Chronic Sinusitis Symptoms: What you NEED to know

What do you NEED to know about chronic sinusitis symptoms?

I want to be specific in this article: if you have chronic sinus symptoms, chronic sinus infections, or chronic allergies you NEED to read this article.


I see about 2-3 people a week who have been on months to years of improper medications, unnecessary surgeries and are still miserable due to chronic sinus symptoms.

So I wrote this EPIC article to get you the help you deserve.

Note: if you’re busy, you can download this article to read it later or jump down to the quiz and get an answer for your symptoms immediately

fix chronic sinus infection with this article
This is the only article you’ll need to get help with chronic sinus symptoms

Let me get into this straight away: chronic sinus symptoms and chronic sinusitis affects up to 16 out of every 100 people in the US ( 1 in 4 people in Europe) and is a missed diagnoses among many healthcare providers.

  • Chronic sinus infections cost about $12.8 billion a year in diagnostic tests, medical and surgical therapies, and INAPPROPRIATE consults
  • From my clinic this week:
    • I saw a lady who had ‘allergy symptoms’ for the past 18 months that made her coworkers treat her as being ‘chronically sick.’ She had spent about $300 out of pocket in the past year on medications… and it wasn’t allergies at all!
    • I saw a man who had 8 months of an ‘infection that never went away’ who had 2 urgent care visits, 3 doctors visits and 3 rounds on inappropriate treatment before seeing me (estimated cost $1600)
    • I saw a man who had a sinus surgery out of state for chronic sinus infections. This didn’t help, so he saw a second ENT and got a second surgery with minimal success. Then he finally saw me and we got him on the right plan (I don’t even know how to guess that cost!)

That was this week alone.

Now, I’m not some savant doctor who limps around the allergy clinic uncovering the secrets of chronic sinusitis in between mocking my staff and taking Percocet (although as I type it out… that does sound pretty awesome).

Instead, my medial mentors raised me with a different philosophy: “if you hear hooves, think horses nor zebras.”

Common things are common. And an unusual presentation of a common diagnosis is more likely than a rare diagnosis.
Chronic Sinusitis is common. Consider it early in your diagnostic workup

I’ll make this article as efficient as possible for you to read. But you can also download a copy of this article here and keep it for later:
Get Your Copy of this Complete Chronic Sinusitis Article

Who should read this article?

Most chronic sinus infection sufferers don’t even know they have chronic sinusitis.

This is because we try to rationalize the symptoms as something we know more about: allergies, regular sinus infections, regular colds, etc.

Because of this, you will benefit from reading this article if you have:

  • A cold or infection that doesn’t seem to go away
  • Allergies that normally go away but are still around or worsening
  • Have new seasonal allergies as an adult
  • A constant sinus headache or chronic headaches
  • Sinus headaches without congestion
  • Have chronic sinus drainage or feel frequent sinus blockage
  • Cough that lingers (and might get worse when laying down at night)
  • Chronic sinus pain or frequent facial pain
  • Sinus pressure or fullness that didn’t get fixed by antibiotics
  • Recurrent or constant sinus infections
  • Decreased sense of smell
  • Or more generalized sinus problems

I know. It’s a long list.

But these were the exact complaints of patients over the past 3 months that I saw for chronic sinusitis.

And if you have a chronic sinusitis, you can fix it and, for many people, completely resolve it!

Identifying chronic sinusitis symptoms is important because IF you have a chronic sinusitis then, with proper treatment, you can get your symptoms fixed and feel better!

Too busy to read this chronic sinus infection article?

I get it.

You’re busy and you want just want to know whether you have to worry about this without reading the entire article.

I still want to get you the best care possible. So fill out these 9 simple questions (5 minutes) and I’ll get you an answer:
Take this QUIZ to see if you have chronic sinusitis

Table of Contents

find your chronic sinusitis symptoms
I feel this wooden guy knows what is is like to have a chronic sinusitis (or to cause one, maybe?)

I made this article thorough and the only source you’ll need to feel better from chronic sinus symptoms.  Which is awesome if you love reading about chronic sinus infections. Less so otherwise.

So you can jump around if you want specific topics:

How Common is Chronic Sinusitis?

Last week, 1 out of 6 patients (15%) of the people who saw me for ‘severe allergies’ had chronic sinusitis.

The actual statistics:

  • In the US, 2-16% of the population has chronic sinusitis
  • In Europe, it’s 7-27% of people!

I bring these two facts up to show that chronic sinus infections are not an obscure, rare diagnosis but something that is either affecting you or one of your close friends

The economic cost of chronic sinusitis symptoms

I mentioned above that chronic sinus infections cost about $12.8 billion in medical burden due to diagnostic testing, medical and surgical therapies, inappropriate consults and lost work and school productivity!

This estimation is a lot… but seems reasonable. As my 3 patients this week had combined extraneous costs of about $2000+the cost of 2 sinus surgeries.

