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Sinusitis

Sinusitis is inflammation of the lining of your sinuses. Your sinuses are the air-filled spaces within the bones of your face, around your nose.

Sinusitis is when the lining of your sinuses becomes swollen and inflamed. This swelling can block your sinuses and close the openings that lead to your nose. This can trap air and mucus inside your sinuses, which can cause pain and a blocked up feeling.

Your sinuses are connected to the inside of your nose. They are lined with cells that produce mucus and this is called the mucous membrane. It helps to keep your nose from drying out. Mucus also helps to trap any dirt and bacteria that you breathe in.

You have four main pairs of sinuses, which are the:

  • maxillary sinuses, inside your cheekbones
  • frontal sinuses, on either side of your forehead, above your eyes
  • ethmoid sinuses, behind the bridge of your nose, between your eyes
  • sphenoid sinuses, between the upper part of your nose and behind your eyes

There are two main types of sinusitis.

  • Acute sinusitis lasts up to four weeks. It usually has severe symptoms and often follows a cold.
  • Chronic sinusitis lasts for more than 12 weeks. It may start as acute sinusitis that doesn’t get better. If you have chronic sinusitis, the lining of your sinuses is constantly swollen and inflamed.

The medical terms acute and chronic refer to how long you have a condition for, rather than how severe it is.

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Where the sinuses are found
Sinusitis is inflammation of the lining of the sinuses that surround your nose
An image showing the locations of the frontal, ethmoid and sphemoid sinuses
An image showing the location of the frontal and maxillary sinuses

Details

  • Symptoms Symptoms of sinusitis

    The main symptom of sinusitis is pain, particularly if you have acute sinusitis. The pain can be in different parts of your face, depending on which of your sinuses are affected. The main areas where you might have pain include:

    • your forehead
    • the top of your jaw, teeth and cheeks
    • between your eyes
    • the top of your head
    • your ears

    Other symptoms of sinusitis can include:

    • a blocked or stuffy nose
    • loss of your sense of smell or a reduced sense of smell
    • green or yellow mucus, which can drain down the back of your nose into your throat
    • a fever, particularly if you have acute sinusitis

    Less common symptoms of sinusitis include tiredness, a cough or sore throat, and bad breath (halitosis).

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  • Diagnosis Diagnosis of sinusitis

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP will usually be able to diagnose sinusitis by examining you and asking about your symptoms. Most people don’t need any other tests.

    If you have chronic sinusitis and treatment hasn’t worked, your GP may refer you to an ear, nose and throat (ENT) specialist. Your GP may also refer you if acute sinusitis keeps coming back after treatment, which is called recurrent sinusitis.

    Your ENT specialist may suggest you have a test called a nasal endoscopy. In this test, your doctor will insert a narrow, flexible, tube-like, telescopic camera (called an endoscope) into your nose and sinuses. This will allow your doctor to see the lining of your sinuses and check for any blockages. You may need other tests too, such as a CT scan. A CT scan uses X-rays to make a three-dimensional image of your soft tissues and cavities.

  • Treatment Treatment of sinusitis

    Acute sinusitis usually takes about two weeks to get better. Many people are able to manage their symptoms at home and don't need to see their GP.

    Sinusitis is usually caused by a virus, like the common cold, so you’re unlikely to be prescribed antibiotics.

    Self-help

    There are a number of things you can do to help ease the symptoms of sinusitis. These include the following.

    • If you put a warm flannel or cloth on your face, it can help to ease pain and discomfort.
    • Salt water sprays or drops that you inhale through your nose may help to ease the feeling of a blocked nose. Inhaling warm, moist air may help too.
    • Make sure you drink enough fluids and get plenty of rest.

    Medicines

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    Decongestant nasal sprays and tablets may help to reduce the swelling and inflammation caused by sinusitis. It's important not to use decongestant nasal sprays or drops for longer than five consecutive days. If you use them for more than this, they can actually cause sinus congestion.

    If you have acute or chronic sinusitis, your GP may prescribe you a steroid nasal spray.

    Although they aren't used very much for sinusitis, your GP may prescribe antibiotics if you develop an infection caused by bacteria. You’re more likely to be given antibiotics if:

    • you have other health problems, such as heart disease, that increase your risk from an infection
    • your symptoms are severe and last longer than seven days

    If you have chronic sinusitis and you also have allergies or hay fever, your GP may suggest you take antihistamines to control these. This may help to ease the symptoms of sinusitis.

    Surgery

    If you have chronic sinusitis and it doesn't get better with other treatments, your ENT specialist may suggest you have surgery. An operation may help to unblock your sinuses and improve the drainage of mucus. There are a number of different procedures available.

    In functional endoscopic sinus surgery (FESS), your surgeon will wash out your sinuses and widen the drainage holes using an endoscope. This can be done under local or general anaesthesia.

    Balloon sinuplasty is another type of operation used to treat chronic sinusitis. Your surgeon will put a small, flexible tube into your blocked sinus and inflate a balloon on the end of it. This will unblock the opening and help your sinuses to drain properly. You will need to have a general anaesthetic.

    Ask your doctor for more information about the different types of surgery and what treatment is best for you.

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  • Causes Causes of sinusitis

    Acute sinusitis is usually caused by an infection of the mucous membranes in your nose or upper airways, for example a cold. When you have a cold, your mucous membranes become swollen and this can block the openings of your sinuses. Mucus that builds up in your sinuses can sometimes become infected with bacteria and cause more severe symptoms. This is called bacterial sinusitis.

