Sinusitis

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have sinusitis, or who would like information about it.

Sinusitis is inflammation of the linings of the sinuses that surround the nose. Common symptoms include a tender face and a blocked nose. It's often caused by an infection.

Where the sinuses are found

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About sinusitis

What are sinuses?

The sinuses are air-filled spaces within the bones of your face that open up into the nasal cavity. They are lined with the same membrane as your nose. This lining is called the mucous membrane and it produces a slimy secretion called mucus to keep the nasal passageways moist and to trap dirt particles and bacteria.

You have four main pairs of sinuses.

• The maxillary sinuses are in each cheekbone.
  
• The frontal sinuses are on either side of your forehead, above your eyes.
  
• The smaller ethmoid sinuses are behind the bridge of your nose, between your eyes.
  
• The sphenoid sinuses are between the upper part of your nose and behind your eyes.

What is sinusitis?

Sinusitis is inflammation of the lining of one or more of your sinuses.

If your sinusitis lasts less than eight weeks (or less than 12 weeks in a child) it's called acute sinusitis. If your sinusitis lasts three months or more you may have chronic sinusitis. This is where the lining in your nose and sinuses is thickened and constantly inflamed. The medical terms acute and chronic refer to how long the condition lasts for, rather than how severe it is.

Symptoms of sinusitis

If you have sinusitis your symptoms may include:

• pain and pressure in your face, which is worse when you lean forwards
  
• a blocked nose with green or yellow mucus, which can drain down the back of your nose into your throat and may cause a sore throat and cough
  
• a headache
  
• less common symptoms of sinusitis include tiredness, a reduced sense of smell, bad breath (halitosis) and a fever

The pain you have will depend on which of your sinuses are affected.

• Frontal sinusitis can cause pain just above your eyebrows, and your forehead may be tender to touch.
  
• Maxillary sinusitis can cause your upper jaw, teeth and cheeks to ache and may be mistaken for toothache.
  
• Ethmoid sinusitis can cause pain around your eyes and the sides of your nose.
  
• Sphenoid sinusitis can cause pain around your eyes, at the top of your head or in your temples. You may also have earache and neck pain.

On very rare occasions, a sinus infection can spread to the bones of the face or the membranes lining the brain. Also very rarely, sinusitis can spread to form a pocket of pus (abscess) in the eye socket, the brain or a facial bone. If you develop swollen eyelids while you have sinusitis you should see your GP immediately.

Causes of sinusitis

Sinusitis is often caused by an infection of the mucous membranes with a virus, bacterium or fungus. Most people with acute sinusitis have had a viral infection such as the common cold. During a cold the mucous membranes become swollen and tend to block the openings of the sinuses.

Irritants and allergens can inflame the linings of your nose and sinuses, causing sinusitis. Some examples of irritants include:

• airborne allergens such as grass and tree pollen
  
• smoke and air pollution
  
• sprays containing chemicals (eg household detergents)

Enlarged adenoids and growths on the mucous membranes, such as nasal polyps, may block the openings to the sinuses and cause sinusitis.

People with certain medical conditions, such as cystic fibrosis, are more likely to get sinusitis.

Diagnosis of sinusitis

Your GP will ask you about your symptoms and will examine you. He or she may also ask you about your previous illnesses and operations.

Your GP will usually be able to diagnose acute sinusitis just from examining you and no further medical tests are usually necessary.

If you have chronic sinusitis and if your treatments haven't worked, your GP may refer you to a doctor who specialises in ear, nose and throat conditions. You may have an X-ray to help determine the cause of your chronic sinusitis. The specialist may recommend a nasendoscopy (also known as nasal endoscopy), where he or she will insert a small, flexible tube with a light and a camera lens at the end (endoscope) into your nostril to look at the inside of your sinuses.

Treatment of sinusitis

Most people with acute sinusitis get better without treatment. However, if your symptoms continue for more than a week, or seem to be worsening, you may wish to see your GP.

Self-help

Some people find that breathing in steam from a bowl of hot (but not boiling water) provides some relief from the symptoms. However, this isn't scientifically proven. Try sitting in your bathroom with the hot shower running. Putting a warm flannel on the areas of your face that are painful and sleeping with your head and shoulders propped up with pillows may help, but there is no scientific evidence that this works.

There is some evidence that using salt-water nasal sprays or drops may help with the symptoms of chronic sinusitis. These are available from pharmacies without a prescription.

Medicines

Over-the-counter painkillers such as ibuprofen or paracetamol may relieve pain and bring your temperature down if you have a fever. Always read the patient information leaflet that comes with your medicine and ask your pharmacist or doctor for advice.

Several nasal sprays are available over-the-counter and on prescription from your GP. These include decongestants (eg Sudafed) and mild steroids (eg Beconase). Your GP or pharmacist can recommend the most appropriate remedies for you.

If your GP thinks your sinusitis is caused by a bacterial infection, or you develop a secondary bacterial infection due to your inflamed sinuses, he or she may prescribe antibiotics. However, research shows that eight out of 10 people with acute sinusitis get better within two weeks without antibiotics.

If you have sinusitis and an allergy then you may find that controlling your allergy helps to reduce the symptoms of your sinusitis. Antihistamine tablets such as loratadine (eg Clarityn) may help to do this.

Surgery

If you have chronic sinusitis that doesn't get better with home or medical (drug) treatments, your specialist may suggest that you to consider surgery.

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

Other types of surgery can remove nasal polyps or correct an obstruction in the nose that may be the cause of your sinusitis. Ask your doctor for more information about the different types of surgery, as all types of surgery carry the risk of complications and side-effects.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.