What Is Sinusitis? Symptoms and Treatment

What is sinusitis?

Sinusitis is inflammation of the lining of the sinuses, the air-filled spaces within the facial bones that connect to the nasal cavity through narrow channels. Because the lining of the nose and the lining of the sinuses sit so close together and are almost always affected at the same time, the condition is often called rhinosinusitis in medical terms. It is classified by duration into four groups: acute sinusitis, lasting less than 4 weeks; subacute sinusitis, lasting 4 to 12 weeks; chronic sinusitis, lasting more than 12 weeks; and recurrent acute sinusitis, with 4 or more attacks a year and full recovery in between each one.

What are the symptoms of sinusitis?

The most common symptoms of sinusitis are:

• A blocked nose and difficulty breathing through it
• Pressure or pain in the face, especially around the forehead, cheeks and eyes
• Thick, coloured (yellow-green) nasal discharge and postnasal drip
• A reduced sense of smell and taste
• A cough, often worse at night because of postnasal drip
• Tiredness and, in some cases, a fever

A headache on its own, with no other symptoms, is more likely to be a migraine or tension-type headache that has been mistaken for sinusitis. Pain and swelling can also occasionally be felt in the nasal bone; our article on the causes of pain and swelling in the nasal bone explains more.

What causes sinusitis?

The most common cause of sinusitis is the viruses that lead to upper respiratory tract infections, and most cases that develop after flu or a common cold fall into this group. If symptoms last longer than 10 days or get worse again after improving, a bacterial sinusitis may be involved. Allergic rhinitis can also increase the risk of sinusitis by causing long-term swelling of the sinus lining.

Beyond these, problems with the structure of the nose itself also have a direct effect on how often sinusitis occurs:

• Deviated septum (a bent nasal septum): This disrupts airflow inside the nose and makes it easier for the sinus openings to become blocked.
• Turbinate hypertrophy (enlarged turbinates): Excessive enlargement of the soft tissue structures inside the nose narrows the sinus drainage channels. See also turbinate reduction surgery.
• Nasal polyps: These are soft tissue growths that block the sinus openings and are particularly common in people with chronic sinusitis.

Sinus problems caused by pressure changes, for example after diving or flying, are a separate subject, covered in our article on sinus barotrauma.

Acute or chronic sinusitis? When should bacterial sinusitis be suspected?

Telling viral sinusitis from bacterial sinusitis matters for treatment decisions. Bacterial sinusitis becomes more likely if any one of the following three situations applies:

• Symptoms last longer than 10 days and show no sign of improving
• A fever above 38.3°C together with thick coloured discharge or facial pain that is severe during the first 3 to 4 days of illness
• "Double worsening": symptoms that initially improve and then return, more severely, within 10 days

The great majority of mild, short-lived cases outside these three criteria are viral and clear up on their own with supportive treatment.

How is sinusitis diagnosed?

Sinusitis is largely a clinical diagnosis, which means that in most cases it is made from the symptoms you describe and the findings of an examination, without the need for imaging. Having at least two of the following together is considered enough for a diagnosis: a blocked nose, thick coloured discharge, facial pressure or pain, and loss of smell. Seeing pus (purulent discharge) inside the nose or at the back of the nose during examination is the most valuable finding in support of the diagnosis. Where needed, a camera examination inside the nose (nasal endoscopy) is used to check the middle meatus for discharge, polyps or an anatomical obstruction.

A computed tomography (CT) scan is not requested routinely to diagnose sinusitis, because even a significant proportion of people with no symptoms at all show minor changes in the sinuses, which can make imaging misleading on its own. A CT scan is usually requested when a complication such as spread to the eye or brain is suspected, when another diagnosis is being considered, or when surgery is being planned.

Sinusitis treatment

The first step of treatment, whether the sinusitis is viral or bacterial, aims at relieving symptoms:

• Regular nasal rinsing with salt water (isotonic or hypertonic)
• Drinking plenty of fluids and humidifying the room
• Using a nasal steroid spray on your doctor's advice
• Short-term decongestants (for no more than 3 to 5 days); with prolonged use a "rebound" effect can make the blockage worse, so the time limit should be respected

Antibiotic treatment is started only when bacterial sinusitis is strongly suspected, and only after assessment by a doctor. It is worth stressing that, because a large proportion of sinusitis is viral, antibiotics are not automatically needed for every case, and starting antibiotics on your own is not recommended.

Home care and supportive methods

Particularly in viral sinusitis, there are a few simple measures that can speed up recovery alongside medication:

• Rinsing the nose with salt water regularly through the day thins the secretions in the sinus openings and helps them drain
• Keeping the air moist and breathing warm steam helps soften thickened secretions
• Drinking plenty of fluids makes secretions more fluid
• Sleeping with your head slightly raised may ease the feeling of pressure around the sinuses
• Avoiding cigarette smoke and other irritating smells helps the lining recover

These measures do not replace treatment, but they support recovery when used alongside the treatment your doctor recommends; for broader advice on a blocked nose, see our article on what helps a blocked nose.

Surgical treatment for chronic sinusitis

Surgical options are considered in chronic sinusitis when symptoms have not improved after 8 to 12 weeks of appropriate medical treatment, or when there is an underlying structural cause (a deviated septum, turbinate hypertrophy or polyps). In that case, correcting the structural problem is important if the treatment is to last; our nasal congestion treatment article describes methods such as septoplasty and turbinate reduction in detail. The most commonly used technique in sinus surgery is Functional Endoscopic Sinus Surgery (FESS), in which the sinus openings are widened under camera guidance; in selected cases, balloon sinuplasty, in which the sinus openings are widened with a balloon catheter, may also be preferred. FESS is generally performed under general anaesthesia as a day case or with a short hospital stay. Recovery varies from person to person, but most patients are able to return to daily life within a few days.

Is it possible to prevent sinusitis?

It is not possible to prevent every attack of sinusitis, but some habits do reduce the risk. Practising good hand hygiene and being careful in crowded places during flu and cold season lowers the risk of infection. In people with allergic rhinitis, keeping the allergy under regular control reduces long-term swelling of the sinus lining and therefore how often sinusitis occurs. Avoiding cigarette smoke, keeping the inside of the nose moist and rinsing regularly with salt water are also among the protective habits. For people who get frequent attacks of sinusitis, investigating an underlying structural cause is the most effective prevention in the long term.

When should you seek urgent medical help?

Sinusitis rarely leads to serious complications. If swelling or redness around the eye, changes in vision, a severe and unusual headache, a stiff neck, confusion or a high fever accompany the symptoms, seek medical attention without delay.

Frequently asked questions

This page has been written for general information purposes. To discuss your specific situation with Dr. Çağatay Ruhi, please get in touch.