    Chronic sinusitis is often caused by irritants and allergens that affect the lining of your nose and sinuses. These include:

    • airborne allergens, such as grass and tree pollen
    • house dust mites
    • smoke and air pollution
    • sprays that contain chemicals, for example household detergents

    You sinuses can also become blocked or narrowed by growths such as nasal polyps, or if you injure your face or nose. If you have another health condition that affects your airways and mucus, such as cystic fibrosis, you’re also more likely to develop sinusitis.

  • Complications Complications of sinusitis

    Although rare, a sinus infection can potentially spread to the bones in your face or your eye socket. The infection can also spread to your brain and cause meningitis.

    If you develop a swollen eyelid while you have sinusitis, this can be a sign of an infection in the soft tissues around your eye. If this happens, you must seek urgent medical attention. For more information see our frequently asked questions.

    If you have other symptoms that could be a sign of meningitis, you should also seek urgent medical attention. These symptoms may include:

    • a headache
    • fever
    • vomiting
    • stiff neck
    • pain brought on by bright light
  • FAQs FAQs

    Can I fly if I have chronic sinusitis?

    Answer

    Flying can cause pain in your sinuses, so your GP may suggest that you don’t fly if you have sinusitis. However, if you use a decongestant spray, it may relieve your symptoms enough for you to be able to fly more comfortably.

    Explanation

    When you’re in an aeroplane, the pressure inside changes as it takes off, climbs, levels out and comes down to land. This air inside your sinuses will expand when you’re going up to altitude and contract when you’re coming down. If your sinuses are blocked or inflamed, the air inside them may not be able to escape. If the air pressure in your sinuses becomes much higher or lower than the surrounding air pressure, it can be painful. It can also potentially cause bleeding and even rupture your eardrum.

    If you're planning on going on a flight, it may be best to wait until your symptoms improve. If this isn't possible, use a decongestant before flying. Ask your GP for more advice.

    Can sinusitis be prevented?

    Answer

    No, sinusitis can’t be prevented. However, there are things that you can do that may help to reduce your risk of getting it.

    Explanation

    There is no proven way to prevent sinusitis. However, there are some steps you can take that may help to reduce your risk of developing sinusitis. The main ones are listed below.

    • Use salt water sprays or drops to keep the inside of your nose moist.
    • If you live or work in a very dry environment, try using a humidifier. This will help to keep the air around you moist.
    • Don’t smoke.
    • Try not to spend time in places where there is cigarette smoke or strong odours from chemicals.
    • If you have allergies that may trigger sinusitis, try to steer clear of them.
    • If you keep getting sinusitis, it may be helpful to have allergy tests. Ask your GP for more information.
    • Chlorine in swimming pools can irritate the lining of your nose and sinuses, so try not to spend long periods in the pool.

    I've had sinusitis for a few days and have noticed the area around my eye is getting red and puffy. What should I do?

    Answer

    If you have an infection in your sinuses, it can spread to your eye socket and the surrounding area. This can lead to serious health problems, so it’s important to seek urgent medical attention.

    Explanation

    For most people, sinusitis gets better without any problems, often without any specific treatment. However, more serious complications can develop if the infection spreads to the parts of your face and skull that are nearby. These include your eye sockets and brain. The infection can also spread into your surrounding bone and blood.

    These problems are rare, but they can be very serious, so it’s important to get treatment quickly.

    If you have sinusitis and develop the following symptoms, it could be a sign of infection in your eye socket.

    • Swelling or redness around your eye.
    • Problems with your sight, such as double vision.
    • A bulging eye.
    • Pain when you move your eye.

    This is called orbital cellulitis. Without treatment orbital cellulitis can lead to serious problems, including blindness and meningitis. It’s important to get treatment quickly if you have any of these symptoms. Treatment may include antibiotics given directly into a vein (intravenous antibiotics) or an operation to drain the swelling.

  • Resources Resources

    Further information

    Sources

    • Rhinosinusitis. PatientPlus. www.patient.co.uk/patientplus.asp, published 20 April 2011
    • Sinusitis. National Institute of Allergy and Infectious Diseases. www.niaid.nih.gov, published January 2012
    • Where are my sinuses? National Institute of Allergy and Infectious Diseases. www.niaid.nih.gov, published 11 January 2011
    • Sinus infection (sinusitis). ENT UK. www.entuk.org, accessed 2 January 2014
    • Sinusitis (acute). BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published June 2011
    • Rhinosinusitis – suspected. Map of Medicine. www.mapofmedicine.com, published 21 July 2011
    • Acute sinusitis. Medscape. www.emedicine.medscape.com, published 4 December 2013
    • Chronic sinusitis. Medscape. www.emedicine.medscape.com, published 15 February 2012
    • Orbital and preseptal cellulitis. PatientPlus. www.patient.co.uk/patientplus.asp, published 2 August 2013
    • Bacterial meningitis in adults – suspected. Map of Medicine. www.mapofmedicine.com, published 19 October 2012
    • Sinusitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2009
    • Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database of Systematic Reviews 2008, Issue 2. doi:10.1002/14651858.CD000243.pub2
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 2 January 2014
    • Trestioreanu AZ, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Systematic Reviews 2013, Issue 12. doi:10.1002/14651858.CD005149.pub4
    • Functional endoscopic sinus surgery. Medscape. www.emedicine.medscape.com, published 30 April 2012
    • Balloon catheter dilation of paranasal sinus ostia for chronic sinusitis. National Institute for Health and Care Excellence (NICE), September 2008. www.nice.org.uk
    • Balloon sinuplasty. Medscape. www.emedicine.medscape.com, published 16 April 2012
    • Health tips for airline travel. Aerospace Medical Association. www.asma.org, accessed 2 January 2014
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  • Author information Author information

    Produced by Rachael Mayfield-Blake, Bupa Health Information Team, February 2014.

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