Prof. Dr. Gediz Murat Serin | Teşvikiye ENT Group
We all experience that persistent nasal congestion and postnasal drip from time to time… Those moments when we can no longer breathe through our nose and resort to mouth breathing, when the middle part of our face feels pressured and our head literally feels heavy. When this condition lasts a few days, most of us think “it’s a cold, it will pass.” However, if the complaints exceed 10 days or worsen again just when they seem to be getting better, the situation may not be so innocent.
At this point, the first problem that comes to mind is sinusitis, which is inflammation of the sinuses. Sinusitis is more common than you think, but it is often a condition that exhausts the patient quite a bit until the correct diagnosis is made. In this article, I will explain what sinusitis is, why it occurs, and how it is treated, based on the real disease flow I see in my daily practice as a doctor.
Why Do Sinuses Exist and Why Do They Get Inflamed?
Sinuses are small air chambers located inside the bones around the nose. Normally, they fill with air, form a thin layer of mucus (natural discharge), and drain this mucus into the nose. When this system works properly, we don’t even notice it; breathing is a silent automatic process.
However, when the narrow channels between the sinus and nose swell and consequently become blocked due to a cold, flu, or allergy, things change. The air in the sinuses cannot escape, mucus becomes trapped inside, and inflammation occurs very quickly. This leads to the onset of classic sinusitis symptoms: pressure, discharge, pain, and congestion.
In some patients, this process can also occur independently of infection due to smoking, air pollution, polyps, or structural nasal problems. In short, sinusitis is not just “catching germs”; it is a complex condition related to the disruption of the nose’s internal balance.
Acute and Chronic Sinusitis: Why Is the Difference Important?
The duration and recurrence pattern of sinusitis is critically important for diagnosis.
Acute sinusitis
The disease has recently started and usually lasts less than 4 weeks. It is often an extension of the common cold and tends to resolve on its own.
Chronic sinusitis
If symptoms persist for 12 weeks or longer, it is now considered chronic sinusitis. In these patients, the sinus walls have thickened, inflammation has settled, and treatment has become somewhat more complex.
Recurrent acute sinusitis
Four or more attacks occur within a year, but the person fully recovers between attacks.
This distinction determines how treatment will proceed; therefore, it is one of the points that must be questioned during the initial examination.
Sinusitis Symptoms: Which Complaints Should Be Taken Seriously?
Patients think that sinusitis is only nasal congestion; however, the disease presents with a much wider range of findings.
Most common symptoms in acute sinusitis:
- Colored or cloudy nasal discharge
- Severe nasal congestion
- Pressure sensation in the face and around the eyes
- Pain in the forehead and head regions
- Fatigue and decreased sense of smell
- Cold lasting longer than 10 days
More than 90% of acute sinusitis cases are initially viral in origin. This means antibiotics are often unnecessary.
Symptoms seen in chronic sinusitis:
Chronic sinusitis is a more insidious and long-lasting condition. Most patients don’t even realize the situation, saying “I’ve always been like this.”
- Persistent nasal congestion
- Postnasal drip that hasn’t resolved for months
- Thick, sticky nasal discharge
- Loss of smell or significant decrease in sense of smell
- Mild but persistent pressure sensation in the face and head
- Fatigue, decreased concentration
When these symptoms exceed 12 weeks, professional evaluation is absolutely necessary.
Causes of Sinusitis: Virus, Bacteria, Allergy… Which One?
What causes acute sinusitis?
It usually begins with an upper respiratory tract infection. Since the tissues inside the nose swell, the sinus cavities become blocked.
Bacterial sinusitis is more likely in the following situations:
- If symptoms last longer than 10 days
- If they first improve and then worsen significantly
Causes of chronic sinusitis:
In chronic sinusitis, the main cause is long-term inflammation.
- Allergic rhinitis
- Nasal polyps
- Asthma
- Immune system disorders
- Anatomical problems (deviation)
- Smoking, dust, mold, chemicals
- Occupational exposures
In these patients, there is not a single cause; often many factors come together.
How Is Diagnosis Made?
When we examine the inside of the nose, we can see discharge, polyps, edema, or blockage in the sinus openings. For more detailed examination, endoscopic examination is performed. In cases where complaints are prolonged or recurrent, the condition of the sinuses is clearly visualized with sinus CT (computed tomography).
There is no need for CT in simple, first-time sinusitis; this is important to prevent common misconceptions.
Sinusitis Treatment: Not the Same for Every Patient
Acute sinusitis treatment
- Nasal sprays
- Regular nasal irrigation with saline
- Pain relievers and fever reducers
- Plenty of water consumption
Most patients recover without antibiotics.
Chronic sinusitis treatment
The approach in chronic sinusitis is more comprehensive.
- Long-term intranasal corticosteroid sprays
- Regular nasal irrigation with saline
- Allergy treatment
- Antibiotics
- Additional steroid treatments if polyps are present
Many patients respond to these treatments; however, surgery may become inevitable in patients with structural obstruction or polyps.
When Is Surgery Necessary?
Surgery comes into play in patients who do not respond to medical treatment, have impaired sinus drainage, or have nasal polyps.
Endoscopic Sinus Surgery (FESS)
Sinus passages are naturally widened and drainage is provided. It is the most frequently performed surgery in chronic sinusitis.
Balloon Sinuplasty
It is a minimally invasive method suitable for some sinuses, offering faster recovery. Tissues are not removed; only the blocked area is widened with the help of a balloon.
Conclusion: Sinusitis Can Be Controlled When Properly Managed
If your complaints of persistent nasal congestion, facial pressure, and colored discharge last longer than 10 days, the possibility of sinusitis is quite high. If this condition continues for months, chronic sinusitis should now be considered. With proper diagnosis, regular treatment, and surgical approach when necessary, this disease can be brought under control and quality of life can be significantly improved.
