Symptoms and causes

Symptoms

At least two of the four primary signs and symptoms of chronic sinusitis must be present with confirmation of nasal inflammation for a diagnosis of the condition. They are:

  • Thick, discolored discharge from the nose or drainage down the back of the throat (postnasal drainage)
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Pain, tenderness and swelling around your eyes, cheeks, nose or forehead
  • Reduced sense of smell and taste in adults or cough in children

Other signs and symptoms can include:

  • Ear pain
  • Aching in your upper jaw and teeth
  • Cough that might worsen at night
  • Sore throat
  • Bad breath (halitosis)
  • Fatigue or irritability
  • Nausea

Chronic sinusitis and acute sinusitis have similar signs and symptoms, but acute sinusitis is a temporary infection of the sinuses often associated with a cold. The signs and symptoms of chronic sinusitis last longer and often cause more fatigue. Fever isn't a common sign of chronic sinusitis, but you might have one with acute sinusitis.

When to see a doctor

You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis. You may be referred to an allergist or an ear, nose and throat specialist for evaluation and treatment.

Schedule an appointment with your doctor if:

  • You've had sinusitis a number of times, and the condition doesn't respond to treatment
  • You have sinusitis symptoms that last more than seven days
  • Your symptoms don't improve after you see your doctor

See a doctor immediately if you have any of the following, which could indicate a serious infection:

  • High fever
  • Swelling or redness around your eyes
  • Severe headache
  • Confusion
  • Double vision or other vision changes
  • Stiff neck

Causes

Common causes of chronic sinusitis include:

  • Nasal polyps. These tissue growths can block the nasal passages or sinuses.
  • Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
  • Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux, or HIV and other immune system-related diseases can result in nasal blockage.
  • Respiratory tract infections. Infections in your respiratory tract — most commonly colds — can inflame and thicken your sinus membranes and block mucus drainage. These infections can be viral, bacterial or fungal.
  • Allergies such as hay fever. Inflammation that occurs with allergies can block your sinuses.

Risk factors

You're at increased risk of getting chronic or recurrent sinusitis if you have:

  • A nasal passage abnormality, such as a deviated nasal septum or nasal polyps
  • Asthma, which is highly connected to chronic sinusitis
  • Aspirin sensitivity that causes respiratory symptoms
  • An immune system disorder, such as HIV/AIDS or cystic fibrosis
  • Hay fever or another allergic condition that affects your sinuses
  • Regular exposure to pollutants such as cigarette smoke

Complications

Chronic sinusitis complications include:

  • Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
  • Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
  • Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
  • Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.