Chronic sinusitis is a persistent inflammatory condition of the nasal passages and sinuses that significantly affects quality of life. This condition is formally defined by symptoms that last for 12 weeks or longer, which differentiates it from a typical short-term sinus infection. Common indicators include chronic nasal obstruction, thick, discolored nasal discharge, facial pain or pressure, and a reduced sense of smell. Navigating the medical system to find relief involves consulting different specialists, depending on the severity and underlying cause of the long-term inflammation.
The Starting Point: Primary Care Physician
For most patients, the initial visit for chronic nasal or sinus issues should be with a Primary Care Physician (PCP), such as a Family Medicine or Internal Medicine doctor. The PCP’s role is to take a detailed medical history and perform a basic physical examination, which includes looking into the nasal passages to assess for inflammation. This initial assessment helps to confirm the diagnosis of chronic sinusitis and rule out other common issues like acute infections or the common cold.
The PCP will typically initiate a course of conservative, first-line medical treatments to manage the symptoms. These treatments often include long-term use of saline nasal rinses and intranasal corticosteroids, which target swelling in the sinus lining. Short courses of oral antibiotics or systemic steroids may also be prescribed if a bacterial infection is suspected or inflammation is severe.
The critical decision point for the PCP is determining when to seek specialized care. If symptoms persist despite a dedicated course of medical therapy—usually four to twelve weeks of treatment—a referral to a specialist is warranted. The PCP serves as the gatekeeper, managing most cases while identifying those who require advanced diagnostic tools or interventions.
The Specialist: Otolaryngologist (ENT)
An Otolaryngologist, often called an ENT specialist, is the definitive medical professional for the complex diagnosis and management of chronic sinusitis. This specialist investigates the structural and anatomical factors contributing to chronic inflammation. Their expertise focuses specifically on the head and neck, including the paranasal sinuses.
The ENT’s diagnostic process starts with a nasal endoscopy, an in-office procedure where a thin, flexible tube with a camera is inserted into the nasal cavity. This allows for a direct view of the sinus drainage pathways, turbinates, and any polyps or thick discharge causing obstruction. A low-dose Computed Tomography (CT) scan is commonly ordered to provide a detailed, three-dimensional image of the underlying bone and soft tissue structure of the sinuses.
For patients who do not respond to initial medical therapy, the ENT can employ advanced topical treatments, such as custom-compounded steroid irrigations. When structural issues are the primary cause, or medical management has failed, the ENT offers procedural interventions. Functional Endoscopic Sinus Surgery (FESS) is a common procedure that widens the natural sinus drainage openings to restore proper ventilation and mucus flow.
A less invasive option is balloon sinuplasty, where a small balloon catheter is inserted and inflated to gently dilate the sinus openings without removing tissue. The ENT focuses on resolving physical blockages and structural abnormalities, such as a deviated septum or obstructive polyps. This structural correction is necessary to allow medications to work effectively in the long term.
Addressing Underlying Causes: The Allergist or Immunologist
When chronic sinusitis is not primarily caused by a structural issue or simple infection, it is often driven by underlying systemic triggers requiring the attention of an Allergist or Immunologist. These specialists focus on identifying and managing environmental factors, such as allergies, or internal immune system irregularities that fuel chronic inflammation. They view the condition as an inflammatory disease of the airways, similar to asthma.
Diagnosis begins with identifying specific triggers using tools like skin prick testing, which reveals hypersensitivity to common aeroallergens such as pollen, mold, or dust mites. Blood tests may also be used to measure specific IgE antibodies or to screen for underlying immune deficiencies, such as low levels of certain immunoglobulins (IgG subclasses). Identifying these systemic issues is crucial for providing targeted, long-term relief.
Treatment from an Allergist focuses on modifying the immune response to reduce inflammation at its source. Immunotherapy, commonly known as allergy shots, works by gradually desensitizing the body to specific allergens, reducing allergic inflammation in the sinuses. For patients with confirmed primary immune deficiencies, the Immunologist may manage their condition with immunoglobulin replacement therapy. These specialists often work closely with the ENT, managing systemic triggers while the ENT addresses structural damage.