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Sinus pain

Congestion

Airway obstrucion

Headache

Drainage


Nasal congestion lasting more than 6 weeks

Chronic sinusitis is probably the most common cause of a frequent and constant congestion. Chronic sinusitis is just that, chronic inflammation of the sinus cavities. It can be from chronic low grade bacterial infections, chronic inflammation from mold spore inhalation, and from anatomic abnormalities that interfere with adequate drainage. There are other less common causes also.

Allergies

Allergies can cause constant congestion. The type of allergies that are year round are called Perennial Allergic Rhinitis. To be frequent and year round the "irritant" must be constantly present. Examples of allergens that cause persistent symptoms are dust mite, mold spore, pet dander, and cockroach antigen.

Anatomic abnormalities

It is possible to have only anatomic problems as a cause of constant congestion. Enlarged adenoids, enlarged inferior turbinates, concha bullosa, and nasal septal deviations can all cause constant congestion. To identify these causes, an examination by a specialist is usually necessary.

What to do ?

If this sounds like your situation. First, you should explore the section on treating allergies with OTC medicines and treating Chronic Problems with OTC medicines. Consider a trying some of these recommendations if you haven't already.

If that doesn't help, a visit to the doctor may be in order. If your problem has persisted for 6 weeks, and hasn't responded well to OTC medicines, it is time to find out what is going on.
If nothing seems to work, you may have chronic sinusitis and should see a specialist.

Diagnosis of chronic sinusitis

Chronic sinusitis is initially diagnosed by symptoms. Later, to confirm the diagnosis, a CT scan is usually obtained. The initial diagnostic criteria for chronic sinusitis are:

2 or more of these major symptoms:
  • facial pain or pressure
  • nasal obstruction or blockage
  • nasal discharge or purulence or discolored postnasal discharge
  • hyposmia or anosmia
  • purulence in nasal cavity
or one of the above and 2 of these
  • headache
  • fever (for chronic rhinosinusitis)
  • halitosis
  • fatigue
  • dental pain
  • cough
  • ear pain, pressure, or fullness
Of note, facial pain requires another major factor associated with it for diagnosis (facial pain plus 2 minor factors is not deemed sufficient for diagnosis of rhinosinusitis).

The 2003 diagnostic criteria for chronic rhinosinusitis requires the above criteria for longer than 12 weeks or more than 12 weeks of physical findings. In addition, one of the following signs of inflammation must be present:
  • Discolored nasal drainage from the nasal passages, nasal polyps, or polypoid swelling as identified on physical examination with anterior rhinoscopy after decongestion or nasal endoscopy
  • Edema or erythema of the middle meatus or ethmoid bulla on nasal endoscopy
  • Generalized or localized erythema, edema, or granulation tissue (If the middle meatus or ethmoid bulla is not involved, radiologic imaging is required to confirm a diagnosis.)
Imaging modalities confirming the diagnosis include the following:
  • CT scanning demonstrating isolated or diffuse mucosal thickening, bone changes, or air-fluid levels
    OR
  • Plain sinus radiography revealing air-fluid levels or greater than 5 mm of opacification of one or more sinuses
  • MRI not recommended for routine diagnosis because of its excessive sensitivity and lack of specificity
In general, plain radiography has low sensitivity and specificity. CT scanning is considered the imaging standard for evaluation of chronic sinusitis




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Chronic sinusitis is a very
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