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Call Chronic Sinusitis (Chronic Rhinosinusitis) Evaluation
Chronic sinusitis, also called chronic rhinosinusitis, involves at least 12 weeks of compatible nasal and sinus symptoms plus objective evidence of inflammation. Evaluation distinguishes prolonged inflammation from repeated short infections and identifies polyps, allergy, asthma, or structural contributors that may change care.
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Duration and Symptom Pattern Matter
What Defines Chronic Rhinosinusitis
Duration and symptoms
A compatible pattern includes at least two core symptoms: nasal blockage, nasal drainage, facial pressure or fullness, and reduced sense of smell. At least one should be blockage or drainage, and symptoms persist for 12 weeks or longer.
Objective confirmation
Migraine, dental disease, nonallergic rhinitis, medication effects, structural blockage, and other conditions can resemble sinus disease. A history of repeated short “sinus infections” should be reviewed carefully rather than automatically treated as continuous bacterial infection.
Confirm Inflammation Objectively
Examination, Nasal Endoscopy, and CT
The clinician examines the nose and reviews prior imaging and treatment. Nasal endoscopy may identify swelling, drainage, polyps, crusting, or another structural concern. A sinus CT can define anatomy and inflammation when the diagnosis remains uncertain, symptoms persist despite appropriate treatment, or surgery is being considered.
Routine repeated imaging is not needed for every flare. Incidental mucosal thickening on a scan can occur without chronic rhinosinusitis and must be matched to symptoms and examination.
Identify the Clinical Subtype
Polyps, Allergy, Asthma, and Other Contributors
Inflammatory connections
Chronic rhinosinusitis is commonly separated into disease with and without nasal polyps because treatment decisions differ. Asthma, aspirin-exacerbated respiratory disease, environmental allergy, immune deficiency, dental infection, cystic fibrosis, ciliary disorders, and fungal disease are considered only when the history supports them.
Individual contributors
Targeted allergy or immune testing may help a defined question, but broad panels do not diagnose chronic sinusitis. One-sided symptoms, bleeding, severe crusting, or an unusual mass require a different and often more urgent evaluation.
Begin With Evidence-Based Medical Care
Saline, Intranasal Steroids, and Selected Medicines
Saline irrigation and an intranasal corticosteroid are common first-line treatments. Use sterile, distilled, or previously boiled and cooled water for nasal irrigation and clean the device as directed. Technique and consistent use affect benefit.
Antibiotics are not automatically indicated for chronic inflammation and should be reserved for a clinical situation in which the expected benefit outweighs risk. Short courses of oral corticosteroids, other topical therapy, or treatment of a contributing condition require individualized risk review.
Reassess Persistent Disease
When ENT Surgery or Advanced Therapy Is Considered
If symptoms and objective disease persist despite appropriate medical treatment, an ear-nose-throat specialist may discuss endoscopic sinus surgery. Surgery can improve ventilation and access for topical treatment but does not guarantee that inflammation will never recur.
Patients with nasal polyps may have additional options, including selected biologic therapy. Choice depends on disease severity, prior surgery, smell loss, asthma, need for systemic steroids, treatment response, preferences, and current availability. See the nasal polyps page for that distinct topic.
Know When to Get Urgent Help
Emergency and Red-Flag Symptoms
Seek urgent medical care for swelling or redness around an eye, vision change, severe pain with eye movement, confusion, stiff neck, a severe unusual headache, forehead swelling, or rapidly worsening illness. Call 911 for severe neurologic symptoms, loss of consciousness, or other life-threatening signs.
Patient Questions
Frequently Asked Questions
A compatible symptom pattern generally persists for at least 12 weeks and is supported by objective evidence of nasal or sinus inflammation.
No. Facial pressure can occur with migraine, dental disease, and other conditions. The full symptom pattern and objective findings matter.
Not automatically. Chronic rhinosinusitis is primarily inflammatory, and antibiotics are used only in selected clinical situations.
CT may help confirm or define disease when symptoms persist, the diagnosis is uncertain, complications are suspected, or surgery is being considered.
Surgery can improve drainage and topical medication access, but inflammation may recur and ongoing medical care may still be needed.
Respiratory conditions directory
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