What is sinusitis?
The sinuses are air-filled spaces inside the facial bones that open into the nose. Sinusitis (medically, rhinosinusitis) is inflammation and swelling of the lining of these spaces and the nose. When the swelling blocks the sinus openings, mucus builds up, causing facial pressure, a blocked nose and discharge.
- Acute sinusitis: symptoms last less than 4 weeks. It usually follows a cold and is caused by viruses; most cases clear up on their own.
- Chronic sinusitis: symptoms last more than 12 weeks. The main problem is long-standing inflammation rather than infection; nasal polyps, allergies and asthma may be present.
- Recurrent acute sinusitis: four or more acute episodes in a year, with symptom-free periods in between.
Symptoms
- A blocked nose and thick, yellow-green discharge from the nose or down the back of the throat.
- Pain, pressure or fullness in the cheeks, around the eyes or in the forehead, which may get worse when bending forward.
- A reduced sense of smell.
- Headache, toothache, bad breath, cough and tiredness; sometimes fever.
Cold symptoms usually start to ease noticeably within 7–10 days. Symptoms in the first 10 days that are not getting worse usually point to a viral infection.
When to see a doctor
Straight away / urgently
Spread of sinusitis to the eye area or the brain is rare but needs emergency treatment. Go to the emergency department without waiting if you have any of the following:
- Swelling or redness of the eyelid or around the eye.
- Double vision, reduced vision, an eye that looks pushed forward or difficulty moving the eye.
- A severe headache, especially in the forehead, or swelling over the forehead.
- Confusion, unusual drowsiness, a stiff neck or weakness on one side of the body.
- High fever with feeling very unwell; people with a weakened immune system (for example during chemotherapy) should seek help even sooner.
Within a few days to weeks
- Symptoms have lasted more than 10 days without improving.
- Symptoms get worse again after starting to improve.
- Fever lasts more than 3–4 days, or painkillers do not help.
- You get sinusitis often, or symptoms have gone on for more than 12 weeks.
- Symptoms are on one side only: one-sided blockage, blood-stained discharge or one-sided facial pain should be examined.
What happens at the appointment
Uncomplicated acute sinusitis is usually diagnosed from your history and examination; X-rays or scans are usually not needed. In an ENT examination, the inside of the nose may be looked at with a lighted instrument or a thin endoscope (nasal endoscopy), which can show polyps, infected discharge or structural problems. A computed tomography (CT) scan may be requested if symptoms are long-lasting or keep coming back, if surgery is being considered or if a complication is suspected. A definite diagnosis and treatment decision are made at examination.
Treatment options
When are antibiotics needed?
Most acute sinusitis is caused by viruses, and antibiotics do not help; they can also cause side effects such as diarrhoea, rash and allergic reactions. Your doctor considers bacterial sinusitis if symptoms last beyond 10 days without improving, get worse again after improving, or are severe. Even then, a few days of close monitoring may sometimes be suggested instead of starting antibiotics straight away.
Medicines
- Steroid nasal sprays: reduce swelling of the nasal lining; in chronic sinusitis and polyps, regular use over a longer period may be needed.
- Painkillers: paracetamol or ibuprofen can ease pain and fever. Aspirin should not be given to anyone under 16.
- Antihistamines recommended by your doctor if allergy plays a part.
Chronic sinusitis and nasal polyps
The mainstay of chronic sinusitis treatment is regular saline rinsing and steroid nasal sprays. Nasal polyps are benign, grape-like swellings of the sinus lining that cause blockage and loss of smell. A short course of oral steroids may be used to shrink them. For severe, recurring polyps, biologic medicines may also be considered in selected patients.
When is surgery discussed?
In acute sinusitis, surgery is rarely needed and only if a complication develops. In chronic sinusitis, functional endoscopic sinus surgery (FESS) may be discussed if symptoms continue despite medical treatment used properly and for long enough. In this operation, thin cameras passed through the nostrils are used to widen blocked sinus openings and remove polyps, with no external cut. In some selected cases, widening a sinus opening with a balloon may be an option. Every operation carries risks such as bleeding, infection and, rarely, problems involving the eye or the lining of the brain; these risks and the expected benefit are discussed in detail after examination. Most patients still need to continue nasal sprays and rinses after surgery.
What you can do at home
- Drink plenty of fluids and rest; if you smoke, stop, and avoid second-hand smoke.
- Rinsing the nose with salt water thins mucus and can ease blockage. Use boiled-and-cooled, distilled or sterile water — not water straight from the tap — and clean the rinse bottle after each use.
- Decongestant nasal sprays give short-term relief but should not be used for more than 5 days; longer use can make the blockage worse (rebound congestion). Check the leaflet and ask a pharmacist before using them in children.
- A warm compress on the face or breathing in steam from a shower may help; take care to avoid scalds with hot water, especially around children.
- If you have allergies, avoid your triggers.
Frequently asked questions
Sources
The general information on this page is based on the guideline and institutional sources below. Individual diagnosis and treatment decisions require an examination.