Sinusitis

Sinusitis is a common condition in which the lining of the sinuses becomes inflamed. It's usually caused by a viral infection and often improves within two or three weeks.

The sinuses are small, air-filled cavities behind your cheekbones and forehead.

The mucus produced by your sinuses usually drains into your nose through small channels. In sinusitis, these channels become blocked because the sinus linings are inflamed (swollen).

Signs and symptoms

Sinusitis usually occurs after an upper respiratory tract infection, such as a cold. If you have a persistent cold and develop the symptoms below, you may have sinusitis.

Symptoms of sinusitis include:

• a green or yellow discharge from your nose
• a blocked nose
• pain and tenderness around your cheeks, eyes or forehead
• a sinus headache
• a high temperature (fever) of 38C (100.4F) or more
• toothache
• a reduced sense of smell
• bad breath (halitosis)

Children with sinusitis may be irritable, breathe through their mouth, and have difficulty feeding. Their speech may also sound nasal (as though they have a stuffy cold).

The symptoms of sinusitis often clear up within a few weeks (acute sinusitis), although occasionally they can last three months or more (chronic sinusitis).

When to see your GP

If your symptoms are mild and getting better, you don't usually need to see your GP and can look after yourself at home.

See your GP if:

• your symptoms are severe or getting worse
• your symptoms haven't started to improve after around 7-10 days
• you experience episodes of sinusitis frequently

Your GP will usually be able to diagnose sinusitis from your symptoms and by examining the inside of your nose.

If you have severe or recurrent sinusitis, they may refer you to an ear, nose and throat (ENT) specialist for further assessment.

How sinusitis is treated

Most people with sinusitis will feel better within two or three weeks and can look after themselves at home.

You can help relieve your symptoms by:

• taking over-the-counter painkillers such as paracetamol or ibuprofen
• using nasal decongestants – these shouldn't be used for more than a week, as this might make things worse
• holding warm packs to your face
• regularly cleaning the inside of your nose with a saline solution – you can make this at home yourself or use sachets of ingredients bought from a pharmacy

If your symptoms aren't improving or are getting worse, your GP may prescribe antibiotics or corticosteroid spray or drops to see if they help.

If your symptoms don't get better after trying these treatments, you may be referred to an ENT specialist for surgery to improve the drainage of your sinuses.

Read more about treating sinusitis

What causes sinusitis?

Sinusitis is usually the result of a cold or flu virus spreading to the sinuses from the upper airways. Only a few cases are caused by bacteria infecting the sinuses.

An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed.

It's not clear exactly what causes sinusitis to become chronic (long-lasting), but it has been associated with:

• allergies and related conditions, including allergic rhinitis, asthma and hay fever
• nasal polyps (growths inside the nose)
• smoking
• a weakened immune system

Making sure underlying conditions such as allergies and asthma are well controlled may improve the symptoms of chronic sinusitis.

Most people with sinusitis don't need to see their GP. The condition is normally caused by a viral infection that clears up on its own.

Your symptoms will usually pass within two or three weeks (acute sinusitis) and you can look after yourself at home.

If the condition is severe, gets worse, or doesn't improve (chronic sinusitis), you may need additional treatment from your GP or a hospital specialist. This can be difficult to treat and it may be several months before you're feeling better.

Looking after yourself at home

If your symptoms are mild and have lasted less than a week or so, you can usually take care of yourself without seeing your GP.

The following tips may help you feel better until you recover:

• Take over-the-counter painkillers such as paracetamol and ibuprofen to relieve a high temperature and pain – check the leaflet that comes with your medication first to check it's suitable, and never give aspirin to children under 16 years of age.
• Use over-the-counter decongestant nasal sprays or drops to help unblock your nose and allow you to breathe more easily – these shouldn't be used for more than a week at a time.
• Apply warm packs to your face to soothe your pain and help mucus drain from your sinuses.
• Regularly clean the inside of your nose with a salt water solution to help unblock your nose and reduce nasal discharge.

