CONDITION / CARRY

Chronic sinusitis.

Chronic sinusitis is an inflammation of the maxillary (maxillary) sinuses that lasts for more than 12 weeks. It is treated with washings and sprays, and when they do not help, endoscopic surgery through the nose.

Discuss your case How it is treated in the clinic ↓

CONCEPTUAL VISUALIZATION

BRIEFLY

what is it: Inflammation of the maxillary sinuses lasting more than 12 weeks.
How often: Chronic rhinosinusitis is present in approximately 8.7% of people according to the combined data of 20 studies.
The role of teeth: From 25% to 40% of sinus infections are caused by dental diseases or dental interventions.
Who treats: ENT doctor; with odontogenic sinusitis - together with the dentist.

01 / WHAT IS IT

What is
chronic sinusitis.

The maxillary sinuses are the largest air cavities in the bones of the face, under the eyes above the upper teeth. They connect to the nose through a narrow opening. If the mucous membrane is inflamed for a long time, the opening narrows, the mucus stagnates, and the inflammation supports itself.

Chronic sinusitis is said to occur when symptoms last for more than 12 weeks. Doctors call it chronic rhinosinusitis: the inflammation often affects not only the maxillary sinus.

A separate type is odontogenic sinusitis, when the source of infection is a tooth of the upper jaw or the result of its treatment or removal. It is usually unilateral and usually does not go away without treatment of the tooth.

This is general information. How to treat you, the doctor will tell you after the endoscopy and CT scan.

02 / SIGNS

How does
sinusitis manifest itself.

Chronic rhinosinusitis is manifested by congestion, secretions, pressure or pain in the face and a decrease in the sense of smell. Symptoms are less acute than a cold, but last for months.

Constipation

The nose is constantly blocked, often more on one side.

Allocation

Thick mucus from the nose or running down the back of the throat.

Pressure in the face

Heaviness or pain under the eyes, in the cheek, which increases when bending over.

Smell

Smells are worse.

Unpleasant smell

A putrid smell from the nose is a typical sign of odontogenic sinusitis.

03 / REASONS

Why inflammation
doesn't go away.

Chronic rhinosinusitis is more common in adults, smokers, people with obesity, asthma, diabetes, eczema, and a deviated septum.

Teeth

The most common dental causes are inflammation near the apex of the tooth root and the connection of the sinus with the mouth after tooth extraction.

The structure of the nose

A curved septum or enlarged shells prevent the sinuses from ventilating.

Distortion of the septum

Associated diseases

Asthma, cystic fibrosis, immunodeficiency and disorders of the cilia of the mucous membrane change the approach to treatment.

Foreign body

A filling material or an implant in the sinus supports the inflammation.

Foreign body of the sinus

04 / SEEK MEDICAL ADVICE

When to seek urgent medical care?

Chronic sinusitis usually does not require emergency care. But inflammation of the sinuses can rarely spread to the eye socket or the skull cavity - then the count goes on for hours.

103 immediately if:

swelling and redness of the eyelids, pain when moving the eyes, double or impaired vision;
severe headache with high fever, stiff neck, or confusion.

See an ENT doctor in the coming days if:

Pain in the face with temperature and purulent discharge does not go away in a few days or worsens, the symptoms are unilateral with an unpleasant smell, or bloody discharge appeared from the nose. If congestion and discharge last for months, make an appointment for a scheduled consultation.

05 / DIAGNOSTICS

How the
diagnosis is made.

Nasal endoscopy
The doctor looks for pus, swelling, or polyps near the sinus opening. Pus in the middle nasal passage is one of the strongest signs of odontogenic sinusitis.
CT scan of the sinuses
Shows which sinuses are affected and whether the inflammation is related to the teeth; thin sections are needed for planning the surgery.
Examination of the dentist
If the sinusitis is unilateral or there is a suspicion of a tooth.
Additional analyses
If necessary, check for allergies and immunity.

06 / TREATMENT

How to treat
chronic sinusitis.

Treatment depends on the cause. Guidelines advise not to require the same preoperative course of medication for all, but to assess symptoms, quality of life, and prior treatment.

Without surgery

Washes and sprays: Saline rinses and nasal sprays prescribed by the doctor are the basis of treatment.
Odontogenic sinusitis: Antibiotics alone usually do not help if the tooth is not treated. When both the tooth and the sinus are treated, according to the examination, recovery is expected in the vast majority of cases.

Endoscopic surgery

Through the nose, without incisions on the face.

Micropharyngotomy: The surgeon widens the natural opening of the sinus and removes the contents of the sinus and the polyp, preserving the mucosa, so that the sinus can be ventilated again.
The result: In the randomized MACRO trial (514 adults, mostly with polyps), after 6 months, quality of life after endoscopic surgery was significantly better than after a long course of antibiotics or placebo.
What to expect: Chronic rhinosinusitis can come back, so sometimes long-term treatment with sprays is needed after surgery. Narrowing of the new opening is rare: 10 cases among 288 operated on.

