Why Sinusitis Keeps Coming Back

why sinusitis keeps coming back

Sinus infections can be incredibly painful, and they can become debilitating if when they are not diagnosed and treated properly. The relief of a “cured” sinus infection quickly evaporates when the telltale symptoms of an infection return and patients are left wondering why sinusitis won’t stay away. In addition to causing discomfort and/or missed days of work, untreated and recurrent sinus infections can lead to more permanent damage in the sinus cavities and nasal passages. 

While the very occasional, acute sinus infection (sinusitis) is relatively normal, recurrent or chronic sinus infections are not. If a sinus infection returns again after you’ve finished a round of antibiotics and/or have followed your physician’s at-home treatment instructions to the letter, please schedule another appointment ASAP.  

You may need a referral to an ENT (ear-nose-throat) specialist to determine why the sinus infection continues to come back, and whether anatomical corrections may be necessary to fix the problem once and for all.  

Acute Versus Chronic Sinus Infection 

The American Academy of Otolaryngology defines sinus infections in one of two ways: 

Acute sinusitis 

This is the normal manifestation of a sinus infection. Acute sinusitis clears up in four weeks or less and is often the unfortunate effect of a respiratory infection (cold or flu) or from chronic allergies. It occurs once, it lasts for a short time, the infection is treated with or without medication (yes, some sinus infections clear on their own!), and the patient should remain sinus infection free for a year or more.  

Chronic sinusitis 

If your sinus infection lasts for longer than 12-weeks, or it continues to come back again and again within a matter of weeks or months, you’re diagnosed with chronic sinusitis. There are multiple causes of untreatable or frequently occurring sinus infections. Chronic infections are most frequently connected to some type of obstruction that prevents sinus cavities from draining properly, trapping bacteria and/or viruses inside the sinus cavities. 

Visit our video about the Cause of Chronic Sinusitis to learn more. 

Reasons Your Sinusitis Keeps Coming Back 

Here are some of the reasons your chronic sinusitis continues to come back: 

Excessive inflammation of the nasal passages 

Contrary to what most people think, the sinuses consist of far more space than just the nasal passages and behind the cheekbones. There are four sets of sinuses located in the head, and all of these drain mucus through the nasal passages, which act as one of the body’s sinus exit points. Your throat also acts as a drain for the sinuses. This is why people with sinusitis often experience discomfort in the throat, resulting from post-nasal drip. 

If the nasal passages become inflamed, they get stopped up and the body has a hard time draining all of that backed up, infected, and often thickened mucus. This exacerbates the sinus infection, causing it to settle in even more.  

There are several things you can do to relieve and reverse swollen and sensitive sinus passages: 

  • Inhale steam (a hot shower is great for this) and use a nasal-specific saline solution to flush the nasal passages once, twice, or three times per day. Your doctor can show you how to do this safely. 
  • Avoid smoking cigarettes or inhaling second-hand smoke 
  • Use an air purifier and humidifier, especially while you sleep, to keep the passages moist 
  • Take a shower at night to flush allergens from the day down and out of your sinuses, and then splash your face with warm water in the morning to flush allergens and irritants that settled on your face or in your nose while you slept 
  • Drink lots of fluids (hot teas, especially herbal teas designed to support breathing, sinus pressure and/or allergies are highly recommended) 
  • Avoid outdoor activities that over-expose you to pollen such as mowing the grass, laying in a field, hiking through high grasses/weed, etc. 
  • Take care of your immune system by eating well (try an anti-inflammatory diet), getting plenty of rest, and managing stress. This is your body’s best chance of fighting infections on its own. 

Dr. Hester may prescribe a corticosteroid nasal spray or even an oral steroid to provide more immediate and dramatic inflammation relief. These meds should be used as directed. NEVER use corticosteroid nasal sprays or oral steroids for longer than advised. You can wind up doing more harm than good. If the sinus symptoms persist, contact your doctor to schedule a follow-up appointment. 

Your sinusitis keeps coming back because you don’t have an accurate diagnosis 

If the infection lasts longer than a couple of weeks or the pain is becoming unbearable, seek medical treatment immediately. Accurate diagnosis is key to treating sinusitis, especially when the infections return over and over again. You can treat allergies all you want, but a polyp, deviated septum, or other anatomical abnormalities in the nasal passages won’t disappear without more expert treatment. 

A comprehensive examination of the nose and sinus passages by a specialist is necessary to evaluate the correct diagnosis and cause of your symptoms. In some cases, what has been previously diagnosed as a ”sinus” issue has, in fact, been caused by another issue. Identifying the correct diagnosis is the first step to feeling better.

