This article on Epainassist.com has been reviewed by a medical professional, as well as checked for facts, to assure the readers the best possible accuracy.

We follow a strict editorial policy and we have a zero-tolerance policy regarding any level of plagiarism. Our articles are resourced from reputable online pages. This article may contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

The feedback link “Was this Article Helpful” on this page can be used to report content that is not accurate, up-to-date or questionable in any manner.

This article does not provide medical advice.


The Immune System and Chronic Sinusitis : Understanding the Connection

Chronic sinusitis is a chronic condition most frequently originates from complex interactions between immunological, genetic, and microbial factors. The main role behind chronic sinusitis is auto-immunity, although a couple of recent studies have started emerging for the proper treatment of the patients.

Today, in our post, we will discuss the link of auto-immunity between chronic sinusitis and other diseases specifically attained through bullous dermatoses and review the recent evidence.

We will raise a few additional considerations for auto-immunity from both the clinical and research perspectives.

Overview of Chronic Sinusitis

Chronic sinusitis is a persistent swelling or inflammation of the sinuses that is often associated with infections and can last for a long period of time, typically more than 12 weeks. The sinuses are four paired cavities(1) in the head that are connected by narrow channels.

These four cavities are named for the bones closest to them: The maxillary, ethmoidal, frontal, and sphenoidal. The sinuses produce mucus that drains through these channels in the nose and serves as a filtering system to keep the nose clean and free from bacteria.

Sinusitis occurs when the sinuses become infected, filled with fluid, or blocked. There are various types of sinusitis, including acute, subacute, and chronic.

Acute sinusitis usually lasts a few days and can be resolved with minimal to no treatment in about 4 weeks. However, chronic sinusitis requires different forms of treatment and in severe cases, surgery may be necessary if other methods are not effective.

Chronic sinusitis should not be confused with recurrent sinusitis, as symptoms of chronic sinusitis persist for long periods, whereas in recurrent sinusitis, one experiences 4 or more episodes of sinusitis within a year but also has symptom-free intervals in between.

The Link Between The Immune System & Chronic Sinusitis

The Link Between The Immune System & Chronic Sinusitis

The generic predispositions are mainly affected by the role played by the mucosal epithelium that works as a barrier to both functionality and structure.(2) The immunity deficiencies are known to get implicated in chronic sinusitis, specifically for patients resistant to treatment.(3)

Some evidence backs the frequent occurrence of chronic sinusitis in patients with common variable humoral immunodeficiency.(4)

The implication of indirect support for other immune deficiencies is that there is a disequilibrium between TH1 and TH2 responses, with a stronger emphasis on TH2 responses.(5) Additionally, there are aberrant TLR functions in innate immunity and a constant feed-forward loop of pro-inflammatory cytokines, leading to chronic low-grade inflammation.

The emerging role of the microbiome in the model that gets governed by the interactions of the gene-environment is like the permanent members of dysbiotic bacteria colonizing the mucosa, which is chronically inflamed to keep this latter incorrectly repaired and dysfunctional.(6)

The link between premorbid autoimmune diseases and chronic sinusitis has become important. Initially, chronic sinusitis is a multifactorial disease with a massive spectrum of links ranging from genetics to comorbid diseases and environmental factors. Autoimmune diseases are considered to have a risk factor linked with chronic sinusitis.(7)

Secondly, patients suffering from autoimmune diseases should share identical pathogenic mechanisms to develop chronic sinusitis or their specific subtypes. Thirdly, autoimmune diseases are considered a predictive factor linked to frequent acute sinusitis exacerbations.(8) The autoimmune diseases should contribute to the negative prognosis of chronic sinusitis.

To date, the link between premorbid autoimmune diseases and chronic sinusitis remains entirely uncertain. Consequently, we focus on using specific research and conducting retrospective case-control studies clarifying whether chronic sinusitis is linked with premorbid autoimmune diseases.

Causes for Chronic Sinusitis

The sinuses are air-filled spaces in the skull, located near the nasal bones, forehead, eyes, and cheeks. Healthy sinuses are free of bacteria and other germs. Several times, mucus starts to drain out while the air flows through the sinuses.

When the sinus openings become congested with mucus or are blocked, bacteria and other germs can grow more easily. Chronic sinusitis can develop from several conditions, including:

  • Blocked airways due to allergies or asthma or cystic fibrosis
  • Infections from viruses, bacteria, or fungal
  • Abnormal nose structure, such as a deviated septum or crooked cartilage and bones.
  • A weakened immune system.

Diagnoses of Chronic Sinusitis

Chronic sinusitis is diagnosed when symptoms of sinus infections persist for more than 12 weeks. In some cases, the doctor may use an endoscope, a small and flexible tool that allows them to inspect the inside of the sinuses and nose. Structural issues can be detected using CT scans or MRIs, including deviated nasal septum or growth of polyps.

In some cases, the healthcare provider may order a biopsy to determine if the infection has spread, which involves taking a sample of bone or tissue for examination under a microscope.

