Sinusitis

Sinusitis is swelling or inflammation of the sinuses, the hollow, air-filled spaces behind the cheeks, forehead, and around the nose. When the lining of these spaces becomes inflamed, mucus cannot drain properly, leading to congestion, pressure, and discomfort in the face.

Sinusitis is very common and most often develops after a cold or other viral infection. It is usually short-lived and clears up on its own. It is described as acute when it lasts up to about four weeks and chronic when symptoms persist for around 12 weeks or more.

Common symptoms include a blocked or runny nose, thick or discoloured nasal mucus, pain, tenderness, or pressure around the cheeks, eyes, or forehead that may be worse when bending forward, and a reduced sense of smell. Some people also have a headache, toothache, bad breath, a cough, or a raised temperature.

Symptoms often follow a cold and may seem to get better and then worse again. In most cases the symptoms, while uncomfortable, are not serious and improve over a couple of weeks.

Most sinusitis is caused by a viral infection, such as the virus that causes the common cold, which is why antibiotics usually do not help. Less often, a bacterial infection develops, sometimes after a viral illness, and this can cause more severe or longer-lasting symptoms.

Other factors can contribute, especially in longer-lasting or recurring sinusitis, including allergies such as hay fever, nasal polyps (small growths in the nose), a deviated nasal septum, and exposure to smoke or irritants. These can interfere with normal drainage and keep the sinuses inflamed.

Sinusitis is usually diagnosed from the typical symptoms and a simple examination, including looking inside the nose. Most people with short-lived sinusitis do not need any tests, as the diagnosis is clear from the history and the fact that it often follows a cold.

For symptoms that are persistent, recurring, or unusually severe, a clinician may look further for an underlying cause. This can involve referral to an ear, nose, and throat specialist, who may use a small camera to examine the nose and sinuses or arrange imaging such as a scan, particularly if chronic sinusitis or a structural problem is suspected.

Most cases can be managed at home while they settle. Helpful measures include rest, drinking plenty of fluids, using over-the-counter pain relief if needed, applying a warm compress to the face, and rinsing the nose with salt-water solutions. Decongestants may give short-term relief but should not be used for more than about a week.

Because most sinusitis is viral, antibiotics are usually not needed and are only considered when a bacterial infection is likely or symptoms are severe or prolonged. For chronic or allergy-related sinusitis, a clinician may recommend steroid nasal sprays or treat the underlying allergy. When sinusitis is persistent and linked to a structural problem such as polyps, surgery is occasionally considered.

Since most sinusitis follows viral infections, the usual measures that reduce colds can help, such as good hand hygiene. Managing allergies, avoiding cigarette smoke and known irritants, and keeping the nose clear can lower the chance of repeated episodes in people prone to them.

The outlook is generally very good. Acute sinusitis usually clears within two to three weeks and often sooner, frequently without specific treatment. Chronic sinusitis can be more persistent but can usually be controlled with the right combination of treatments and, where needed, specialist care.

Most sinusitis is not serious, but rarely an infection can spread beyond the sinuses. Seek urgent medical help if you develop swelling, redness, or pain around an eye, changes in vision such as double or reduced vision, a severe headache that is unlike your usual headaches, a stiff neck, or confusion.

Also get prompt advice if symptoms are very severe, keep getting worse, or last longer than expected despite self-care, especially with a high temperature. These signs can indicate a more serious infection that needs urgent assessment.