It seems like you’ve been feeling stuffed up for months. Perhaps you had a cold or a sinus infection a couple weeks ago, but you still feel congested. Or maybe it seems like your allergies are worse than usual. Should you be concerned?

For some people, these symptoms may be signs of chronic sinusitis, a condition that can be caused by infection, inflammation, growths or the shape of your nasal passages. Read on to find out more information about sinusitis, why it happens and your treatment options.

What is chronic sinusitis?

Chronic sinusitis, also called chronic rhinosinusitis, is a condition where you have swelling, inflammation or a blockage in the nasal passages that lasts for 12 weeks or longer. If you have chronic sinusitis, your symptoms may sometimes feel better, but they never go away completely.

If your sinusitis symptoms go away but keep coming back, it could be that you have recurring sinusitis. If you have four episodes of sinusitis in a year, it’s considered recurring sinusitis.

What are the symptoms of chronic sinusitis?

Chronic sinusitis shares many of the symptoms of a typical sinus infection. However, they are not the same. It’s possible to have chronic sinusitis without first getting a sinus infection. One way to rule out a sinus infection is if your symptoms continue even after you’ve received antibiotics and no longer have an infection in your nasal passages. Also, one of the main differences is that if you have chronic sinusitis, your symptoms last longer. Common symptoms of chronic sinusitis include:

  • Inflammation of the sinuses
  • A runny nose, possibly with yellow or green drainage
  • Drainage that goes down the back of your throat
  • Facial pain or the feeling of fullness near your cheekbones or under your eyes – if there’s no infection, you’re more likely to feel fullness rather than pain
  • A reduced sense of smell or taste
  • Difficulty breathing through your nose
  • Headache (more common in children)
  • Coughing (more common in children)

Who is at greater risk for chronic sinusitis?

Anyone can get chronic sinusitis, but it’s more common in young adults and middle-aged adults. Children are more likely to get chronic sinusitis if they have asthma, eczema, allergies or get six or more colds per year.

What causes chronic sinusitis?

There are many specific causes of chronic sinusitis, but they can be grouped into three main categories: infection, inflammation and the shape of the passages inside your nose.

Infection

Chronic sinus infections are one of the most common causes of chronic sinusitis and can be caused by an untreated bacterial or fungal infection in the nasal passages. However, chronic sinusitis can also be caused by other infections in your face such as an infected tooth.

Inflammation

If you have ongoing inflammation in your sinuses, it can make it hard for you your nasal passages to drain, leading to a buildup of mucus in your sinuses. Possible reasons for lasting inflammation include:

  • Inflammation in your sinuses that didn’t go away when your sinus infection did.
  • Allergic sinusitis, a cold, asthma or another condition that causes inflammation in the nasal passages.
  • You smoke or are often around someone who smokes.
  • You breathe air that has higher levels of pollution.

The shape of your nasal passages

It’s also possible that you have one or more nasal features that change the shape of your nasal passages, making it more difficult for your sinuses to drain. Over time, your nasal cavities may become fully or partially blocked, leading to a buildup of mucus and chronic sinusitis. Some of these nasal features include:

  • Nasal polyps – You may have nasal polyps, small growths in the nasal cavity, if you have inflammation from conditions such as allergies, asthma or sinus infections.
  • Deviated septum – The nasal septum is the structure inside your nose that divides it into two halves, forming your right and left nasal passages. If you have a deviated septum, it means that this divider is off-center or crooked. You may have a deviated septum because you were born with one or because your nose was injured.
  • Scar tissue – Causes for scar tissue in your nose include an earlier injury or sinus procedure. It’s also possible you may have been born with extra tissue in your nostrils.
  • Turbinate hypertrophy – The turbinates are bony structures inside your nose that are covered with a special skin called mucosa. The purpose of these structures is to filter, warm and moisten the air you breathe. Sometimes allergies or a lengthy cold cause turbinates to become enlarged or inflamed. If they get too big, they can block the nasal passages.

Conditions that affect the immune system

Chronic medical conditions can cause low levels of inflammation, even when other symptoms are under control. You’re more likely to have nasal blockage and mucus buildup if you have cystic fibrosis, HIV or other conditions that affect your immune system.

Does chronic sinusitis go away without treatment?