The Treatment Options For Chronic Sinusitis

Doctors now believe that chronic sinusitis may involve an inflammatory disorder similar to allergies and asthma.(9) The following are some of the options for treatment:


Antibiotics are a common treatment for bacterial sinus infections. The length of treatment can range from three to twenty-eight days, depending on the type of antibiotic. However, longer treatments may be prescribed for severe or long-lasting cases, and these longer treatments can lead to restricted blood supply in the deep-seated sinuses.

The overuse and abuse of antibiotics have contributed to a rise in antibiotic resistance. Therefore, patients with sinus symptoms should only consider taking antibiotics if their symptoms include discolored nasal discharge that persists beyond seven to ten days.

While antibiotics can help eliminate the sinus infection by attacking the bacteria causing it, they do not provide much relief until they take effect. A few over-the-counter medications can be used to provide relief.

Nasal Decongestant Sprays

Topical nasal decongestants can be helpful if used for no more than three to four days. These medications help reduce swollen nasal passages and facilitate drainage from the sinuses. However, overuse of these sprays can lead to the “rebound phenomenon”, where the nasal passages become dependent on the spray and swell shut when it is not used.


Antihistamines can block the inflammation caused by an allergic reaction and help alleviate symptoms of allergies that cause swollen sinus and nasal passages.

Nasal Decongestants & Antihistamines

Patients should use caution when using over-the-counter combination drugs. Some of these drugs contain drying agents that can thicken mucus. These drugs should only be used if prescribed by an allergist.

Topical Nasal Corticosteroids

Prescription nasal sprays of topical corticosteroids can prevent and reverse inflammation and swelling in the nasal passages and sinus opening. These sprays can effectively shrink and prevent the return of nasal polyps.


Surgery is typically recommended as a last resort if other treatments have failed. An otolaryngologist usually performs the procedure, targeting anatomical defects. The surgeon can fix these defects in the bone that separates the nasal passages, such as by removing nasal polyps and opening up closed passages. Sinus surgery is performed under local or general anesthesia, and patients often go home after the procedure.

Why Should You Contact Your Healthcare Provider?

You should reach out to your healthcare provider if your sinusitis symptoms persist despite treatment or if you experience pain. Other reasons to seek medical attention include a stiff neck, swelling around the eyes, changes in vision, and any changes in mental function.

It’s important to take your health seriously and not endure symptoms for an extended period. Be aware of the duration of your sinusitis symptoms, as your healthcare provider may ask about this during your visit.

Complications of Chronic Sinusitis

If left untreated, chronic sinusitis can lead to difficulties in breathing and a lack of oxygen in the body, making it difficult to be active. Prolonged conditions can result in serious complications, including:

  • Permanent loss of the sense of smell due to damage to the olfactory nerve
  • Loss of vision if the infection spreads to the eyes
  • Inflammation of the spinal cord and brain membranes
  • Spread of infections to the skin or bones.

Final Notes

Understanding the underlying cause of your chronic sinusitis symptoms may not necessarily lead to a complete cure, and you may require ongoing medical care to manage the symptoms and prevent them from affecting your daily life.

However, in some cases, these symptoms can be effectively managed through home remedies, over-the-counter medications, and a treatment plan recommended by your doctor.


  1. Hsu J, Avila PC, Kern RC, Hayes MG, Schleimer RP, Pinto JM. Genetics of chronic rhinosinusitis: state of the field and directions forward. J Allergy Clin Immunol. 2013;131(4):977–93.
  2. Tournas A, Mfuna L, Bosse Y, Filali-Mouhim A, Grenier JP, Desrosiers M. A pooling-based genome-wide association study implicates the p73 gene in chronic rhinosinusitis. J Otolaryngol Head Neck Surg. 2010;39(2):188–95.
  3. Shapiro GG, Virant FS, Furukawa CT, Pierson WE, Bierman CW. Immunologic defects in patients with refractory sinusitis. Pediatrics. 1991;87(3):311–6.
  4. Srinivasa BT, Alizadehfar R, Desrosiers M, Shuster J, Pai NP, Tsoukas CM. Adult primary immune deficiency: what are we missing? Am J Med. 2012;125(8):779–86.
  5. Van Zele T, Claeys S, Gevaert P, Van Maele G, Holtappels G, Van Cauwenberge P, Bachert C. Differentiate chronic sinus diseases by measurement of inflammatory mediators. Allergy. 2006;61(11):1280–9.
  6. Kramer MF, Heath MD. Probiotics in the treatment of chronic rhinoconjunctivitis and chronic rhinosinusitis. J Allergy. 2014;2014:983635.
  7. Min, J. Y. & Tan, B. K. Risk factors for chronic rhinosinusitis. Curr. Opin. Allergy Clin. Immunol. 15, 1–13 (2015)
  8. Kwah, J. H. et al. Clinical factors associated with acute exacerbations of chronic rhinosinusitis. J. Allergy Clin. Immunol. 145, 1598–1605 (2020).
  9. https://acpinternist.org/archives/2011/01/sinusitis.htm

Also Read:

Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 1, 2023

Recent Posts

Related Posts