07 / AT THE VALIKHNOVSKY CLINIC

How do we
treat it.

Chronic sinusitis is operated on at Dr. Valikhnovsky's Institute of Surgery in the "New Nose" direction - endoscopically, through the nostrils.

DIRECTION TO THE CLINIC A new nose Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors. Go to direction

What do we do in this condition

Endoscopic microhygrotomy — expansion of the opening of the maxillary sinus and cleaning of the sinus.
Revision of the ostiomeatal complex — restoration of the ways by which the sinuses communicate with the nose.
Endoscopic septoplasty — if the curved septum prevents the sinuses from ventilating.

Rostislav Valikhnovsky

Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.

About the doctor ORCID

How is the treatment in us

ConsultationTalk about complaints and preliminary treatment, endoscopy of the nose.
CT scan of the sinusesThin sections for sinus assessment and surgery planning; if necessary, a dentist's examination.
PlanIs it enough to treat without surgery, or is a microhymnotomy necessary — and what to do with a septum or a tooth.
OperationEndoscopically, through the nostrils.
ControlExaminations with endoscopy in the first months after surgery; the doctor will explain what is possible and what should be avoided after the operation.

Discuss your case to call

08 / QUESTIONS AND ANSWERS

Frequently asked
questions.

Short answers. What is right for you, the doctor will tell you during the consultation.

What is the difference between chronic sinusitis and acute sinusitis?

Duration: chronic is said to occur when symptoms persist for more than 12 weeks. Acute usually passes in a few weeks.

Can sinusitis be caused by a tooth?

Yes, and more often than thought: from 25% to 40% of sinus infections are odontogenic. It is suspicious if the inflammation is unilateral and there is an unpleasant smell. Then both the tooth and the sinus are treated.

Is it necessary to make a puncture?

For the diagnosis and treatment of chronic sinusitis today, endoscopy and CT are used, and if necessary, the sinus is opened endoscopically through a natural opening.

Will surgery help better than antibiotics?

In the randomized MACRO trial (514 adults, 410 of them with polyps), after 6 months, quality of life after endoscopic surgery was significantly better than after a long course of antibiotics or placebo. Decisions are made individually.

Can sinusitis return after surgery?

Yes, chronic rhinosinusitis tends to return, so after surgery, control examinations and sometimes long-term treatment with sprays are required.

What examination is required before surgery?

Thin-section sinus CT and nasal endoscopy. If necessary, a dentist's examination, allergy and immunity check.

09 / SOURCES

Sources

10 sources · reviews, guidelines and studiesShowCollapse

European Position Paper on Rhinosinusitis and Nasal Polyps 2020Rhinology, 2020doi:10.4193/Rhin20.600 ↗
Clinical Practice Guideline: Adult Sinusitis UpdateOtolaryngology–Head and Neck Surgery, 2025doi:10.1002/ohn.1344 ↗
Clinical Practice Guideline: Surgical Management of Chronic RhinosinusitisOtolaryngology–Head and Neck Surgery, 2025doi:10.1002/ohn.1287 ↗
Global Incidence and Prevalence of Chronic Rhinosinusitis: A Systematic ReviewClinical & Experimental Allergy, 2025doi:10.1111/cea.14592 ↗
Epidemiology of Odontogenic SinusitisOtolaryngologic Clinics of North America, 2024doi:10.1016/j.otc.2024.07.001 ↗
Odontogenic sinusitis: A state-of-the-art reviewWorld Journal of Otorhinolaryngology – Head and Neck Surgery, 2022doi:10.1002/wjo2.9 ↗
Predicting Odontogenic Sinusitis in Unilateral Sinus Disease: A Prospective, Multivariate AnalysisAmerican Journal of Rhinology & Allergy, 2021doi:10.1177/1945892420941702 ↗
The clinical effectiveness of clarithromycin versus endoscopic sinus surgery for adults with chronic rhinosinusitis with and without nasal polyps (MACRO)Lancet, 2025doi:10.1016/S0140-6736(25)01248-6 ↗
Endoscopic sinus surgery compared to continued medical therapy for patients with refractory chronic rhinosinusitisInternational Forum of Allergy & Rhinology, 2014doi:10.1002/alr.21366 ↗
Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal Antrostomy Site StenosisAnnals of Otology, Rhinology & Laryngology, 2020doi:10.1177/0003489420929365 ↗

The figures on the page are from these sources.

VALIKHNOVSKI SURGERY PARTNERS

Sinusitis that
doesn't go away?

Describe how long symptoms have been present and what was treated, or send a CT scan. The doctor will tell you if surgery is necessary.

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