This is why I want to get this article to as many people as possible: I can help make sure you’re on the correct pathway before shelling out thousands of dollars in medical bills.

The negative impact on your life

$12.8 billion is ‘a lot of money’ but is such a large number it’s hard to know what it means. So let me tell you that chronic sinusitis also has a proven negative effect on your quality of life.

A good study showed chronic sinus symptoms cause:

  • Lower quality of life score – for social functioning
  • Lower quality of life score – for physical health
  • Lower quality of life score – for general health

To put this into a comparison:

Sufferers of chronic sinusitis symptoms have similar quality of life as patients with chronic lung disease and chronic heart problems!

 chronic sinus infection infographic

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What is Chronic Sinusitis?

The chronic sinusitis disease state is an inflammation of the sinuses and nasal passages that lasts for 12 weeks (3 months) or longer.

Chronic sinus infections may appear suddenly but usually begin as a cold/flu, upper respiratory infection or sinus infection that ‘doesn’t go away.’ Symptoms can be present for months to YEARS!

Chronic sinus infection risk factors

These are some “risk factors” for getting chronic sinus infections:

  • Allergies
  • Asthma
  • Aspirin induced respiratory disease
  • Depression
  • Smoking
  • Irritants or pollution
  • Immune system problems
  • Viral infections
  • Systemic diseases
  • Dental infections
  • Anatomical abnormalities
  • Indoor dampness/ mold exposure

What makes diagnosing chronic sinus infection so difficult?

The problem with the chronic sinusitis disease is symptoms overlap many other problems.

Many chronic sinusitis symptoms are nonspecific such as fatigue, generalized sickness, cough, sleep disturbances, ear pain or pressure, dizziness, bad breath, dental pain, nasal or throat irritation.

But the most reliable and common chronic sinusitis symptoms are:

  1. Mucous drainage (out of the nose or down the back of the throat)
  2. Stuffy nose or nasal congestion
  3. Facial pain, sinus pain or pressure, or sinus fullness
  4. Reduction or loss of smell in adults (or constant cough in children)

I’ll discuss these symptoms below.

Want to know if you have chronic sinusitis? Take this 5 minute quiz to find out and get a treatment plan:
Take this 5 minute quiz to  here to find out if you have chronic sinusitis

chronic mucus is a part of chronic sinusitis
Thick Mucus is one of the 4 symptoms of chronic sinus infection

Chronic Sinusitis Symptom #1 – Mucus Drainage

The first chronic sinusitis symptom is mucus.

  • It may drain out the front of your nose or, more likely, drains down the back of your throat
  • It is usually a cloudy white or yellow thick mucus
  • It can get worse when you lay down at night or first thing in the morning
  • It is annoying, like sand, which gets everywhere…

If you have chronic mucus drainage, it might be due to chronic sinusitis.

But there are two exceptions that you need to know:
1) If you have clear drainage, it is LESS likely to be chronic sinusitis
2) If you have thick yellow, green or brown mucus (described as peanut butter consistency) then it might be a fungal sinusitis. If you have this, email me NOW (it’s not an emergency, but I want to tell you exactly what to do to get this fixed!)

Chronic Sinusitis Symptom #2 – Nasal congestion / stuffy nose

Again, I know that stuffy noses are common. You can have a stuffy nose with allergies, irritant rhinitis, cold/flus, and even certain medication uses.

So how do you know if you have chronic sinus infection symptoms or a regular stuffy nose?

Here are a few questions to ask yourself:

  • Is your nose stuffy all the time, even when your allergies are usually better?
  • Is your nose stuffy but your eyes are normal? (allergies often have itchy eyes)
  • Is your nose stuffy and everyone tells you it’s due to allergies… but you’ve never had allergies before in your life?
  • Did you feel you had a cold/flu that never went away?
  • Is your nose stuffy on once side or both?
    • If it’s just one side, it’s not a chronic sinusitis
    • If it’s both… it might be a chronic sinusitis symptom

If you answered any of these as a yes, then your stuffy nose is likely a chronic sinusitis symptom!

chronic sinusitis symptoms include facial pain or sinus pressure
Sinus pain or fullness is another common chronic sinus infection symptom

Chronic Sinusitis Symptom #3 – Facial or sinus pain / sinus fullness

Facial / sinus pain or sinus fullness is another non-specific symptom that could be found in a lot of problems.

But 8 out of 10 (83%) chronic sinusitis sufferers have sinus pain or sinus fullness!

It might not be just sinus pain or pressure that suggests chronic sinus infection symptoms. Other possibilities are:

  • If you have pain in your upper teeth it might be a chronic sinus infection
  • If you have chronic headaches… it might be a chronic sinus infection
    • Chronic headaches are a tough diagnosis
    • Chronic sinusitis might be a cause but not always

Chronic Sinusitis Symptom #4 – Decreased sense of smell (in adults)

This is a symptom you don’t complain about but after I mention it there is a ‘lightbulb moment’ and it clicks.

If you have a reduced sense of smell or even lost your sense of smell, consider chronic sinus infections as a possible cause.

