A blocked nose, facial pressure and that heavy, congested feeling around your cheeks and eyes are familiar to almost everyone — usually after a cold. But how do you know whether you have a short-lived sinus infection that will pass on its own, or a longer-term problem that needs specialist attention? The difference comes down to two categories: acute and chronic sinusitis.
Understanding which one you are dealing with helps you know what to expect and when it is time to seek help. Here is a clear comparison.
What is sinusitis?
Sinusitis is inflammation of the sinuses — the air-filled spaces within the bones of your face that connect to your nasal passages. When the lining of these spaces becomes inflamed and swollen, the sinuses cannot drain properly, leading to a build-up of pressure, congestion and discomfort. The shared symptoms include facial pressure, a blocked nose, nasal discharge, a high temperature and a reduced sense of smell. You can read an overview on our sinusitis page.
The key difference between acute and chronic forms is how long the symptoms last and, often, what is causing them.
Acute sinusitis
Acute sinusitis comes on relatively suddenly and is usually short-lived, typically lasting up to around four weeks. It most often develops after a viral infection such as the common cold, when swelling temporarily blocks the sinuses and allows secretions to build up.
The encouraging news is that the majority of acute sinus infections clear up on their own within a couple of weeks without any specific treatment. Supportive measures usually help:
- Rest and fluids
- Saline nasal rinses to ease congestion
- Steam inhalation for comfort
- Over-the-counter pain relief for facial pressure
Antibiotics are not usually needed, because most cases are viral rather than bacterial. If a clearly bacterial infection develops and is not improving, a clinician may consider them — but this is the exception rather than the rule.
Chronic sinusitis
Sinusitis is described as chronic when symptoms persist for 12 weeks or more, often despite treatment. Rather than a single infection, chronic sinusitis usually reflects ongoing inflammation, and it can be linked to underlying factors such as allergies, structural narrowing of the nasal passages, or nasal polyps.
The symptoms are similar to the acute form but more persistent and wearing: a constantly blocked nose, lingering facial pressure, post-nasal drip and a long-standing reduction in smell that can affect day-to-day quality of life.
Because chronic sinusitis does not simply resolve on its own, it usually needs a more structured approach — and sometimes investigation to find the underlying cause. We explore the treatment pathway, including when an operation is considered, in our article on when chronic sinusitis needs surgery.
How are they treated differently?
The treatment approach reflects the duration and cause:
- Acute sinusitis is usually managed with simple supportive care while the body recovers.
- Chronic sinusitis is typically treated first with a sustained course of saline rinses, steroid nasal sprays and management of contributing factors such as allergies.
When chronic symptoms persist despite proper medical treatment, or when imaging shows significant blockage or polyps, surgery may be considered. The most common procedure is functional endoscopic sinus surgery (FESS), which opens the sinus drainage pathways through the nostrils with no external incisions — explained fully on our endoscopic sinus surgery (FESS) page.
Sometimes a blocked nose is driven by structure rather than inflammation. A deviated septum or enlarged turbinates can worsen congestion, and may be addressed with a septoplasty or turbinate reduction where appropriate.
When should you see a specialist?
It is worth seeking a specialist opinion if:
- Symptoms last longer than 12 weeks
- You have recurrent sinus infections
- You have a persistent loss of smell
- Symptoms keep returning once treatment stops
Frequently asked questions
Is sinusitis contagious?
Sinusitis itself is not contagious, although the viral cold that triggers acute cases can be passed on.
Do I need antibiotics for sinusitis?
Usually not — most acute cases are viral and resolve without antibiotics. They are reserved for specific bacterial infections.
How do I know if mine is chronic?
The main clue is duration: symptoms persisting beyond 12 weeks, often despite treatment, suggest a chronic problem worth investigating.
Get expert advice on your sinus symptoms
If your sinus symptoms are dragging on or keep coming back, a specialist assessment can identify the cause and the right treatment. Book an appointment with Mr Samit Unadkat, or learn more about our nose surgery and sinus treatments.
This article is for educational purposes only and is not a substitute for professional medical advice. Nasal and sinus surgery carries potential risks, including infection, bleeding and scarring.
