The real cause for 93% of patients

Chronic sinusitis is the most common long-term disease in the US. Even though more than half of all cases of sinusitis clear up on their own within two weeks, about 40 million Americans develop the chronic variety.

What happens: The sinuses, four pairs of cavities in the skull that filter and warm air as it passes through the nose on its way to the lungs, are lined with mucus-producing tissue. The tissue typically produces more than a quart of mucus a day, which drains through tiny holes into the back of the throat. When these holes are blocked, mucus can’t drain properly. The holes often become blocked when the tissues swell during an allergy flare-up or an upper-respiratory infection.

Result: Facial pain, headache, fatigue, nasal and ear congestion, postnasal drip, cough, snoring, nosebleeds and a reduced sense of smell or taste, along with other cold-like symptoms. As mucus accumulates, it provides an optimal environment for bacterial or fungal growth. The resulting infection can further irritate and inflame sinus tissues.


Sinusitis is defined as “chronic” when it lasts for more than four weeks or keeps coming back. For many patients, sinusitis is a lifelong disease. The symptoms may come and go, but the underlying problems persist. Patients need to manage it daily just as they would any other chronic disease, such as diabetes or arthritis. A total cure is unlikely — but with the right medical treatment, patients can expect a significant improvement in quality of life.

A short-term course of antibiotics usually will eliminate a case of acute sinusitis (assuming that the infection is bacterial), but this rarely works for chronic sinusitis.

Reason: Most cases are multifactorial. Patients with a bacterial infection might simultaneously harbor viruses or mold, organisms that aren’t affected by antibiotics. A Mayo Clinic study found that 93% of all chronic sinus disease cases are caused by fungus (mold) found in the nasal passages. The mold can cause persistent infection. Even in the absence of infection, mold spores can stimulate an allergic reaction that causes persistent congestion.

Antibiotics can make a difference in patients with chronic sinusitis, but only when they are used for three to eight weeks. The same is true of anti-fungal sprays or oral drugs. Long-term therapy (up to three months) usually is required.

Recommended: Regardless of the underlying cause, most patients can get some relief with prescription steroid nasal sprays. Decongestants (oral or spray) also can be helpful but should not be used for more than 48 hours without your doctor’s OK. Nasal irrigation is among the best ways to promote mucus drainage and relieve sinusitis symptoms.


Every patient with a history of chronic sinusitis needs to be alert to lifestyle factors that increase congestion and symptom flare-ups. Important…

Track your diet. Even patients without clear-cut food allergies may find that they produce more mucus when they eat certain foods, such as dairy or foods with gluten or certain sugars, including high-fructose corn syrup. I advise you to keep a food diary for a month or more. Write down everything that you eat and drink, and make a note when your sinuses feel worse. When you suspect that a certain food is causing problems, give it up for a few weeks and see if you feel better.

Take control of your allergies. They are among the main triggers for sinusitis. When you have an allergy flare-up — whether from pollen, animal dander or anything else — treat it promptly with an antihistamine to keep mucus from building up.

Blow your nose gently. Blow one nostril at a time. This is more effective than blowing both at once.

Clean your house and car. Any area that’s moist, such as the bathroom or under the refrigerator, can harbor mold spores that irritate sinus tissues. Clean these areas well with soap and water or a commercial mold-killing solution. Don’t neglect your car. Cars trap humidity as well as heat, both of which encourage mold growth. Keep the seats and dashboard clean.


Some patients may require surgery to restore normal drainage. Endoscopic sinus surgery (sinoscopy) is now the standard approach. A thin tube is inserted through the nostrils. Surgical instruments are used to remove blockages and sometimes to remove bone to enlarge the sinus openings. The procedure is done in an operating-room setting. Typically, patients are home that night and back to work the next day with minimal discomfort that rarely requires more than Tylenol.

Recently, surgeons have added balloon sinuplasty to the procedure. A guide wire is used to position a deflated balloon inside the sinus openings. Then the balloon is inflated, which enlarges the openings and promotes better drainage, without removing tissue. It is appropriate in only about 10% or fewer of total cases — usually those involving a less severe condition.

Important: Most patients improve significantly after surgery, but few achieve a total remission of symptoms. Most still will need occasional help from steroid nasal sprays, decongestants, etc.