Not usually. If you’ve had sinusitis for more than 12 weeks, you will likely need treatment for the underlying cause – whether it’s infection, inflammation or something that changed the shape of your nasal passages.

What happens if you leave chronic sinusitis untreated?

  • Spread of infection – An untreated infected can spread to other parts of your body, including your bones, spinal fluid, brain and eyes.
  • Changes to your sense of smell – You may experience a complete loss of smell that may be permanent.
  • Sinus mucocele – You may develop a hardened mass in your sinuses called a mucocele. These masses usually aren’t dangerous but can put uncomfortable pressure on your sinuses and nose. If a mucocele gets infected, you’ll need surgery to remove it.
  • Sinus thrombosis – Very rarely, your body may create a thrombosis (blood clot) in your sinuses as a self-defense mechanism to protect you from infection. While extremely uncommon, these clots can prevent blood from getting to your brain, causing damage to the brain, eyes and surrounding nerves. You can get a blood clot in your sinuses even if you don’t have an infection – but that’s even rarer.

How do I get rid of chronic sinusitis?

Treatment for chronic sinusitis depends on what’s causing your symptoms.

Antibiotics for active infections

Your chronic sinusitis may be caused by an untreated infection. If you have fever, pain in your cheeks or upper back teeth, or yellow or green drainage from your nose, it’s likely the case. If you think your chronic sinusitis is caused by an untreated bacterial or fungal infection, make an appointment with your primary care doctor.

Untreated infections can quickly become serious – and sometimes you shouldn’t wait for the next available appointment. Instead, head to urgent care if you are experiencing any of the following:

  • Fever over 103 degrees Fahrenheit
  • Swelling across your forehead or around your eyes
  • Severe headache
  • Confusion
  • Vision changes such as double vision
  • Stiff neck

Home remedies for inflammation

If your chronic sinusitis is caused by inflammation, you may be able to find relief with at-home treatments such as:

  • Washing your nasal passages with saline – Saline washes can help unblock your nasal passages by washing out mucus and bacteria. You can buy saline drops or sprays online or at the store. Another choice is using a neti pot to flush out your nasal passages with a saline solution. If you make your own saline solution, be sure to use distilled water since using tap water can cause serious infections.
  • Breathing warm, humid air – Moist, warm air can help open your nasal passages and loosen mucus buildup. Using a humidifier, especially while you sleep, is helpful. Taking a hot shower is another way to breathe warm, humid air.
  • Drinking plenty of fluids – Drinking fluids can help reduce congestion and thin mucus. Hot, herbal teas may also make breathing easier and reduce sinus pressure.
  • Managing allergies – If you think allergies are contributing to your chronic sinusitis, talk to your primary care doctor about ways to manage your allergies. Antihistamines like Claritin or Zyrtec, and nasal steroid sprays like Flonase or Nasacort can be effective at reducing inflammation caused by allergies. It can also be a good idea to limit exposure to pollen and other allergens, and take a shower after you’ve been outside.
  • Boosting your immune system – Getting enough sleep, eating a healthy diet and managing stress are all ways to boost your immune system. This will give your body a better chance of overcoming your chronic sinusitis.

Surgery for chronic sinusitis or recurring sinusitis

Depending on what’s causing your symptoms, your doctor may recommend sinus surgery. Functional endoscopic surgery is the most common sinus surgery for chronic or recurring sinusitis caused by polyps or other nasal features.

During the procedure, the ENT doctor will use an endoscope, a thin flexible tube with a camera on the end, to look into your nasal passages and sinus cavities to see what’s causing the problem. Then the doctor will remove the blockage using specialized surgical instruments.

Depending on your preferences, the surgery can be done with either general anesthesia or a local anesthetic. In most cases you’ll be able to go home on the same day. Full recovery takes about 1-2 weeks, but most people start to notice improvements in their symptoms within a few days.

Expert care to help you breathe easier

If your nose has been stuffed up or runny for weeks, make an appointment with your primary care doctor. Your doctor will evaluate what’s causing your sinus problems, provide tips on managing your symptoms and prescribe antibiotics if appropriate.

If you have chronic sinusitis that isn’t helped by antibiotics, or your sinusitis keeps coming back, your doctor may recommend you talk to an ear, nose and throat (ENT) doctor about sinus surgery.