Understanding Acute and Chronic Pansinusitis

Medically reviewed by Josephine Hessert, DO

Pansinusitis is a rare ailment that involves the infection of all four pairs of sinuses. The problem is a more intense version of a common sinus infection, or sinusitis, which affects just one part of your four pairs of sinuses.

This type of problem causes more severe symptoms than a normal sinus infection. It is often more painful and has a higher risk of problems than an illness that affects just one sinus.

Most cases of normal sinusitis are acute (brief) and clear up without treatment. However, having more than one inflamed sinus can make treatment harder. It can lead to a chronic (long-term) problem that spreads to other parts of your body. Though rare, this can increase the risk of the disease harming your eye or brain.

This article describes how acute and chronic pansinusitis differ, common symptoms, and treatments.

Pansinusitis: When Your Whole Head Feels Inflamed

Pansinusitis can feel like a severe sinus infection that attacks more than one part of your facial area. It affects the four pairs of air-filled hollow spaces within your nose and eyes, called the paranasal sinuses.

Your four paranasal sinus pairs are named after the bones that contain them. These include the following:

• Maxillary sinus (on your cheekbone)

• Frontal sinus (directly above your eyes on your lower forehead)

• Ethmoid sinus (beside your eye and upper nose)

• Sphenoid sinus (behind your nose, just below the base of your brain)

A sinus infection happens when the air spaces become inflamed, blocking drainage. As the fluid builds inside your sinuses it causes pain and pressure. It also allows germs like viruses and bacteria to grow and multiply. When a sinus infection extends past one sinus, the pain and pressure become more intense as more areas are involved.

Causes of pansinusitis can involve the following:

• Upper respiratory infection (URI) (any infection that attacks your upper respiratory tract, which includes your nose, sinuses, and throat)

• Infection from bacteria, viruses, or fungi

• Hay fever (allergic reaction to factors like plants, pollen, dust, pets, and mold)
  

• Infections from dental problems

• Physical obstructions in your nasal or sinus cavities, such as nasal polyps (growths that result from inflamed mucous membranes in your sinuses and nasal passages), deviated septum (a condition in which the cartilage and bone that separate the right and left nasal airways are crooked), nasal bone spur (extra pieces of bone that grow out from your septum), or sinus tumor

• Physical injury to your sinuses

• Changes in air pressure (due to swimming or a change in altitude)
  

Learn More: Causes and Risk Factors of Sinus Infection

Is It Acute or Chronic Pansinusitis?

The symptoms of acute and chronic pansinusitis have many similar symptoms, including the following:

• Facial pain or pressure in your temples, forehead, cheeks, nose, and behind your eyes

• Nasal congestion

• Yellow or green nasal discharge

• Postnasal drip (a feeling of mucus dripping down the back of your throat, usually at night or when you lie down)

• Changes in vision or vision loss

• Toothache

• Cough, which worsens at night

• Sore throat

• Fever

• Halitosis (bad breath)

• Loss of your sense of smell

• Fatigue

• An overall feeling of malaise (not feeling well)

• Frontal headache

The key difference between acute and chronic pansinusitis is the length of time that symptoms persist without improving or resolving.

Acute pansinusitis lasts from 10 days to eight weeks. Chronic pansinusitis lasts longer. Chronic pansinusitis can involve repeated acute infections or an infection that does not improve during that time.

Learn More: Symptoms of a Sinus Infection

Getting Care for Pansinusitis

A healthcare provider can diagnose pansinusitis and advise the most appropriate treatment for your condition. A primary care provider can determine the extent of your condition and whether you need treatment and/or the care of a specialist. If you don't have a primary care provider, you can get the care you need from one of the following options:

• Pharmacy-based walk-in clinic (such as MinuteClinic): A walk-in clinic staffed by nurse practitioners and physician assistants who can diagnose common conditions and illnesses and write prescriptions as needed
  

• Urgent care: A same-day medical clinic that provides immediate outpatient medical services for acute and chronic illnesses that are not life-threatening
  

• ZocDoc: A website and mobile app that helps you find and schedule an appointment with a private primary care provider or specialist
  

Acute or Chronic, How Do You Get Relief for Pansinusitis?

