Sinusitis

What is it?

According to the CDC: a sinus infection occurs when fluid builds up in the air-filled spaces in the face, and this build-up "allows germs to grow". MedlinePlus defines the sinuses as hollow air spaces in the skull bones around the nose that produce mucus which drains into the nasal cavity, and sinusitis means they are inflamed.

Types according to MedlinePlus: acute (up to 4 weeks), subacute (from 4 to 12 weeks), chronic (lasts more than 12 weeks and may extend for months or years), and recurrent (several attacks a year).

Causes

According to the CDC: "Viruses cause most sinus infections, but bacteria can cause some". MedlinePlus states that acute inflammation often develops when a cold turns into a bacterial infection, and contributing factors include allergies, structural problems in the nose and some diseases. The NHS states that it usually follows a respiratory infection such as a cold or flu.

Risk factors

According to the CDC: a previous cold, seasonal allergies, smoking or exposure to others' smoke, structural problems in the sinuses such as nasal polyps, and a weakened immune system.

Symptoms

According to the CDC: runny or blocked nose, facial pain or pressure, headache, postnasal drip, sore throat, cough, and bad breath. MedlinePlus also mentions fever, weakness and fatigue.

The NHS mentions pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked or runny nose, reduced sense of smell, coloured nasal discharge, fever, headache, toothache and cough.

How is it diagnosed?

According to MedlinePlus: the healthcare provider evaluates the symptoms and physically examines the nose and face, and imaging tests may be needed to confirm. This page does not cover details of the types of imaging or endoscopy.

Treatment

The treatment categories usually used are listed here; this is not a prescription. The doctor chooses the plan according to each person's condition; do not change any medicine or dose without a specialist.

According to the CDC: "most sinus infections get better on their own without antibiotics", and antibiotics may cause side effects including rash, severe allergic reactions and Clostridioides difficile (C. difficile) infection. Some healthcare providers recommend "watchful waiting" for 2 to 3 days or a "delayed prescription" before resorting to an antibiotic. The doctor decides whether an antibiotic is needed.

To ease symptoms according to the CDC: warm compresses on the nose and forehead, decongestants or saline spray, steam inhalation, and over-the-counter medicines according to the guidelines. MedlinePlus mentions painkillers, heat compresses, saline sprays, air humidifiers and saline sinus rinses. The NHS adds rest, drinking fluids, avoiding allergy triggers, quitting smoking, and rinsing the nose with a homemade saline solution up to three times a day, and the painkillers mentioned are paracetamol or ibuprofen.

The NHS states that a pharmacist or healthcare provider may prescribe steroid nasal sprays to reduce swelling (possibly for months) or antihistamines when there is allergy, and that antibiotics are rarely needed because viruses are usually the cause. In chronic cases functional endoscopic sinus surgery (removing tissue or widening with a balloon) under general anaesthetic may be suggested. Treatment categories are chosen in consultation with the doctor.

Follow-up

The NHS states that the condition usually clears within 4 weeks, and that referral to an ear, nose and throat specialist is after 3 months of unsuccessful treatment or when attacks recur.

Prevention

According to the CDC: hand hygiene, flu and pneumococcal vaccines, avoiding contact with sick people, avoiding smoking, and using clean air humidifiers.

Common questions