Nasal congestion, runny nose and mucus in the throat are often mistaken for a common cold or allergic rhinitis. If the symptoms improve after a few days, they may not be a major concern. However, if nasal blockage persists, nasal discharge becomes thick, or symptoms are accompanied by facial pressure and reduced sense of smell, the problem should not simply be dismissed as a lingering cold. Rhinosinusitis refers to inflammation of the mucosal lining in the nasal cavity, nasopharynx and paranasal sinuses. According to the Centre for Health Protection in Hong Kong, rhinosinusitis that lasts for 12 weeks or more without complete resolution is defined as chronic rhinosinusitis.
The sinuses are small air-filled spaces located around the forehead, cheeks, eyes and nasal cavity. Under normal circumstances, they help with air circulation and mucus drainage. When the lining of the sinuses becomes inflamed and swollen, mucus may not drain properly, leading to nasal blockage, postnasal drip, facial pressure and changes in smell. These symptoms are not always severe at the beginning, but they can persist like a damp cloud trapped inside the nose, gradually affecting breathing, sleep and quality of life. Because chronic sinusitis may overlap with allergic rhinitis, a common cold, dental problems or structural nasal problems, patients should pay attention not only to individual symptoms, but also to how long they last, whether they recur, and whether they are becoming worse.
The first warning sign is persistent nasal blockage. A patient may feel that the nose is constantly blocked, breathing through the nose becomes difficult, and mouth breathing becomes more common. Symptoms may be more noticeable during sleep, and some people may snore or sound nasal when speaking. The Hospital Authority in Hong Kong states that nasal obstruction is a very common symptom in ear, nose and throat services, and chronic sinusitis may present with nasal blockage, coloured discharge and changes in smell.
The second warning sign is thick yellow or green nasal discharge, or postnasal drip. Some patients may not notice obvious runny nose. Instead, they may feel mucus dripping down the back of the throat, frequent throat clearing, throat discomfort in the morning, or coughing caused by airway irritation. The Centre for Health Protection notes that clinical features of rhinosinusitis may include cough, nasal symptoms, fever, halitosis, headache, facial pain and facial swelling. It also states that nasal discharge can range from watery to purulent, and its appearance cannot reliably indicate whether the cause is bacterial or viral. The third warning sign is pressure or pain around the cheeks, forehead, eyes or bridge of the nose. Some patients describe it as a heavy sensation between the eyebrows, pain behind the eyes, or a feeling that the cheeks are “blocked up”, especially when bending forward. Others may also experience headache, toothache or a feeling of pressure in the ears. The NHS lists pain, swelling and tenderness around the cheeks, eyes or forehead as one of the main symptoms of sinusitis, along with blocked or runny nose, reduced sense of smell and green or yellow mucus.
The fourth warning sign is reduced sense of smell or taste. Patients may notice that food smells weaker, perfume is harder to detect, or even smoke and burnt odours become less obvious. This is not merely a small inconvenience. It may reflect ongoing inflammation in the nasal cavity and sinuses, preventing smell molecules from reaching the olfactory area properly. Mayo Clinic lists thick discoloured mucus, postnasal drip, nasal congestion, facial pain or tenderness, and reduced sense of smell and taste as common symptoms of chronic sinusitis. It also notes that chronic sinusitis lasts at least 12 weeks.
Chronic sinusitis can resemble a cold that refuses to leave, but the two should not be treated as the same problem. A common cold usually improves gradually. If nasal blockage, thick discharge, postnasal drip, facial pressure or reduced smell persists for weeks, keeps recurring, or begins to affect sleep, work and daily life, medical advice should be considered. An ENT doctor may assess the patient’s medical history and symptoms, and may arrange nasal endoscopy, imaging or other tests if needed. This can help determine whether the symptoms are caused by chronic sinusitis, nasal polyps, allergic rhinitis, a deviated nasal septum or another nasal condition.
Certain warning signs should be taken more seriously. The Hospital Authority advises patients to seek medical advice if they have nasal obstruction associated with danger signs, including persistent symptoms lasting for more than two weeks, one-sided blood-stained discharge or bleeding, abnormal cheek sensation, visual or dental changes, neurological symptoms, or symptoms that do not improve after first-line treatment. Mayo Clinic also advises prompt medical attention for symptoms that may suggest a serious infection, such as fever, swelling or redness around the eyes, severe headache, forehead swelling, confusion, double vision, other visual changes or stiff neck.
Treatment depends on the cause and severity. In some cases, doctors may recommend saline nasal irrigation, nasal steroid sprays, allergy management or other medical treatment. Cleveland Clinic notes that treatment for chronic sinusitis often focuses on controlling inflammation and may include nasal saline irrigation, nasal steroid sprays or procedures for selected structural problems. It also advises avoiding triggers such as smoke, allergens and infections where possible. Antibiotics should not be used casually unless there is a clear indication of bacterial infection, as not every case of sinusitis requires antibiotic treatment.
In short, chronic sinusitis may not always arrive with dramatic symptoms. Sometimes it begins with long-lasting nasal blockage, postnasal drip, facial pressure and reduced sense of smell, quietly disguised as a stubborn cold or allergic nose. The real problem may not be one episode of nasal congestion, but assuming it is harmless and delaying proper assessment. If you have these symptoms repeatedly or they last for weeks, please consult an ENT doctor.