You may have an anatomical issue blocking sinus drainage 

There are several anatomical issues that prevent sinus cavities and/or the nasal passages from draining properly. Examples of these include: 

A previous nasal fracture (you broke your nose) 

Nasal bones are the most commonly broken bones in the body. Sometimes they heal well on their own, or they seem as if they did. Over time, you may experience signs or symptoms that the nose didn’t heal as well as you’d hoped. In fact, your previously fractured nose may have set in a crooked position. Or, the break may have been worse than you knew, leading to fractures deeper in the sinus cavities that didn’t heal well.  

Anyone who has broken their nose in the past is at higher risk for chronic sinus infections, so make sure to mention your nasal fracture history when you make an appointment with our office. 

Nasal polyps or other soft tissue obstructions 

Sometimes, for reasons that are unclear, the thin tissue lining the nasal passages develop small, benign (non-cancerous) tumors. We call these nasal polyps. As you know, it does not take much to obstruct the airway, so even a single polyp can lead to significant airway and breathing issues – including chronic snoring – as well as recurring sinus infections. Most often though, people with polyp-related sinusitis have multiple polyps obstructing the nasal passages.  

Fortunately, we can remove nasal polyps or other soft tissue obstructions using minimally-invasive procedures such as nasal airway remodeling. 

Deviated septum 

Some people are born with deviated septums, others develop them after a traumatic accident or injury – even when the injury seemed relatively mild. The nasal septum is that thin wall that divides the right and left sides of your nasal passages. If the wall is offset or deviated to a severe enough degree, it compromises both breathing and sinus drainage.  

If the septum has deviated to the point that it causes health problems, Dr. Hester will work with you to determine which treatment method or surgical procedure is best for correcting the deviation.  

Scar tissue in the sinus cavities 

Previous injuries, anatomic defects from birth, or previous sinus injections can all cause scar tissue to build up in the sinuses. This blocks the cavities from functioning and draining properly, which can trap irritants in the cavity. Recurrent sinus infections can continue causing more scar tissue, further compounding the problem. 

If Dr. Hester notices that scar tissue is impacting sinus function, he may recommend endoscopic sinus surgery to clear the tissue away.  

Turbinate hypertrophy 

The turbinates are long, narrow passageways that occur along the main nasal passageways. Their job is to warm and moisten the air that you breathe. Most people have three turbinates – inferior, middle, and superior turbinates. Once in a while, people are born with four. If the turbinates become inflamed or enlarged (called turbinate hypertrophy), they fill up the nasal cavity and it won’t drain properly. 

Turbinates are responsible for all kinds of sinus and breathing issues, including difficulty breathing, snoring, chronic stuffiness, and sinus infections that never seem to end. Enlargement of the inferior and/or middle turbinates are the most likely to cause issues. If you are diagnosed with turbinate hypertrophy, Dr. Hester can provide a comprehensive outline of treatment options to find the one that is right for you. In some cases, home treatments and/or medications can reduce their enlargement enough to be effective. For others, surgical procedures are the only successful mode of treatment. 

Abnormal growths or other anatomical abnormalities 

The body is a mysterious and complex series of systems. Seemingly out of nowhere, tissues can thicken, cells can excessively multiply causing tumors, or small issues that didn’t cause problems in the past can begin to cause you trouble. If your nasal passages or sinus cavities experience abnormal growths of any kind, they can usually be removed through surgery. If it is a tumor or mass, we will biopsy the tissue to make sure it is not cancerous.  

Most anatomical abnormalities affecting the bony or soft tissues comprising the sinus cavities can be repaired via surgery, greatly eliminating the experience of recurrent sinus issues. 

Accurate Sinus Diagnosis And Treatments Is Essential 

The only way to stop recurring sinus infections once and for all is to have an evaluation by a specialist who has the specialized training and experience to accurately diagnose their cause. Once you have an accurate diagnosis, we can discuss the options. The goal is always to provide the patient with all the available options, discuss the advantages and disadvantages of each, and help you find the best treatment plan for you.

Stop Suffering 

Do you suffer from recurring sinus infections? Contact us here at the office of Dr. Jerome Hester, ENT, or give us a call at (650) 268-5133, to discuss your concerns. Dr. Hester is an expert at treating all of the variations that lead to chronic sinusitis, and he always strives to find the least invasive treatment methods. Everyone deserves to breathe easily, and we look forward to helping you do just that.

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