FAQs Chronic Sinusitis - Impact on Quality of Life

The nose and/or sinuses that are inflamed will respond more aggressively to irritants like temperature changes, strong odours or airconditioning with symptoms including a runny or blocked nose. This is called 'nasal hyperreactivity'.

It is known that patients with chronic (rhino)sinusitis can experience impaired quality of life compared to healthy people. The symptoms of chronic (rhino)sinusitis can affect how you function both in your personal and social life, and can also affect your work or hobbies.

Symptoms of chronic (rhino)sinusitis can increase or decrease as result of changed hormone levels during pregnancy. Nasal rinsing with saline and nasal sprays with corticosteroids can be continued during pregnancy. Oral corticosteroids and surgery should in general be avoided during pregnancy. Pregnancy itself will not be affected by having chronic (rhino)sinusitis. 

Not all patients experience symptoms of chronic (rhino)sinusitis in the same way because both the severity and degree of inflammation and/or nasal polyps can be very different between patients. Also the patients' response to treatment may therefore vary.

Nasal polyps and asthma are chronic conditions characterized by airway inflammation and often co-exist or make each other worse. Therefore, it is important to treat both conditions well. If you have troublesome chest symptoms, it means that you should discuss them with your doctor who might consider adjusting your asthma medication.

Patients with chronic (rhino)sinusitis in general feel that their health is impaired by their disease. They have symptoms of chronic (rhino)sinusitis like nasal blockage, runny nose, loss of smell and facial pressure/pain. They can also have other symptoms like feeling tired, having sleep problems and reduced concentration.  

When you smell a flower, particles are inhaled into the upper part of the nose and bind with the receptor cells on the olfactory (smell) mucosa high in the nose. Chronic (rhino)sinusitis, especially with nasal polyps causes an inflammatory response of the olfactory (smell) mucosa that leads to a reduced sense of smell. In patients with severe nasal polyps, the polyps itself also block the olfactory (smell) mucosa making it difficult for odours to reach that area.

When you smell a flower, particles are inhaled into the upper part of the nose and bind with the receptor cells on the olfactory (smell) mucosa high in the nose. Chronic (rhino)sinusitis, especially with nasal polyps causes an inflammatory response of the olfactory (smell) mucosa that leads to a reduced sense of smell. In patients with severe nasal polyps, the polyps itself also block the olfactory (smell) mucosa making it difficult for odours to reach that area.

Chronic (rhino)sinusitis, especially with nasal polyps causes inflammation of the the olfactory (smell) mucosa that leads to a reduced sense of smell. Although after surgery the nasal polyps that block the olfactory (smell) mucosa have been removed, the inflammation will remain. To improve your smell it is important to continue to use nasal sprays containing corticosteroids every day because they reduce the inflammation of the olfactory (smell) mucosa. When this is not sufficient, sometimes corticosteroid tablets like prednisolone or celestone (betamethasone) can improve the sense of smell, but they can only be used for a limited period.

Both medical and surgical treatment aim to reduce the inflammation in sinuses caused by (rhino)sinusitis. Nasal sprays containing corticosteroids or corticosteroid tablets can usually clear this up and restore your sense of smell. If the medical treatment fails, sinus surgery may be considered. However, it is challenging to predict improvement following the surgery. Some evidence supports a positive impact of sinus surgery on improving the loss of smell. However, if you stop taking your nasal medications after surgery, the reduced smell is likely to return.

Having a sense of smell will also enhance your ability to taste. Tiny particles from our food travel into the nasal cavity via the passage that connects it to the back of our throat while we are eating. A person with fully functioning sense of smell can partially test this by eating food while pinching their nose shut to see how important smell is to the sensory experience.

The mechanism of smell impairment in patients with chronic (rhino)sinusitis is not primarily a physical obstruction from swollen mucosa and polyps but more a chronic inflammation of the olfactory (smell) mucosa. For that reason nasal sprays containing corticosteroids that reduce the inflammation can often improve or restore your sense of smell. However, if there is already damage to the olfactory (smell) mucosa, the return of the sense of smell to normal state might not be possible.

