Chronic Sinusitis: Symptoms and How It's Diagnosed

What counts as chronic sinusitis?

Sinusitis — inflammation of the paranasal sinuses — is called "chronic" when it lasts at least 12 continuous weeks despite attempted treatment. It is one of the most common conditions encountered in primary care and ENT practices.

The AAO-HNS clinical practice guideline defines chronic rhinosinusitis (CRS) by the presence of at least two of the following symptoms, sustained for 12 weeks or longer 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Clinical definition of chronic rhinosinusitis: 12-week duration, at least two of four cardinal symptoms, confirmation of inflammation:

1. Mucopurulent nasal drainage — thick, colored discharge from the front or back of the nose 2. Nasal obstruction or congestion — one or both sides feel blocked 3. Facial pressure, fullness, or pain — often around the cheeks, forehead, or between the eyes 4. Decreased or absent sense of smell (hyposmia/anosmia)

Symptoms alone are not enough for diagnosis — a clinician also needs to confirm inflammation, either by examining inside the nose or with imaging.

How is chronic sinusitis different from repeated acute sinus infections?

Acute sinusitis lasts up to four weeks and often follows a cold or upper respiratory virus. It typically resolves on its own or with treatment.

Recurrent acute sinusitis means having four or more separate acute episodes per year, with symptom-free periods in between.

Chronic sinusitis is different: symptoms are continuous and never fully clear, even between bouts of worsening. Many people with chronic sinusitis do not have high fevers or the dramatic pain peak typical of acute episodes — instead, they live with a persistent background of congestion, dull facial pressure, postnasal drip, and reduced smell.

The distinction matters because the causes and treatments differ. Recurrent acute infections may be driven by viral exposures, while CRS often involves structural, allergic, or immune factors.

What does chronic sinusitis actually feel like?

People describe it in different ways:

• A constant feeling of congestion or stuffiness, even without a cold
• Thick mucus draining down the back of the throat (postnasal drip), sometimes causing a chronic cough or throat clearing
• Dull, pressure-like facial discomfort — not usually the sharp pain of an acute infection
• A sense that food and drink have less flavor, because smell and taste are linked
• Fatigue, which many attribute to the ongoing nature of the condition and disrupted sleep from nasal obstruction
• Morning headaches or a feeling of facial heaviness that improves somewhat during the day

Are there different types of chronic sinusitis?

Clinicians distinguish between CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Nasal polyps are soft, non-cancerous growths in the sinus lining.

• CRSwNP tends to involve more severe smell loss and is more often associated with asthma and aspirin sensitivity. Polyps can grow large enough to fully block airflow.
• CRSsNP more commonly causes congestion and drainage-dominant symptoms without significant smell involvement.

The SNOT-22 (Sino-Nasal Outcome Test) is a validated patient questionnaire sometimes used in clinical practice to track symptom burden over time 2Ref 2Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP (2009).Psychometric validity of the 22-item Sinonasal Outcome Test.SNOT-22 as a validated patient-reported outcome tool for tracking CRS symptom burden.

What causes chronic sinusitis?

No single cause explains all CRS. Common contributing factors include:

• Allergic rhinitis — ongoing allergic inflammation in the nose extends into the sinuses 3Ref 3Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. (2015).Clinical Practice Guideline: Allergic Rhinitis.Allergic rhinitis as a common contributor to chronic sinusitis; treatment of allergy as part of CRS management
• Structural issues — a deviated septum, enlarged turbinates, or prior nasal injury can impair sinus drainage
• Immune dysfunction — impaired mucociliary clearance allows bacteria or fungi to persist
• Aspirin-exacerbated respiratory disease — a triad of nasal polyps, asthma, and sensitivity to NSAIDs
• Prior infections — rarely, a severe acute infection leaves lasting structural damage

How is chronic sinusitis diagnosed?

A clinician takes a history and performs nasal endoscopy — a quick in-office procedure using a small scope to look inside the nasal passages — or orders a CT scan of the sinuses, or both. Allergy testing may follow if allergic rhinitis is suspected.

Chronic sinusitis is not diagnosed from symptoms alone or from a plain X-ray (which is not sensitive for sinus disease). If you have had persistent sinus symptoms and want a proper evaluation, a Gale primary care clinician can see you and refer to an ENT when appropriate.

What are the treatment options?

Initial management for most CRS includes:

• Nasal saline irrigation — rinsing with a neti pot or squeeze bottle to clear mucus and reduce inflammation
• Intranasal corticosteroid sprays — the cornerstone of medical treatment; reduce mucosal swelling over weeks to months
• Allergy treatment if allergic rhinitis is contributing 3Ref 3Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. (2015).Clinical Practice Guideline: Allergic Rhinitis.Allergic rhinitis as a common contributor to chronic sinusitis; treatment of allergy as part of CRS management

For patients with polyps or disease that does not respond to medical therapy, an ENT may recommend endoscopic sinus surgery to open the sinus drainage pathways. Newer biologic medications have also been approved for CRS with polyps.