Sinusitis (sinus infection): symptoms, self-care and treatment

Sinusitis is a very common problem, especially after a cold. It can cause pain, a blocked nose and tiredness, and it usually clears up on its own. This review uses information from the NHS, the US CDC and MedlinePlus.

1. Introduction

Sinuses are air-filled spaces in the bones around the nose. They make mucus that drains into the nose, and when they swell the drainage can become blocked and painful ^[3]. The NHS describes sinusitis as swelling of the sinuses, usually caused by infection, which often clears up within 4 weeks ^[1].

MedlinePlus groups sinusitis by length. Acute lasts up to 4 weeks, subacute lasts about 4 to 12 weeks, chronic lasts more than 12 weeks, and recurrent means several episodes in a year ^[3].

2. Signs and symptoms

The NHS lists these symptoms ^[1]:

• Pain, swelling or tenderness around the cheeks, eyes or forehead
• A blocked or runny nose
• A reduced sense of smell
• Green or yellow mucus from the nose
• A high temperature
• Headache, toothache, bad breath, a cough or pressure in the ears

In young children, signs can include irritability, feeding difficulties and breathing through the mouth ^[1]. The CDC and MedlinePlus add post-nasal drip, which is mucus draining down the back of the throat ^{[2, 3]}.

3. Causes and risk factors

Sinusitis often follows a cold or flu. The lining of the sinuses swells, mucus cannot drain properly and the sinuses become blocked. The NHS says it is usually caused by a virus rather than bacteria, and allergies can trigger symptoms too ^[1]. The CDC says viruses cause most sinus infections, and bacteria cause some ^[2].

The CDC lists these risk factors ^[2]:

• Recent colds or seasonal allergies
• Smoking or secondhand smoke
• Structural problems such as nasal polyps, which are growths on the lining of the nose or sinuses
• A weakened immune system, or medicines that lower immunity

Sinusitis can look like a cold or a seasonal allergy, which is why the CDC lists both as similar conditions ^[2]. The CDC says a stuffy nose that is not improving may be a sinus infection, so symptoms that linger, or that return again and again, are a reason to ask a doctor for a check rather than assume you need antibiotics ^{[1, 2]}.

4. Diagnosis and tests

The CDC says a provider usually diagnoses a sinus infection by asking about symptoms and examining the patient ^[2]. MedlinePlus says imaging, such as a CT scan of the sinuses, may be needed in some cases ^[3]. The NHS says people with long-lasting, returning or one-sided symptoms may be referred to an ear, nose and throat (ENT) specialist ^[1].

5. Treatment and management

Self-care. The NHS suggests resting, drinking plenty of fluids, avoiding allergy triggers, not smoking, and rinsing the nose with a salt water solution made with boiled and cooled water, up to three times a day. It says paracetamol or ibuprofen can ease pain, and that children under 16 should not be given aspirin. People with a high temperature should stay at home ^[1]. The CDC adds warm compresses on the nose and forehead, saline nasal spray and steam from a hot shower ^[2]. MedlinePlus lists US Food and Drug Administration and CDC pages on the safety of nasal rinsing, so check that guidance before using a rinsing device ^[3].

Medical treatment. The NHS says steroid nasal sprays or drops may be used to reduce swelling, and antihistamines if allergy is the cause. Antibiotics are rarely needed because the condition is usually viral ^[1]. The CDC explains that antibiotics do not help when they are not needed and can cause side effects, including rashes, severe allergic reactions and resistant infections, so providers may use watchful waiting for 2 to 3 days or delay a prescription ^[2].

For chronic sinusitis, the NHS says an ear, nose and throat specialist may recommend surgery, called functional endoscopic sinus surgery. It is done under general anaesthetic and widens the sinuses, for example by removing blocked tissue ^[1].

6. Prevention and self-care

The CDC suggests these steps ^[2]:

• Wash hands regularly.
• Keep up to date with recommended vaccines, including flu and pneumococcal vaccines.
• Avoid close contact with people who have colds.
• Do not smoke and avoid secondhand smoke.
• Keep any humidifier clean.

7. Special groups

The NHS advises that children aged 11 or younger should see a doctor, and that people with a weakened immune system, for example during chemotherapy, should seek urgent help ^[1]. The CDC says children under 4 should not be given cough and cold medicines unless a doctor advises it, and aspirin should never be given to children ^[2].

8. When to see a doctor

The NHS advises seeing a doctor if there is no improvement after 7 days of treatment from a pharmacist or doctor, or after 3 weeks of self-care, or if sinusitis keeps returning ^[1]. The CDC lists severe headache or facial pain, symptoms that worsen after improving, symptoms lasting more than 10 days, fever lasting longer than 3 to 4 days and multiple sinus infections in a year ^[2]. The NHS says to seek urgent help if you feel very unwell, painkillers do not help or symptoms are getting worse ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Sinusitis is usually viral and often clears up on its own, and rest, fluids and simple self-care can ease symptoms. Antibiotics are not usually needed, but long-lasting, severe or returning symptoms should be checked. Your doctor decides which treatment is right for you.