Congestion. A runny nose. Pressure in your face. Sometimes, even pain. Is it a common cold or a sinus infection? If the symptoms linger it could be chronic sinusitis. The real question, though, is how or when do you treat it?

According to Matthew Hensler, MD​, an otolaryngologist with The Christ Hospital Physicians-Ear, Nose & Throat, paying attention to your symptoms can help you figure out what’s wrong and point you to the most effective path toward treatment

“Every day in the clinic, we see people coming in with some combination of common sinus symptoms. But not all patients will have underlying chronic sinusitis,” he says. “It’s largely a quality-of-life concern, but a lot of symptoms can mimic sinus disease. So, it’s important to talk with a doctor if symptoms linger.”

Here’s what Dr. Hensler says you need to know about the cause of your sinus problems—and what you can do to start breathing easily again.

What is chronic sinusitis?

Chronic sinusitis is a condition that causes long-lasting inflammation in your sinuses, the empty spaces in your skull that connect to either side of your nose. When your sinuses swell, mucus doesn’t drain well, increasing your risk of other infections. It’s also harder to breathe through your nose. As a result, you may have trouble sleeping, leading to daytime fatigue and difficulty concentrating.

Unlike acute sinusitis, which usually clears up within 10 days, chronic sinusitis causes symptoms that last at least 12 weeks. These signs can include:

• Congestion (stuffy nose)

• Drainage (thick green or yellow mucus that drips from your nose or down the back of your throat)

• Loss of smell or taste

• Pressure or tenderness around your nose, eyes and forehead

Chronic sinusitis can develop by itself, or in the presence of other conditions such as:

• Allergies

• Asthma

• Nasal polyps

• Dental disease

• Weakened immune system

Getting an accurate diagnosis

Diagnosing chronic sinusitis can take some time, Dr. Hensler says. Your doctor will consider your symptoms and how long they’ve persisted.

“Your symptoms are the main criteria for making a diagnosis,” he says. “If you’ve had at least two of the four main symptoms for at least three months, that’s when we start to consider that you may have chronic sinusitis.”

To diagnose you, your doctors may:

• Perform a nose exam. Using an endoscope—a small camera and light attached to a long, flexible tube—your doctor will look at your nasal passages and sinus tissues.

• Conduct a CT scan. CT imaging reveals the structure of your nose and the presence of inflammation or growths, like nasal polyps, that can block your breathing.

If you have signs of inflammation, increased mucus or anatomical changes, like a deviated septum or nasal polyps, they may recommend treating you for chronic sinusitis.

Nasal polyps

Nasal polyps are grape-like growths that extend off the lining of your nose. They typically grow down into your nasal cavity, blocking your airflow and causing more congestion. Approximately 25 percent of percent of people with chronic sinusitis have nasal polyps. Most polyps are noncancerous. But your doctor may suggest getting a biopsy to rule out cancer.

Nasal polyps generally respond well to medication. But some people may need surgery to relieve their symptoms.

Choosing the right treatment

For most people with chronic sinusitis, treatment is simple, Dr. Hensler says. In addition to several weeks of antibiotics to fight any infections, nasal irrigation with saline (salt water) is the first-line therapy.

“The goal is to rinse out the nose, removing any thick debris or crust,” he says. “Flushing out the nose helps the cilia—the little hairs in the nose that trap dust and germs—work better so they can help clear out mucus.”

In addition to cleaning out your sinuses, you may also need medication to reduce swelling and inflammation. To help you breathe better, your doctor may recommend these over-the-counter medications:

• Antihistamine spray (like Astepro®)
• Nasal steroid spray (like Flonase, Nasacort® or Nasonex™)
• Oral antihistamines (like Allegra®, Claritin®, Xyzal® or Zyrtec®)

If the culprit is nasal polyps, injectable biologic medications like Dupixent® or NUCALA can shrink the growths and reduce inflammation.

Surgery

When medications don’t work and your symptoms persist, surgery is an option. Dr. Hensler says you should also consider surgery if you experience bad headaches, fever or vision changes. But surgery isn’t a one-size-fits-all solution. Instead, the procedure is based on the results of your CT scan and the specific parts of your sinuses affected.

“I tell patients that surgery is like opening doorways to different rooms,” he says. “We’re just trying to get better ventilation. We’re aiming for better airflow into the sinuses and clearing out mucus.”

The minimally invasive, outpatient procedure widens blocked sinus passages and removes any polyps or excess tissue. It can improve your breathing and relieve symptoms, but roughly fifteen percent of patients may end up needing another operation. So, if you’re considering surgery, talk with your doctor about the severity of your symptoms and how much improvement you could expect after the procedure.

When to see a specialist

Dr. Hensler recommends making an appointment with an otolaryngology (ear, nose & throat) specialist if you’ve had sinus symptoms for at least three months or if you have recurrent sinus infections. If you also have a severe headache, fever or vision changes, schedule a visit sooner.

The experts at The Christ Hospital are uniquely positioned to deliver convenient, high-quality care for your sinus health. Using state-of-the-art imaging and a team-based approach, we can diagnose your symptoms and recommend the right treatment for you.

“Our group of ear, nose and throat specialists is trained to provide sinus care from managing symptoms to performing surgery,” he says. “We’re well-equipped to manage the disease that’s present and any complications that arise with it.”

Frequently asked questions about chronic sinusitis

Q: Is chronic sinusitis contagious?
A: No, chronic sinusitis itself is not contagious. However, any viruses that lead to the condition can be.​

Q: Is chronic sinusitis different from recurrent sinusitis?
A: Yes, chronic sinusitis symptoms do not go away for any significant time. With recurrent sinusitis, you may have four or more episodes of sinusitis in a single year and be symptom-free between illnesses.