Dr. Bouknight Talks About The 4 Kinds of Sinusitis and The Best Treatment Options

Sinusitis is one the most common diseases – it affects over 40 million Americans each year and is responsible for over $6 billion dollars in healthcare costs. (1, 2, 3)
It is characterized by symptoms including facial pain, headache pressure, nasal drainage, congestion and fatigue. Less common symptoms include fever, facial swelling and tooth pain along the upper molars.
The range of symptoms is related to the nature of the problem: there are many types of sinusitis. How do you know what kind you have and how best to treat it? Here’s a quick breakdown:

The primary symptoms of acute sinusitis are a stuffy nose, congestion, facial pain, headache pressure and cloudy or discolored mucus from the nose. Symptoms can last up to four weeks. CT scans or other X-rays are not necessary for diagnosing this type of sinusitis.
– If symptoms last ten days or less and do not worsen, the sinusitis is usually due to a virus. Treatment for virus-induced sinusitis is primarily intended to achieve symptom relief. Use of over-the-counter decongestants, intranasal steroids, and saline nasal sprays can be helpful. There is no need for the patient to take antibiotics in this scenario.
– Symptoms that worsen over a ten-day period or last at least ten days but less than four weeks usually indicate that the sinusitis is bacterial in nature. Treatment includes over-the-counter decongestants, intranasal steroids, saline sprays and antibiotics.


This type of sinusitis is primarily due to an infection and is characterized by symptoms lasting four to eight weeks. Treatment with a broad spectrum antibiotic and an intranasal steroid is usually an effective treatment for this type of infection.


Chronic sinusitis lasts longer than 12 weeks and is characterized by symptoms of facial pain, headache pressure, and nasal drainage. This type of sinusitis is often associated with a decreased sense of smell and fatigue.
The underlying problem that drives chronic sinus disease is usually inflammation rather than infection. This inflammation causes swelling of the nasal membranes and the tissue lining of the sinus cavities. This results in a build up of mucus and frequently, this obstruction leads to a bacterial infection.
CT scans are important in the diagnosis and management of chronic sinusitis because they help identify which sinuses are inflamed and whether or not there is an anatomic obstruction. CT scans are used in conjunction with an endoscopic nasal exam to help identify factors such as nasal polyps, scar tissue in the nose, a deviated septum or other tissue abnormalities.
Treatment of chronic sinusitis can include a long course of a broad spectrum antibiotics that may last up to four to six weeks, intranasal steroids, saline rinses and even oral steroids.


This type of sinusitis is characterized by three or more episodes of acute sinusitis each lasting up to two weeks. This type of sinusitis may or may not require antibiotics but is frequently associated with underlying allergies triggered by seasonal fluctuations.
The treatment of sinus disease is unique to the patient and the disease presentation. Thorough evaluation with a physical exam that includes nasal endoscopy and CT scanning is invaluable in determining the most appropriate course of treatment for each individual.
If you’re experiencing symptoms of sinusitis, the experts and The Sinus Center of South Carolina can help.

1. Stewart et al., Epidemiology and burden of nasal congestion. J Gen Med. 2010; 3: 37–45.
2. Slavin RG. The diagnosis and management of sinusitis: A practice parameter update. J Allergy Clin Immunol. 2005, 116: (6 Suppl): 13-47.
3. Centers for Disease Control and Prevention: Vital and health statistics: Current estimates from the National Health Interview Survey, 1995. U.S. Dept of Health and Human Services, Centers for Disease Control and Prevention/National Center for Health Statistics.

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