Chronic Sinusitis; Beyond the Decongestants

For those who suffer from chronic sinus inflammation, it can become life altering. Headaches, postnasal drip and sinus pressure are just some of the symptoms that chronic sinusitis sufferers report as their norm. With chronic sinusitis being one of the top chief complaints of patients presenting in doctors offices, it is worthwhile to investigate further the reasons for chronic sinus inflammation and available treatment options.

Classifications and Symptoms

Sinusitis is classified by the frequency and duration of occurrence. Acute sinusitis being classified an infection that lasts up to four weeks, usually occurring after a viral upper respiratory tract infection, however, bacteria and fungus can also settle into the sinus cavity, creating symptoms of an acute sinus infection including:

  • Nasal discharge or post nasal drainage of thick yellow/green mucous
  • Obstruction of nasal passages
  • Pain and swelling around eyes
  • Reduction of smell and taste
  • Headache
  • Fever

Acute sinus infections that occur up to 4 times a year are classified as recurrent acute sinusitis, while sub acute sinus is classified as sinus infections that last between four weeks up to three months, really standing as the middle ground between acute and chronic sinusitis.

Chronic sinusitis is classified as sinus symptoms that do not completely resolve, with acute exacerbations of symptoms several times a year. Symptoms can be similar to acute sinusitis including:

  • Chronic headaches, located around eyes and cheeks
  • Pain in upper jaw and teeth
  • Nasal congestion leading to lack of smell and taste
  • Dizziness
  • Post nasal drip
  • Sore throat
  • Chronic clearing of throat

Antibiotics, nasal decongestants, anti-histamines and steroid nasal sprays are all among the common treatments for acute sinusitis and acute exacerbations of chronic sinusitis. When it comes to chronic sinus inflammation, treating the symptoms with band-aid or suppressive therapies may not bring about true resolution of symptoms. The following are a few of the under investigated causes for chronic sinusitis.


Allergies are a common culprit when it comes to chronic sinus congestion. When the body comes in contact with what it considers an invader, a specialized white blood cell, the mast cell, will release histamine. Histamine is a well-known vasodilator which increases blood flow to the specific area. The reason for this is to bring other white blood cells to the area to engulf bacteria and clear infectious material and debris. Normally, this system helps to prevent foreign invaders from taking hold in our system, however, when mast cells are continually releasing histamine when coming into contact with non noxious stimuli like tree pollen, nuts, or grasses for example, will result in chronic swelling and inflammation of the sinus tissues.  Pinpointing allergic triggers, avoidance of allergens and natural mast cell stabilizers including vitamin c, quercetin and bromelain, are all part of managing allergic causes of chronic sinusitis.

Hormone Imbalances

Mucous lined passages, including the sinuses, contain estrogen receptors. Estrogen receptors, like the name implies, bind to estrogen to become activated. When estrogen binds to receptors on mucous membranes, blood flow increases to the area leading to swelling of tissues. Pregnant women can feel this vasodilating effect of estrogen in the form of nasal congestion and  post nasal drip in addition to creating the “pregnancy glow” when superficial blood vessels in the face dilate. With the connection between estrogen-induced vasodilatation, testing for hormone imbalances can be worthwhile in the treatment of chronic sinusitis.

Dental Causes

An often overlooked cause of chronic sinus inflammation is dental decay. Any issues with the maxiallary teeth, the teeth that line the upper mouth, can lead to sinus pain. The reason for this is the close proximity of the upper teeth to the maxillary sinus, the sinus cavity located directly above the upper mouth. An abscessed tooth infection can easily travel into the maxillary sinus, leading to a chronic sinus infection. Regular dental visits can prevent tooth decay and x-ray examination of sinuses and teeth can reveal dental causes for sinus pain.

Structural Blockages

When the size of the sinus cavity is obstructed or restricted this can be a contributing factor to frequent sinus infections. The most common structural sinus restriction occurs when the septum, the bone/cartilage divide between the two nasal passages, becomes deviated to one side, thereby decreasing normal sinus drainage. This can create stasis of nasal drainage, leading to a breeding ground for infection. A deviated septum can be seen on CAT scan and can be surgically repaired which can thereby alleviate symptoms of chronic sinusitis.

Treatment for chronic sinusitis depends on the root cause. While over the counter products like decongestants can provide temporary band-aid relief, they may not bring about permanent resolution of symptoms. Consider investigating the many reasons for chronic sinus inflammation to bring about lasting relief from the life altering symptoms of chronic sinusitis.

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