What is the difference between acute and chronic rhinosinusitis?

Acute rhinosinusitis is a short-term inflammation of the nasal passages and sinuses lasting up to 12 weeks, whereas chronic rhinosinusitis persists for more than 12 weeks despite treatment. Both conditions involve swelling of the sinus lining, but they differ in duration, underlying causes, and management approach.

Acute cases are often triggered by infections and tend to resolve with minimal intervention. Chronic rhinosinusitis is a longer-term condition that may involve ongoing inflammation, structural issues, or immune-related factors, requiring more comprehensive care.

What causes acute and chronic rhinosinusitis?

Acute rhinosinusitis typically develops after a viral or bacterial upper respiratory tract infection, such as a common cold. The infection causes temporary swelling in the nasal passages, leading to blocked sinus drainage.

Chronic rhinosinusitis, in contrast, develops when inflammation fails to resolve and becomes persistent. This ongoing inflammation prevents normal sinus drainage and leads to long-term symptoms.

Common contributing factors include:

• Recurrent or unresolved infections.
• Allergic rhinitis (hay fever).
• Nasal polyps.
• Deviated nasal septum.
• Environmental irritants such as smoke or pollution.
• Immune system dysfunction.

What symptoms should you look out for?

The symptoms of acute and chronic rhinosinusitis are similar, but chronic symptoms last longer and may fluctuate in severity.

Typical symptoms include:

• Nasal congestion or blockage.
• Thick nasal discharge (yellow or green).
• Facial pain or pressure, especially around the cheeks or forehead.
• Reduced or loss of smell.
• Postnasal drip (mucus in the throat).

Chronic disease is also more likely to significantly affect sleep, concentration, and quality of life.

How is rhinosinusitis diagnosed?

Rhinosinusitis is primarily diagnosed based on symptoms and clinical examination, with further tests used for persistent or unclear cases. A healthcare professional will assess symptom duration and severity to distinguish between acute and chronic forms.

Diagnostic approaches may include:

• Physical examination of the nose and sinuses.
• Nasal endoscopy (a thin camera to view inside the nose).
• CT scan to assess sinus structure and inflammation.
• Allergy testing if allergic triggers are suspected.

Chronic rhinosinusitis often requires imaging to confirm ongoing inflammation and rule out structural problems.

What treatments are available?

Treatment depends on whether the condition is acute or chronic, with most acute cases resolving on their own and chronic cases requiring longer-term management. The goal is to reduce inflammation, relieve symptoms, and restore normal sinus drainage.

Common treatment options include:

• Pain relief such as paracetamol or ibuprofen.
• Saline nasal sprays or rinses to clear mucus.
• Decongestants for short-term relief.
• Nasal corticosteroid sprays to reduce inflammation.
• Antibiotics (only when bacterial infection is suspected).
• Oral steroids in selected chronic cases.
• Surgery for persistent chronic rhinosinusitis or structural issues.

Chronic rhinosinusitis may require a combination of medical therapies and, in some cases, surgical intervention to improve sinus ventilation.

What practical steps can help manage symptoms?

Simple self-care measures can significantly improve symptoms and reduce recurrence, particularly in mild or early cases. These approaches support natural sinus drainage and reduce irritation.

Helpful steps include:

• Staying well hydrated to thin mucus.
• Using steam inhalation for temporary relief.
• Avoiding known allergens and irritants.
• Keeping indoor air clean and humidified.
• Practising regular nasal saline irrigation.

Consistency with these measures is especially important in chronic rhinosinusitis to maintain symptom control.

To discuss your symptoms and explore suitable treatment options, visit Mr Abbad Toma’s Top Doctors profile to arrange an appointment.

References

• NHS. Sinusitis (sinus infection)
• NICE Guidelines. Sinusitis (acute): antimicrobial prescribing
• ENT UK. Chronic Rhinosinusitis Guidance
• Fokkens WJ et al. European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS)