Sinusitis is inflammation of the mucosa that lines the inner surface of the paranasal sinuses—air-filled bony cavities surrounding the nasal cavity. Under normal conditions, these cavities open into the nasal cavity through small channels, drain the secretions they produce, and allow the air inside them to be renewed. When drainage or ventilation is impaired, secretions accumulate in the sinuses, the mucosa becomes swollen, and an inflammatory condition develops. Because the disease is now evaluated together with nasal mucosa, the medical term 'rhinosinusitis' is commonly used in medical literature.
Sinusitis describes a group of conditions that can progress with varying duration and severity. It can be a mild course that resolves within a few weeks or a prolonged course lasting months that significantly affects daily life. For this reason, the approach is individualized; the duration and frequency of symptoms, underlying structural or allergic factors, and response to previously applied treatments are evaluated together. The information on this page is for general educational purposes; individualized evaluation can only be made through physician examination.
Distinguishing acute from chronic sinusitis
Sinusitis is classified based on how long symptoms persist. Acute sinusitis usually develops following an upper respiratory infection and symptoms last less than four weeks. Most acute cases are of viral origin; that is, they follow a self-limiting course that does not require antibiotics. Symptoms persisting longer than ten days, worsening again after improving, or severe facial pain accompanied by high fever may suggest a bacterial process has developed.
In chronic sinusitis, symptoms persist for twelve weeks or longer. Here the condition usually results not from a temporary infection but from an underlying problem that continuously impairs sinus ventilation and drainage. Conditions that recur several times a year and completely resolve between episodes are called recurrent acute sinusitis. This distinction is important because treatment approaches differ for acute and chronic conditions.
Symptoms
Sinusitis symptoms vary from person to person and depending on which sinus area is affected. Usually several symptoms occur together and diagnosis is not based on a single finding. In some people facial pain is prominent, while in others nasal drainage or smell problems are more bothersome.
- Pain, pressure, or fullness sensation in the face; may worsen with forward bending
- Nasal obstruction, can be one-sided or bilateral
- Thick nasal or postnasal drainage
- Reduced sense of smell or loss of smell
- Headache and discomfort radiating to the tooth area
- Prolonged cough, especially at night and toward morning
- Fatigue, sleep disturbances, bad breath
When to see a physician
Cold-like symptoms are expected to resolve within one to ten days. If symptoms persist beyond this time, worsen after improving, or recur several times a year, this is a good time for an otolaryngology evaluation. Reduced sense of smell, persistent one-sided obstruction, or prolonged nasal discharge also warrant evaluation.
Certain findings, however, require prompt evaluation. Swelling or redness around the eyes, difficulty moving the eyes, double vision, severe and progressively worsening headache, neck stiffness, or altered consciousness, though uncommon, can indicate serious complications. These conditions should be evaluated in an emergency care facility.
Underlying factors
When sinusitis has a recurring or prolonged course, there is usually an underlying factor that narrows the natural drainage pathways of the sinuses. Treatments administered without identifying these factors can provide temporary improvement of symptoms but they may recur. For this reason, examination not only focuses on the inflammation itself but also investigates the structures that create its foundation.
- Deviation of the nasal septum
- Allergic rhinitis and accompanying mucosal swelling
- Enlargement of the nasal turbinates
- Nasal polyps; benign, swollen tissue growths in the nose
- Enlarged adenoids in children
- Frequent upper respiratory infections and exposure to cigarette smoke
- Infections originating from upper back teeth
- Diseases affecting the immune system and certain medication sensitivities
Diagnosis: endoscopy and the role of imaging
Evaluation begins with taking a detailed history. When symptoms started, how long they have persisted, whether there are seasonal changes, and response to previous medications are helpful guides. Then nasal and throat examination is performed.
Nasal endoscopy is direct visualization of the inside of the nose using a thin instrument with a light and optical system. In an office setting, it is usually performed after local anesthetic spray and takes a short time. This method allows evaluation of sinus openings, mucosal condition, presence of polyps, and source of drainage in detail that would not be visible in a simple examination.
Paranasal sinus CT imaging allows detailed examination of the sinus cavities and the bone structures between them. CT is not ordered for every sinusitis complaint; it is usually obtained in prolonged or recurrent cases, when surgery is being considered, or when complications are suspected. Imaging findings do not always match the severity of symptoms; for this reason, CT findings are interpreted together with the patient's complaints. When necessary, allergy testing may be added to the evaluation.
Treatment options: medical therapy and surgery
Initial approach to sinusitis is usually medical treatment. The goal is to reduce mucosal swelling, allow sinus openings to open, and control any infection if present. The choice and duration of medication depend on whether the condition is acute or chronic, underlying causes, and the patient's other health conditions. Intranasal corticosteroid sprays are frequently used for long-term management of chronic conditions. Antibiotics are not needed for every case of sinusitis; they are used when a bacterial process is suspected, as determined by physician evaluation.
Nasal irrigation with saline solution is a supportive but important part of treatment. It helps remove accumulated secretions and allergens, moistens the mucosa, and supports the effectiveness of other medications. Long-term and uncontrolled use of decongestant sprays that rapidly open nasal obstruction can lead to persistent obstruction when discontinued, for this reason, continued use without physician recommendation should be avoided.
If symptoms persist despite adequate medical treatment applied for sufficient time, or if a significant structural problem or extensive nasal polyps accompany the condition, surgery may be considered. Functional endoscopic sinus surgery, or FESS, is performed using an endoscope through the nostrils; no facial incision is made. The goal is to enlarge the natural drainage pathways of the sinuses and remove diseased tissue, allowing the sinuses to return to normal function. If accompanying septal deviation or turbinate enlargement is present, these can be corrected during the same procedure.
Like all surgical procedures, FESS carries certain risks including bleeding, infection, adhesion formation, and rarely conditions involving the eyes or skull base. These risks are discussed in detail before surgery along with expected benefits. Response to surgery varies from person to person; when the underlying disease process continues, medication treatment may be needed after surgery.
Recovery process and precautions
In the first days following endoscopic sinus surgery, nasal obstruction, watery or slightly bloody drainage, nasal fullness, and headache may be observed. These findings are generally expected parts of the healing process. Time to return to daily activities varies by individual and the extent of the procedure performed; this is specified individually by the physician.
Internal nasal care is a factor that determines the outcome following surgery. Regular saline irrigation, consistent use of prescribed medications, and attending follow-up examinations are requested. During follow-ups, the inside of the nose is evaluated with endoscopy and cleaning is performed if needed. Following the physician's recommendations regarding strenuous exercise, vigorous nose blowing, tobacco use, and dusty environments supports healing.
If allergic rhinitis or polyps are an ongoing condition, long-term monitoring is needed. Since sinusitis is also related to environmental factors, seasonal evaluation following treatment may be helpful. For appointments and information, you may contact us.