Sinusitis and nasal polyps
Most cases of "sinusitis" are viral infections that clear up on their own. What sets them apart is not how strong the symptoms are, it is time. 10 days with no improvement at all, or getting worse after you had started to feel better, changes the picture. Beyond 12 weeks we are talking about the chronic form, which cannot be diagnosed from symptoms alone.
3 conditions with one name
In everyday language, "sinusitis" covers 3 different things, each with a different course and a different treatment.
Acute viral sinusitis is the common cold that has also reached the sinuses. Stuffy nose, runny nose, pressure in the face. It clears up on its own within a few days and does not need antibiotics.
Acute bacterial sinusitis omes into question on 2 specific criteria: when symptoms show no improvement at all for 10 days or more, or when they get worse within 10 days after they had started to improve. The second is called "double worsening" and is the most reliable sign.
Chronic sinusitis lasts 12 weeks or more and often does not look like an infection at all. It causes a permanently blocked nose, pressure in the face, mucus running down the back of the throat (postnasal drip) and, very typically, a reduced sense of smell.
How is chronic sinusitis diagnosed?
There is one point here that changes everything and is usually skipped.
Chronic sinusitis (chronic rhinosinusitis) is not diagnosed from a description of symptoms. International guidelines require 2 things together: symptoms for 12 weeks or more and objective evidence of inflammation. That evidence can be pus or swelling in the middle nasal passage, visible polyps, or signs of inflammation on imaging.
In practice this means that without an endoscopy or a CT scan, the diagnosis remains an assumption. Since the chronic form is treated over the long term, the difference between an assumption and proof is months of treatment heading in the right or the wrong direction.
Nasal polyps
Nasal polyps are benign growths that develop from chronically inflamed lining of the nose. They are not tumors and have nothing to do with bowel polyps.
The symptom that gives them away is the sense of smell. When someone has stopped smelling, or has smelled much less for months, polyps are among the first things to check. They often occur together with asthma and, in some patients, with sensitivity to aspirin or anti-inflammatory painkillers. This combination changes the treatment and is worth mentioning when you give your history.
Chronic sinusitis is divided into a form with polyps and a form without polyps. This is not a technicality: the 2 forms have different biology and respond differently to treatment.
What happens at the appointment?
We start with your history: how long the symptoms have lasted, whether there was a period of improvement, what color and how thick the mucus is, whether your sense of smell has changed and what treatments you have already had.
Nasal endoscopy
This is the examination that provides the objective evidence. It shows the middle nasal passage, where the sinuses drain, any pus or swelling, and polyps even when they are small and cannot be seen from the entrance of the nose. It is done in the office, takes a few minutes and does not hurt.
When is a CT scan needed?
It is not needed for the acute form. In the chronic form it comes in when the endoscopy is not enough, when a complication is suspected, and always when surgery is being planned, because it maps the anatomy the surgeon will follow.
Checking for related conditions
When there are polyps or the problem keeps coming back allergy is tested and we note whether there is also asthma or sensitivity to anti-inflammatory painkillers. Chronic sinusitis rarely comes alone, and treatment works better when everything else is under control too.
Treatment
In the acute form
In the first days, treatment focuses on the symptoms: saline rinses, nasal steroid spray, pain relief. Even when the criteria for the bacterial form are met, watchful waiting remains an evidence-based option, because some cases clear up without antibiotics. When an antibiotic is needed, it is chosen in a targeted way and for a set period.
In the chronic form
The basis is local and long-term: saline rinses and nasal steroid spray, used steadily and not on and off. This is the treatment patients find tiring because it gives no immediate result, and at the same time it is the one that keeps things stable.
When medication is not enough
Endoscopic sinus surgery is done through the nose, with no external incisions. The aim is not to remove the sinuses, it is to open their natural drainage pathways so that they are ventilated and can drain, and so that the local medication can reach where it is needed.
For selected patients with a severe, uncontrolled form with polyps, biologic medications are now also available. The decision is made individually and in cooperation with the relevant specialties.
Why do polyps come back?
This is worth saying before, not after. Surgery removes the polyps, it does not switch off the inflammation that created them. That is why local treatment continues after surgery, and why follow-up does not stop once the nose has opened up. Patients who know this from the start do better, because they do not stop treatment as soon as they feel well.
Frequently asked questions
No. The color comes from inflammatory cells and also appears in simple viral infections. What matters is how long it lasts and how it develops, not the color.
The viral form usually clears up within 7 to 10 days. If there is no improvement at all by day 10, or if you get worse after you had started to feel better, the approach changes.
It depends on the cause and on how long it has been going on. When it is due to polyps or swelling of the lining, it often improves with treatment. Delay does matter, though, which is why a persistent loss of smell should not be ignored.
No. They are benign growths caused by inflammation. Findings on one side only, however, especially with blood, are investigated separately, because there the list of possibilities is different.
Yes, and they are one of the few measures with good evidence and no side effects. They do need the right technique and enough volume, otherwise they do not reach where they should.
Surgery solves the mechanical part and improves symptoms significantly. The underlying inflammation remains, however, so local treatment and follow-up continue.
When should you not wait?
Immediately
Swelling or redness around the eye
A swollen eyelid, pain when moving the eye, double vision or reduced vision during a sinus infection mean going to a hospital straight away.
Immediately
Very severe headache with fever or confusion
A headache unlike your usual ones, especially with a high fever or reduced consciousness, is not a case for a doctor's office.
Soon
Symptoms on one side with blood or numbness in the face
Symptoms that stay on one side, with bloody discharge or numbness in the face, need an endoscopy without delay.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Payne SC et al., Clinical Practice Guideline: Adult Sinusitis Update, AAO-HNSF, 2025.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