The main reason you might not notice this is that you don’t go from smelling one day to no smell overnight (_or if you did, go see an ENT for a possible nerve problem or tumor. Not to get all WebMD scary on you, but do not ignore this symptom!). Smell decreases slowly so you don’t realize it.

But if you have a decreased sense of smell, consider chronic sinusitis

Chronic Sinusitis Symptom #4.5 – Constant Cough (in kids and some adults)

Ok, this one will make sense once I explain it:

Think of your sinuses like cups of water. All day long they collect mucus and drainage.

  • If they collect a lot, the cup overflows and drains down your throat causing cough
  • But for many people, the cup never overflows that much

But when you lay down at night, you tip the cup on it’s side and all that mucus pours down your throat causing a cough (that is often worse at night)

Consider chronic coughing in kids a possible chronic sinusitis symptom (I wrote an article on chronic coughing in children to help).

How to Diagnose Chronic Sinus Infections

Were you reading through those chronic sinusitis symptoms and thinking ‘this sounds like me?’

It is possible you have chronic sinusitis and, after getting the right diagnosis, can feel better!

There are two ways to diagnose chronic sinusitis:

  1. By history
  2. By CT scan

Diagnose chronic sinusitis by history

There are 4 main chronic sinusitis symptoms:

  1. Mucous drainage
  2. Nasal congestion / stuffy nose
  3. Facial /sinus pain or pressure or sinus fullness
  4. Reduction or loss of smell in adults (or constant cough in children)

How many of those sound like you?

You only need to have TWO of the four main symptoms of chronic sinusitis to have a clinical diagnosis.

If you have at least two of these symptoms, then you might have chronic sinusitis. If you’re not sure, take this quiz and find out:

Diagnose chronic sinusitis by CT Scan

If you want to know for sure if you have a chronic sinusitis, then the appropriate test is a CT scan of the sinuses.


The CT scan will show chronic inflammation in one or multiple sinuses, which would confirm the diagnosis and lead to the best treatment.

The only problem?

After treatment, you should also get a second CT scan to make sure it is resolved and that there isn’t anything else blocking the sinus cavity that led to the initial problem!

This is great if you have a friend who owns a garage CT scan business… but less great if you have to pay the $400 per CT scan out of pocket.

My Mixed Approach

I combine both in my approach to give you the best balance between accuracy and cost effectiveness.

If I see a patient with 2 of the symptoms of chronic sinusitis, I will start treatment.
– If the treatment works, then we are finished. Yay!
– If the treatment doesn’t help or symptoms return, then I get a CT scan

This method is a preference, but works well and has a high success rate in fixing my patients and also balancing out healthcare costs.

Treating Chronic Sinusitis

If you think you have a chronic sinusitis, you will need to see your medical provider for treatment.

But to make sure you get the RIGHT treatment, I’ve written the second part of this post dedicated to treating chronic sinusitis!


This is a long article. I wanted it to be shorter and faster and re-wrote it many times to eliminate the non-essential information.

But chronic sinus infections are a common, missed and important topic so I know this article was still very dense.

What you learned is that chronic sinusitis is an inflammation of the sinuses and nasal passage lasting at least 3 months and usually has at least 2 of these 4 symptoms:

  1. Mucous drainage
  2. Nasal congestion / stuffy nose
  3. Facial /sinus pain or pressure or sinus fullness
  4. Reduction or loss of smell in adults (or constant cough in children)

If you have these symptoms, you might have a chronic sinusitis which is reducing your quality of life and well-being (on par with chronic lung or chronic heart disease)!

Managing the medical system can be costly, so we discussed the clinical diagnosis criteria and linked to an explanation on treatment options.

Finally, if you got bored or your eyes crossed from the length of the article, don’t worry. I created a quiz to give you my best guess whether you could have chronic sinusitis:

Take this 5 minute QUIZ to see if you have chronic sinusitis

Next Steps

If you think you have a chronic sinusitis, read the section on treatment and make an appointment with your medical provider! It’s time you feel better!

And please consider SHARING this post with your friends and family. Warn them this is a long post, but worth their time (and money) to read.


  1. American Rhinologic Society; National Institute of Allergy and Infectious Diseases; American Academy of Otolaryngology; Clinical Practice Guideline (Update): Adult sinusitis. Otolaryngol Head Neck Surg. 2015;152:S1-S39.
  2. Rudmik L, Smith TL. “”Quality of life in patients with chronic rhinosinusitis.” Curr Allergy Asthma Rep. 2011 Jun;11(3):247-52. doi: 10.1007/s11882-010-0175-2. Review.
  3. Fokkens W, Lund V, Bachert C, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60:583.
  4. Scadding GK, Durham SR, Mirakian R, et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008; 38:260.
  5. Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev 2007; :CD006394.
  6. Hamilos DL. Approach to the evaluation and medical management of chronic rhinosinusitis. Clin Allergy Immunol 2007; 20:299.


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