Sinus infections and chronic sinusitis

Common signs and symptoms

• Pressure or pain around the cheeks, eyes or forehead
• Stuffy nose that makes it hard to breathe
• Thick yellow or green drainage
• Postnasal drip and a sore throat in the morning
• Reduced or lost sense of smell and taste
• Aching upper teeth
• Cough that’s worse when lying down
• Fatigue that comes with every flare

Acute, chronic and recurrent sinusitis

Doctors sort sinusitis by how long it lasts and how often it returns. Most acute cases start with a cold, are caused by a virus and improve with rest, fluids, saline rinses and time. Antibiotics help only when bacteria are likely involved. A cold can leave the sinuses swollen for a week or two, so lingering stuffiness alone doesn’t always mean you need them.

Chronic sinusitis is less about infection and more about ongoing inflammation. It comes in two main forms, with nasal polyps and without them, and it often needs a longer-term plan.

• Acute: lasts less than 4 weeks, usually after a cold
• Subacute: lasts 4 to 12 weeks, often a slow-to-clear infection
• Chronic: lasts 12 weeks or longer, even with treatment
• Recurrent acute: four or more separate episodes a year, with clear stretches in between

Common causes

• Common cold viruses
• Untreated nasal allergies
• Nasal polyps
• A deviated septum or narrow sinus openings
• Smoke, strong fumes and very dry air
• Dental infections in the upper jaw
• Low antibody levels, in a smaller number of people

How allergies keep sinuses swollen

When you breathe in pollen or dust mites, allergic inflammation swells the lining of your nose. Swollen tissue can block the small openings that let your sinuses drain. Mucus collects, pressure builds and bacteria have a chance to grow.

That’s why sinus flare-ups in DFW often line up with cedar season in winter, spring tree pollen or the fall ragweed peak. Damp spells after heavy rain can do the same by raising mold counts. Treating the allergy may help keep sinus passages open and lower the number of flares.

Allergy testing shows whether pollen, mold, dust mites or pets are part of the picture. If they are, allergy shots or drops may calm the underlying inflammation over time, rather than treating each flare as it comes.

Nasal polyps and harder-to-treat cases

Nasal polyps are soft, painless growths that form in the nose and sinuses because of long-term inflammation. They can block airflow, dull your sense of smell and make sinus infections more likely. They often occur alongside asthma. Steroid sprays or rinses, short courses of oral steroids and surgery can all shrink or remove polyps, though they may grow back over time.

If you have asthma, nasal polyps and reactions to aspirin or ibuprofen, tell us. That combination is called aspirin-exacerbated respiratory disease, or AERD, and it needs a specialized plan. For polyps that keep coming back, biologics such as dupilumab, omalizumab or mepolizumab may shrink polyps and ease congestion for many patients.

Our approach to sinus problems

We review any CT scans and past treatments you bring, examine your nose and run allergy testing. If you have frequent sinus, ear or chest infections, we may order immune blood tests, such as antibody levels and vaccine responses, to see whether your immune system is working as it should.

It helps to know every antibiotic and steroid course you’ve taken for your sinuses in the past year or two. That record shows how often flares happen and how well past treatment worked.

Treatment may include daily saline rinses, a nasal steroid spray used with good technique, and allergy shots or drops when allergies play a role. We work alongside ENT surgeons. If you have large polyps, a structural blockage or symptoms that don’t improve with medical care, we’ll refer you for an ENT evaluation.

Some symptoms can’t wait for an office visit. Get emergency care right away for swelling or redness around the eye, vision changes, a stiff neck, confusion or a severe headache with high fever.

Daily habits that help your sinuses

Small habits add up. Rinsing with saline after yard work or on high-pollen days washes allergens out before they settle in. Using your nasal steroid spray every day, rather than only on bad days, gives it time to work, since many sprays take a week or more to reach their full effect.

Keep indoor air comfortable but not damp, change air conditioning filters regularly and avoid smoke. If you fly often or swim a lot, ask us how to protect your sinuses during those activities.

When to see an allergist

• You’ve had four or more sinus infections in a year
• Symptoms have lasted longer than 12 weeks
• Antibiotics help only briefly, then symptoms return
• You’ve lost your sense of smell or have nasal polyps
• Sinus flares line up with allergy seasons
• You also have asthma that’s hard to control