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JAMA Patient Page
September 1, 2015

Adult Chronic Sinusitis

JAMA. 2015;314(9):964. doi:10.1001/jama.2015.7892

Chronic sinusitis (chronic rhinosinusitis) is a common condition that involves inflammation in the nose and sinuses that does not go away.

What Causes Chronic Sinusitis?

Adults have 4 air-filled sinuses on each side of the face. These are found in the cheekbones, forehead, and between the eyes. Inflammation in these sinuses can create swelling and excess mucus. This can block nasal breathing and drainage. The inflammation can have more than one cause. For example, you might have an infection. You might also have problems with your immune system or be sensitive to something you have breathed in. Chronic sinusitis can reduce your quality of life, ability to get restful sleep, and ability to work.

What Are the Symptoms?

  • Stuffy or congested nose

  • Thick drainage from your nose

  • Pressure or discomfort in your face

  • Reduced or no sense of smell or taste

If you have 2 or more of these symptoms and they last longer than 3 months, you might have chronic sinusitis. You might also have periods when the symptoms get worse. These periods are called flares (“exacerbations”). Flares do not always mean you have an infection. But flares usually need to be treated with medicine. Some people report having “sinus headaches.” But these headaches are rarely caused by sinusitis. For example, the pain might be related to migraine or tension headaches.

How Is Chronic Sinusitis Diagnosed?

Your doctor will take a medical history and look inside your nose to see how bad the swelling is. He or she will also look for problems that might cause your symptoms.

Your doctor might also suggest other tests. In nasal endoscopy, the doctor uses an instrument to look deeper into the nose and sinuses. This can give information on how bad the swelling is and what treatment you might need. A sinus CT scan is a special type of x-ray. This test can give more information about the sinus swelling (how bad it is; where it is). Your doctor might order a CT scan to help rule out other conditions or if treatment has not helped your symptoms.

How Is Chronic Sinusitis Treated?

The main aim of treatment is to reduce swelling and prevent flares. Reducing the swelling can improve your quality of life. Most people need long-term daily treatment (”maintenance”). Commonly used treatments include

  • Corticosteroids. These medicines decrease the sinus swelling. You can take some of them by mouth. But nasal sprays, rinses, or drops are preferred, since they deliver medicine directly to the swelling. They are also less likely to cause side effects.

  • Saline rinses (irrigations). These are often used to flush mucus, bacteria, and particles from the nose and sinuses.

  • Other medicines. These include antibiotics and other medicines. Your doctor can explain the choices and how they are used.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Soler reported serving as a consultant to BrainLab and Olympus. Dr Rudmik reported no disclosures.

Sources: American Rhinologic Society; National Institute of Allergy and Infectious Diseases; American Academy of Otolaryngology; Clinical Practice Guideline (Update): Adult sinusitis. Otolaryngol Head Neck Surg. 2015;152:S1-S39.

Topic: Ear, Nose and Throat