Cleaning inside your nose

You can clean the inside of your nose using either a home-made salt water solution or a solution made with sachets of ingredients bought from a pharmacy.

To make the solution at home, mix a teaspoon of salt and a teaspoon of bicarbonate of soda into a pint of boiled water that has been left to cool. To rinse your nose:

• wash and dry your hands
• stand over a sink, cup the palm of one hand and pour a small amount of the solution into it
• sniff the water into one nostril at a time

Repeat these steps until your nose feels more comfortable (you may not need to use all of the solution). You should make a fresh solution each day. Don't re-use a solution made the day before.

Special devices you can use instead of your hand are also available from pharmacies. If you choose to use one of these, make sure you follow the manufacturer's instructions about using and cleaning it.

Treatments from your GP

See your GP if your symptoms are severe, don't start to improve within 7 to 10 days, or are getting worse. They may recommend additional treatment with corticosteroid drops or sprays, or antibiotics.

If these treatments don't help, you GP may refer you to an ear, nose and throat (ENT) specialist for an assessment and to discuss whether surgery is a suitable option.

Corticosteroid drops or sprays

Corticosteroids, also known as steroids, are a group of medications that can help to reduce inflammation.

If you have persistent symptoms of sinusitis, your GP may prescribe steroid nasal drops or sprays to help reduce the swelling in your sinuses. These may need to be used for several months.

Possible side effects include nasal irritation, a sore throat and nosebleeds.

Antibiotics

If your GP thinks your sinuses may be infected with bacteria, they will prescribe a course of antibiotic tablets or capsules to treat the infection.

You'll usually need to take these for a week, although sometimes a longer course may be prescribed.

Possible side effects of antibiotics include feeling and being sick, diarrhoea and abdominal (tummy) pain.

Surgery

If your symptoms don't improve despite trying the treatments mentioned above, a type of surgery called functional endoscopic sinus surgery (FESS) may be recommended. This is a procedure to improve the drainage of mucus from your sinuses.

FESS is usually carried out under general anaesthetic. During the procedure, the surgeon will insert an endoscope into your nose. This is a thin tube with a lens at one end that magnifies the inside of your nose. It will allow the surgeon to see the opening of your sinuses and insert small surgical instruments.

The surgeon will then either:

• remove any tissues, such as nasal polyps (growths), that are blocking the affected sinus
• inflate a tiny balloon in the drainage passages from your sinuses to widen them, before the balloon is deflated and removed (this is known as a balloon catheter dilation)

Potential side effects and risks of these procedures include temporary discomfort and crusting inside the nose, bleeding from the nose and infection. Make sure you discuss the risks with your surgeon beforehand.

The National Institute for Health and Care Excellence (NICE) also provides information about balloon catheter dilation for chronic sinusitis.

Complications in children

Complications of sinusitis are more common in children than in adults. If your child has had sinusitis and has swelling around the cheekbone or eyelid, it may be a bacterial infection of the skin and soft tissue or an infection of the tissue surrounding the eye. Read about cellulitis for more information.

If you notice these symptoms, take your child to see your GP, who may refer them to an ear, nose and throat (ENT) specialist. Alternatively, you can call NHS 24's 111 service.

Infection of the bone

When the condition is severe, antibiotics are often able to control the spread of infection to the nearby bone. However, in very rare cases (about one in 10,000), infection can spread to the area surrounding the eye, the bones, the blood or the brain.

Your GP can usually diagnose sinusitis from your symptoms.

Sinusitis is nearly always caused by a viral infection, such as the common cold or flu, and is diagnosed based on the presence of:

• nasal blockage or runny nose with facial pain, and/or
• a reduction or loss of sense of smell

Loss of smell is more common and facial pain less common in chronic (persistent) sinusitis.

Referral to a specialist

If your sinusitis is severe or keeps coming back, your GP may refer you to an ear, nose and throat (ENT) specialist who will carry out tests to determine the underlying cause.