Overview
The sinuses are hollow air spaces inside the bones of the face, around the nose, cheeks and forehead. They are lined by a thin membrane that makes mucus, which drains out through small openings into the nose.
In sinusitis that lining swells. The openings become blocked, mucus collects behind them, and the pressure causes pain over the face. It most often starts a few days into a cold or flu.
Sinusitis is called acute when it lasts up to four weeks and chronic when it goes on for more than twelve weeks. Most cases are acute, are caused by a virus, and settle without .
Symptoms
The main symptoms are pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked nose, a runny nose with green or yellow discharge, and a reduced sense of smell.
There may also be a headache, a raised temperature, toothache, bad breath, a cough and a feeling of pressure in the ears. Young children may be irritable, breathe through the mouth and have trouble feeding.
In chronic sinusitis the symptoms are usually milder but carry on for months, with a nose that never quite clears.
When to see a doctor
Ask for an urgent appointment if you feel very unwell, if painkillers are not helping or symptoms are getting worse, or if your immune system is weakened, for example during .
Make an ordinary appointment if symptoms have lasted more than ten days without improving, if they improved and then got worse again, if a fever has lasted more than three or four days, or if sinusitis keeps coming back.
Causes
Sinusitis nearly always begins with a viral infection such as a cold or flu. The lining swells, the drainage openings close, and mucus that cannot escape builds up. Sometimes bacteria then multiply in the trapped mucus and cause a second, bacterial infection.
Other things keep the lining swollen or block the drainage: allergies such as hay fever, nasal polyps, which are soft growths in the lining of the nose, a deviated septum, which is a bent partition inside the nose, smoking, and irritating dust or fumes.
Risk factors
- Frequent colds and flu
- Hay fever and other allergies
- Nasal polyps
- A deviated septum or naturally narrow nasal passages
- Smoking, and being around tobacco smoke
- Dust, fumes and heavy air pollution
- A weakened immune system
Complications
Complications are very rare, but they are taken seriously when they happen:
- Infection of the skin and tissue around the eye
- A collection of pus, called an abscess
- Infection of the bone around the sinus
- Meningitis, an infection of the lining around the brain
- Sinusitis becoming chronic and lasting for months
Prevention
- Washing hands often, and keeping away from people with colds where you can
- Not smoking, and keeping the home free of tobacco smoke
- Treating hay fever and other allergies, and avoiding what sets them off
- Staying away from dust, fumes and smoke indoors
- Rinsing the nose with a salt water solution when it is blocked
- Drinking enough fluid
- Having a flu vaccination if it is advised for you
Diagnosis
Sinusitis is usually recognised from the pattern of symptoms and how long they have lasted, after looking inside the nose and pressing gently over the cheeks and forehead. Tests are not needed for most people.
If symptoms drag on for months, keep returning, or suggest a complication, an ENT specialist may look into the nose with a thin telescope, a test called nasal , or arrange a . Allergy testing is sometimes added.
Treatment
Most acute sinusitis needs only self care while the body clears the infection: rest, plenty of fluids, pain relief such as paracetamol or ibuprofen, steam from a bowl of hot water, and rinsing the nose with a salt water solution.
are not needed for many sinus infections. A doctor may advise waiting a few days before deciding, and prescribes them when symptoms are severe, when they have lasted well over a week without improving, when they got worse after starting to improve, or when a person is at particular risk.
Steroid nasal sprays reduce the swelling and are used for longer lasting or repeated sinusitis, sometimes for months. Antihistamines help when allergy is part of the problem. Decongestant sprays ease a blocked nose but are used for only a few days at a time.
If symptoms continue after about three months of treatment, an ENT specialist may suggest surgery. Functional endoscopic sinus surgery widens the drainage openings, either by removing a little tissue or by inflating a small balloon, and is done through the nostrils under general anaesthetic.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Sinus comes from eating curd or ice cream, or from drinking cold water.”What is true?
Fact
Sinusitis nearly always starts with an infection such as a cold or flu. The lining of the sinuses swells, the small drainage openings close, and mucus builds up behind them. Cold foods and drinks do not cause it.
Myth“A sinus infection always needs an antibiotic.”What is true?
Fact
Viruses cause most sinus infections, and antibiotics do nothing against them. Many sinus infections need no antibiotic at all, and a doctor may suggest waiting a few days to see whether the body clears it before deciding.
Myth“Any headache across the forehead is sinus.”What is true?
Fact
Sinusitis usually comes with a blocked nose, thick discharge, tenderness over the cheeks or forehead and a poorer sense of smell. A headache on its own, with a clear nose, usually has a different cause and is worth discussing with a doctor rather than treating as sinus.
Myth“Once you get sinus you have it for life, and only an operation will cure it.”What is true?
Fact
Acute sinusitis usually clears within about four weeks. Sinusitis that lasts beyond twelve weeks is managed first with steroid nasal sprays, salt water rinses and treatment of any allergy. Surgery is considered only when that has not worked after about three months, or when attacks keep coming back.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long should sinusitis take to clear?
Acute sinusitis usually gets better on its own within about two to three weeks, and by four weeks at the outside. If it is still there after that, or if it keeps returning several times a year, it is worth being seen so that an allergy, nasal polyps or another blockage can be looked for.
Why will the doctor not give me antibiotics?
Because most sinus infections are caused by viruses, which antibiotics cannot touch. A doctor may suggest waiting a few days to see whether the body clears it, and will prescribe antibiotics if symptoms are severe, if they have dragged on well past a week, or if they got worse after starting to improve.
Are salt water nose rinses safe?
Rinsing the nose with a salt water solution is a standard part of self care for sinusitis and is safe for most people. Use water that has been boiled and cooled, or distilled water, rather than water straight from the tap, and keep the rinsing pot or syringe clean.
How is chronic sinusitis different?
Chronic sinusitis lasts more than twelve weeks and tends to be a longer, milder grumble rather than a short sharp illness. It is usually managed with steroid nasal sprays, which may be needed for months, salt water rinses, and treatment of any allergy. A referral to an ENT specialist is usual if that has not helped after about three months.