Treatment for acute or chronic pansinusitis involves reducing inflammation and clearing sinus congestion. Options include home remedies, over-the-counter and prescription drugs, and surgical treatments.

Therapies that provide symptom relief can be useful in acute or chronic conditions while you wait for the problem to resolve itself or for prescribed medications to take effect. The type of therapy advised varies based on the underlying cause of your case of pansinusitis. The following treatments may help provide relief for pansinusitis.

Home Remedies

Home remedies can help reduce painful and annoying symptoms of pansinusitis, like congestion and sinus pressure but do not help the infection resolve faster. They include the following:

• Holding a warm compress over your nose and forehead to reduce facial pain and swelling

• Using saltwater nasal spray to reduce congestion

• Breathing in the steam from a bowl of hot water or shower two to four times daily to relieve pain, promote drainage, and open sinus cavities

• Saline rinses using a neti pot or another container

• Using a humidifier in your bedroom to help thin mucus

• Drinking a lot of fluids and getting more rest

Over-the-Counter Therapies

Over-the-counter therapies include the following medications:

Pain relievers to manage headaches, pain, and sinus pressure, such as:

• Tylenol (acetaminophen)

• Advil, Motrin (ibuprofen)

• Aleve (naproxen)

• Bayer or Durlaza (aspirin)

Nasal congestion treatments to thin mucus and help it drain easier include:

• Saline nasal spray

• Mucinex (guaifenesin)

• Decongestants such as Afrin (oxymetazoline) nasal spray, Sudafed (pseudoephedrine), Sudafed PE (phenylephrine)

Over-the-counter steroid nasal sprays (most useful for chronic sinusitis) such as:

• Flonase (fluticasone)

• Nasacort (triamcinolone)

Antihistamines given orally or through nasal spray may help to dry up mucus, especially in cases of pansinusitis caused by allergies, and include:

• Allegra (fexofenadine hydrochloride)

• Benadryl (diphenhydramine)

• Claritin (loratadine)

• Unisom (doxylamine)

• Zyrtec (cetirizine hydrochloride)

Prescription Medications

Prescription medication may be used to help relieve symptoms, especially in cases of chronic pansinusitis. These medications include the following:

Prescription steroid medications to open nasal passageways, relieve inflammation, or reduce nasal polyps include:

• Dymista (azelastine and fluticasone)

• Zetonna (ciclesonide)

• Rayos (prednisone)

Leukotriene modifiers (useful if you have an aspirin allergy), such as:

• Singulair (montelukast)

• Zyflo CR and Zyflo (zileuton)

Antibiotics (reserved for indications of bacterial infection) can include many options, such as the following:

• Amoxil (amoxicillin)

• Augmentin (amoxicillin-clavulanate)

• Doryx, Vibramycin (doxycycline)

• Levaquin (levofloxacin)

• Cleocin (clindamycin)

• Suprax (cefixime)

• Vantin (cefpodoxime)

Immunotherapy (allergy shots) may be considered for sinusitis caused or worsened by allergies.

Surgeries and Specialty Procedures

Surgeries and other procedures can help address physical malformations like enlarged tissues, scar tissue, and abnormal growths that block your sinuses and contribute to pansinusitis. These procedures include the following:

• Balloon sinuplasty (the inflation of a balloon catheter to widen and drain sinus passages)

• Septoplasty (surgery to repair a deviated septum by preserving the bone)

• Maxillary antrostomy (surgery to widen the maxillary sinus)

• Nasal polypectomy (surgery to remove nasal polyps)

• Submucosal resection (surgery to treat a deviated septum by removing sections of cartilage and bone)

• Turbinectomy (surgery to remove some or all of the turbinate bone, the bone in your nasal passage, to improve airflow)
  

Learn More: How to Treat a Dry Nose and Sinuses

When Do Providers Prescribe Antibiotics for Pansinusitis?

While about 85% of sinus infections improve or resolve without treatment, the remaining 15% require treatment. Providers prescribe antibiotics when a sinus infection includes symptoms that distinguish it from a viral infection.

