal sprays or tablets can be useless. 

If you have problems with your teeth this can result in an infection of the bone, which is directly in contact with the sinuses right above the teeth. This can result in chronic (rhino)sinusitis (mostly one-sided). Important is to treat the underlying teeth problem first.

Irritation of the nose from some chemical substances, gas or an infection from dirty water with bacteria can trigger an inflammatory reaction inside the nose and sinuses. Sudden infections or irritation caused by chemicals or allergy can result in swollen membranes inside the nose and sinuses that in turn disturbs removal of secretions. This may over time develop into chronic (rhino)sinusitis. However, chronic (rhino)sinusitis is usually caused by a combination of different factors, and other underlying factors that you were not aware of may have contributed to the development of your chronic (rhino)sinusitis. 

Poor indoor air climate and allergies to for example mould and dust mites can contribute to irritation and swelling inside the nose and sinuses, and to the formation of polyps. In some cases, this may lead to chronic (rhino)sinusitis if swelling and inadequate removal of secretions from the sinuses continue over time. It is, however, difficult to state that this alone has caused your disease. 

Inhaled pollutants like cigarette smoke are major causes of irritation to the airways, and it hinders clearance of mucus from nose and sinuses. Cigarette smoke, either active smoking or passive exposure, contributes to the development of chronic (rhino)sinusitis. It increases the likelihood of getting airway infections, makes it more difficult to breathe through the nose, and reduces the sense of smell. Active smoking, although at a higher risk, is not a reason not to perform sinus surgery. The impact of the number of cigarettes per day and the time the patient has smoked on the result after surgery is not fully understood.

Chronic (rhino)sinusitis with nasal polyps is a chronic disease of the nasal mucosa that can be compared to asthma, where the mucosa of the lungs is inflamed. This condition will need contstant treatment with corticosteroids to prevent patients from worsening of symptoms. However, often even the nasal sprays with corticosteroids are not always strong enough to suppress the polyp growth.

Sinusitis is considered to be chronic when symptoms last for 12 weeks or longer. If within the first twelve weeks symptoms disappear and recur again, this should be considered as recurring episodes of acute disease.

Chronic (rhino)sinusitis is different in children compared to in adults with less polyps in children unless they suffer from cystic fibrosis. There is some evidence that chronic (rhino)sinusitis changes its type of inflammatory reaction with ageing. Chronic (rhino)sinusitis with polyps becomes more severe with time when untreated. This might be explained by the process of alternating phases of inflammation and healing of the nasal and sinus mucosa and underlying tissue. Moreover polyps growing over time may exert pressure on the bone even causing deformities of the midface. Another sign of disease progression is the onset of asthma symptoms such as shortness of breath, wheezing, cough and sputum.

We know that the nose, sinuses and lungs are constantly influencing each other. Therefore, uncontrolled chronic (rhino)sinusitis can worsen complaints of asthma and visa versa. In addition, symptoms can be more severe in patients who have both chronic (rhino)sinusitis and asthma. Regarding common colds, several studies have shown that patients with chronic (rhino)sinusitis and asthma have a reduced immune defence  agaist viral infections. This might explain why these patients have more often common colds, which also last longer.

A runny nose and nasal secretions dripping into the throat in a patient with chronic (rhino)sinusitis are both symptoms that can lead to chronic coughing. You also should be tested for asthma to confirm or exclude cough-variant asthma.

The upper (nose and sinuses) and lower (lungs) airways are closely related to each other. A high number of patients with asthma  suffer from chronic (rhino)sinusitis and the more severe the asthma is, the more common chronic (rhino)sinusitis is, with a prevalence of up to 80% in the most severe cases. Chronic (rhino)sinusitis can be first but also asthma can be first; both diseases need to be treated adequately.

Since there is a high concurrence of asthma and chronic (rhino)sinusitis with nasal polyps, asthma should always be suspected and tested. Treatment of chronic (rhino)sinusitis might be more difficult if asthma co-exists and combined therapy needs to be applied and adapted for both conditions. This is especially true for inhalers and nasal sprays with corticosteroids, but also for tablets or injections with corticosteroids for which there is the risk of overdosing and occurence of side effects when combining these medications.

Undiagnosed and untreated chronic (rhino)sinusitis in patients with asthma can hamper therapeutic effects in the latter leading to more severe symptoms or worsening of symptoms. Well-treated chronic (rhino)sinusitis can lead to a better control of asthma and need of less (strong) medication.