Swollen lining of the nasal and sinus mucosa and nasal polyps can cause nasal obstruction. Also mucus and crusts can cause obstruction. If this is the case, nasal rinsing with saline can improve your breathing.

Rhinitis (inflammation inside the nose), sinusitis (inflammation inside the sinuses) and asthma (inflammation inside the lungs and respiratory tracts) are conditions that often co-exist and can make each other worse. The nose is the airconditioner of the body and when you breath through your nose the air is humified and cleaned. Nasal obstruction leads to mouth breathing and the reduction of this important airconditioning function. 

The inflammation of the nasal and sinus mucosa leads to overproduction of nasal mucus causing the patient to experience a fullness of the nose and dripping of excess mucus out of the nose or into the throat.

The healthy nose produces 500 ml of fluid per day. In the healthy nose this is released in small droplets that arrive in the throat and are swallowed. Post-nasal drip is a symptom of chronic (rhino)sinusitis where the patient feels mucus running down the throat from above. The patients feel the urge to swallow more often or spit out the mucus. Sometimes patients feel that despite their effort the mucus cannot be removed. In patients that have been operated on, mucus tends to accumulate in the sinuses and is released some time later. Patients experience this excess accumulation of mucus as post-nasal drip (difficult to remove mucus in the throat). When the mucus production is increased due to inflammation of the nasal/sinus mucosa the problem increases. Rinsing of the nose with saline can remove the mucus and therefore also reduce the symptoms of post-nasal drip.

Headache or facial pain/pressure, is one of the four key symptoms that may be present in patients with chronic (rhino)sinusitis. Headache or facial pain/pressure as the only symptom is never due to chronic (rhino)sinusitis. If combined with symptoms of a runny nose and nasal blockage, the headache or facial pain/pressure is likely to be due to chronic (rhino)sinusitis. The ear-nose-throat (ENT)-doctor can evaluate your symptoms, perform a nasal endoscopy (looking with a camera inside the nose) and often order a CT scan of the sinuses to determine whether the symptoms of headache or facial pain/pressure are caused by chronic (rhino)sinusitis.

Headache or facial pain/pressure as the only symptom is never caused by chronic (rhino)sinusitis. Headache or facial pain/pressure as the only symptom is in most cases due to neurological causes (or conditions related to your brain). Therefore, a consultation with a neurologist is of critical importance. Headache/facial pain that comes without any other nasal symptoms, with no clear signs of inflammation insde the nose (assessed by looking with a camera inside the nose), and does not respond to medicines, is very rarely sinus-related. Nausea, vomiting, aura, photophobia (discomfort or pain due to light exposure), phonophobia (discomfort or pain due to loud sounds) are symptoms that are also linked to headache that is unrelated to chronic (rhino)sinusitis and require  consultation with a neurologist.

Headache can be caused by chronic (rhino)sinusitis especially in case of chronic (rhino)sinusitis without nasal polyps. The headache is usually located around the eyes and the forehead and is usually described as a dull pressing feeling. Pain located at the side of the head or in the neck is seldomly caused by chronic (rhino)sinusitis.   

Chronic (rhino)sinusitis is highly linked to poor sleep quality. Because of increased airflow resistance, mouth breathing and nasal secretions, patients with chronic (rhino)sinusitis find it difficult to get to sleep and often sleep badly resulting in daytime sleepiness. 

There is a clear correlation between chronic (rhino)sinusitis and symptoms of snoring and obstructive sleep apnoea. Whether surgery will improve the symptoms of snoring and obstructive sleep apnoea depends on the amount of nasal obstruction caused by the chronic (rhino)sinusitis. Your ear-nose-throat (ENT)-doctor can discuss the options with you.

Chronic (rhino)sinusitis may affect many aspects of life, and work productivity is certainly considered as one of those. The impact of chronic (rhino)sinusitis in work productivity is usually mentioned in terms of absenteeism (not being able to work) and presenteeism (being present at work but with decreased productivity). It is estimated that patients with chronic (rhino)sinusitis miss approximately 6 days of work annually due to their disease. Moreover, nasal symptoms result in poor concentration, disturbed sleep, fatigue and daytime sleepiness, which all lead to reduced work productivity.