Antibiotics only work with bacterial infections (infections caused by bacteria). They are useless and still pose the risk of harmful side effects like antibiotic resistance when used to treat viral infections (infections caused by viruses).

Antibiotics are typically prescribed when an episode of pansinusitis includes the following criteria:

• At least 10 days with the following symptoms: Thick, pus-filled, green or yellow nasal mucus and/or facial pressure or pain

• The occurrence of "double worsening" sinusitis (symptoms in an episode of sinusitis that improved then worsened, even if it's been less than 10 days)

Since pansinusitis may pose a more complex infection than common sinusitis, antibiotic treatment may involve a high-dose antibiotic, possibly administered intravenously, with or without a steroid.

Learn More: Everything to Know About Antibiotics

Complications of Serious Pansinusitis

Complications of serious pansinusitis are rare but possible. The condition can lead to severe and potentially life-changing consequences without early diagnosis and treatment.

Generally, cases of acute pansinusitis that do not improve with two courses of conventional antibiotic treatment are an indication that the condition may be related to more severe complications.

Complications of serious pansinusitis include conditions in the following categories:

Local complications of the face, including:

• Facial cellulitis (a common bacterial skin infection)

• Facial abscesses (a defined, bump-like collection of pus that develops within or just below the skin's surface)

• Osteomyelitis (a bacterial infection involving bone)

• Mucocele/mucopyocele (a benign mucous cystic lesion on the inner surface of your mouth)

Complications of the orbital area (bony structures of your skull that house your eyeball, its muscles, nerves, and blood vessels) complications include:

• Inflammatory edema (swelling associated with inflammation or fluid overload)

• Orbital cellulitis

• Abscesses of the subperiosteum (the area under the periosteum, the area of blood vessels and nerves that wraps abound bone)

• Cavernous sinus thrombosis (a potentially life-threatening blood clot in the cavernous sinuses located behind your eyes and under your brain)

• Orbital abscesses

Intracranial complications, such as:

• Meningitis (inflammation of the fluid and membranes that surround your brain and spinal cord)

• Brain abscesses

• Intracebreal abscesses (abscesses in the cerebrum)

• Dural sinus thrombosis (a blood clot in one of the dural sinuses, which are the largest blood vessels that carry blood from the brain to your lungs)

• Cranial nerve palsy (lack of function of a cranial nerve, resulting in the weakness or complete paralysis of the area served by the affected cranial nerve)
  

Pansinusitis vs. COVID-19

Pansinusitis and COVID-19 share some common symptoms like congestion, headache, cough, and sore throat. However, the two conditions also cause symptoms that are distinct to each ailment.

Symptoms more likely to occur with pansinusitis include:

• Bad breath

• Swollen eyes

• Facial pain

• Runny nose

• Postnasal drip

• Headaches

• Facial or sinus pain

• Bad breath

• Swelling around your eyes
  

Symptoms more likely to occur with COVID-19 include:

• Shortness of breath

• Muscle aches

• Loss of smell or taste

• Diarrhea

• Fatigue

• Nausea or vomiting

• Chills

• Congestion

Pansinusitis Recovery Time

Pansinusitis recovery time varies based on the type of pansinusitis you develop. Both acute and chronic sinus infections can be viral or bacterial. Some chronic infections can be fungal.

An acute pansinusitis infection can last up to eight weeks. A chronic infection can last longer, usually at least 12 weeks. In some cases, a chronic infection may seem to improve, and then it can return with symptoms just as bad as when they started. These infections can drag on for months before they are resolved.

Chronic sinusitis caused by a bacterial infection can be treated with antibiotics for 10 to 14 days. However, in resistant cases, the course of treatment may be extended to four to six weeks.

Summary

Pansinusitis is a rare problem that involves the infection of all four pairs of sinuses. Common cases of sinusitis only involve one or two sinuses. Having four inflamed sinuses causes a more intense symptoms. It is also more likely to increase your risk of having severe problems that could threaten your life.

Treatment can vary based on the cause of the problem. Therapies include home remedies, over-the-counter treatments, drugs, and surgery. Antibiotics can be used to treat cases caused by bacteria.

Acute cases may resolve on their own without treatment. Chronic cases may last for months or recur after they seem to improve.