Everything you need to know about sinusitis

What is sinusitis? Get expert advice on symptoms, causes and treatment.

sinus infection sinusitis
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A sinus infection is a common condition that is characterised by the swelling and inflammation of the sinuses, known as sinusitis.

Sinuses are hollow air spaces within our facial bones. The largest are the frontal sinuses in the forehead and the maxillary sinuses in the cheek bones. When they're healthy, the sinuses are lined with a thin membrane, but they may become infected as part of a 'rhinosinusitis' (nose and sinus inflammation). This may be an acute process occurring over days or may become a rather more chronic process lasting weeks to months.

Types of sinusitis

Acute sinusitis

This condition comes on usually after a cold or upper respiratory tract infection. Rarely it may occur after dental infection such as a tooth abscess in the upper jaw. Very occasionally it may come about after diving into polluted water or flying with a cold. Because of swelling caused by the infection, the sinus drainage pathways are blocked and infection builds up behind the blockage. It is characterised by facial pain, usually with nasal discharge and blockage and sometimes a diminished sense of smell. In most cases it will settle with no specific treatment. Topical nasal decongestants are helpful for short term usage to encourage drainage. Antibiotics would only be rarely required.

Chronic sinusitis

Chronic sinusitis occurs as a result of unresolved acute sinusitis, in conjunction with possible allergy or a tendency to have abnormal mucosal lining. Long term inflammation and infection develops in the sinuses. The presence of this inflammation/infection drives the process to persist.



Sinus infection symptoms

The symptoms of acute and chronic sinus affections are similar but the severity and length of symptoms may differ.

According to the NHS, symptoms of sinusitis include:

  • pain, swelling and tenderness around your cheeks, eyes or forehead
  • a blocked nose
  • a reduced sense of smell
  • green or yellow mucus from your nose
  • a sinus headache
  • a high temperature
  • toothache
  • bad breath

    In children, sinusitis symptoms may also include:

    • irritability
    • difficult feeding
    • breathing through their mouth
      sinus infection sinusitis
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      Sinus infection diagnosis

      To diagnose a sinus infection, your GP will do an internal examination of your nose, usually with an endoscope, and ask about your symptoms and history. They may also check for pressure by lightly touching your head and checks.

      In some cases, your doctor may require imaging tests to examine your nasal passages and check for mucus blockages or any abnormal structures such as polys. This may be done by CT scan or an MRI.

      Sinus infection treatments

      At-home treatments

      You may treat mild sinusitis by getting plenty of rest, upping your fluid intake, taking painkillers (such as ibuprofen or paracetamol) and cleaning our your nose with a salt water solution to ease congestion.

      Pharmacy treatments

      A pharmacist may be able to advise you on medicines that can help, such as decongestant nasal sprays or salt water nasal sprays. These can be bought without prescription but use should be limited to one week.



      GP treatments

      Treatments are geared to allowing the sinuses to drain and uses topical nasal steroids in either drop or spray form, as well as potentially a prolonged course of antibiotics (often amoxicillin, doxycycline or a macrolide antibiotic such as erythromycin) and sometimes oral prednisolone.

      In some cases, such as if you still have sinusitis after three months of treatment, you keep getting sinusitis or you have symptoms only on one side of your face, a GP may refer you to an ear, nose and throat specialist (ENT). The specialist may recommend surgery.

      Surgery

      Surgery has a role in chronic sinusitis if all medical avenues have been exhausted. The aim of surgery is to open up the drainage pathways to aid drainage and allow re-ventilation of the sinuses.

      The procedure is called functional endoscopic sinus surgery (FESS) and is carried out under general anaesthetic. The surgeon can then widen your sinuses by removing some of the blocked tissue or inflating a tiny balloon in the blocked sinuses and then removing it.



      What are the major risks associated with surgery?

      The brain lies above the roof of the nose and sinuses. It is surrounded by a structure called the dura which contains brain fluid. Injury to the dura can allow this brain fluid to leak out and can allow infection to enter around or into the brain (meningitis). This is a very rare complication. The eyes also lie either side of the sinuses and can potentially be injured, as can the muscles that move the eyes. Again this is very rare.

      Complications of sinusitis

      Sometimes infection may spread outside the sinuses. Rarely it can spread into the eye with swelling of the eyelids and sometimes an abscess can form that can threaten vision. This requires urgent medical and sometimes surgical intervention. Infection can also spread upwards to cause problems such as meningitis or brain abscess. These are very rare.



      Last medically reviewed: 09-06-2020

      Dr Juliet McGrattan Dr Juliet McGrattan spent 16 years working as an NHS GP.
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