Sinusitis

This factsheet is for people who have sinusitis, or who would like information about it including the symptoms, causes and treatments.

Sinusitis is inflammation of the lining of the sinuses that surround your nose. Common symptoms include pain and a blocked nose. Sinusitis is often caused by an infection.

Where the sinuses are found

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About sinusitis

The sinuses are air-filled spaces within the bones of your face, around your nose. They are lined with cells that produce mucus, called the mucus membrane, which 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:

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

Your sinuses are connected to the inside of your nose.

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

If your sinusitis gets completely better within four weeks, then it's called acute sinusitis. If you have symptoms of sinusitis that last for more than 12 weeks, it’s called chronic sinusitis. Acute sinusitis usually has more severe symptoms and often follows a cold. Chronic sinusitis may start as acute sinusitis which doesn’t get better. If you have chronic sinusitis the lining of your sinuses are 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. 

Symptoms of sinusitis

The main symptom of acute sinusitis is pain. If you have chronic sinusitis your pain is likely to be less severe. You may have pain 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
• top of your head
• in your neck
• your ears

The other main symptoms of sinusitis are:

• 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

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

Complications of sinusitis

On very rare occasions, a sinus infection can spread to the bones of your face or your eye socket. Infection can also spread to your brain and cause meningitis.

If you develop swollen eyelids while you have sinusitis, this can be a sign of an infection in your eye socket and you should see your GP immediately. If you have other symptoms which could be a sign of meningitis, for example a severe headache, stiff neck, fever, being sick and dislike of bright lights, you should get medical help straightaway.

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. During a cold the mucous membranes become swollen, which can block the openings of your sinuses. In some cases, mucous that builds up in your sinuses can become infected with a bacteria and cause more severe symptoms (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 mite
• smoke and air pollution
• sprays containing chemicals, for example household detergents

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

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 your treatment hasn’t worked, or if your sinusitis keeps coming back after treatment, your GP may refer you to an ENT specialist (a doctor who specialises in ear, nose and throat conditions). He or she may suggest a test called a nasal endoscopy. This is when a narrow, flexible, tube-like telescopic camera, called an endoscope, is inserted into your nose and sinuses. This allows your ENT specialist to see the lining of your sinuses and check for blockages. You may need other tests, including an X-ray or a CT scan.

Treatment of sinusitis

Acute sinusitis usually takes about two weeks to get better and many people are able to manage their symptoms without needing to see their GP. Sinusitis is usually caused by a virus, like the common cold, so you’re unlikely to need antibiotics.

Self-help

There are a number of things you can do that may help ease the symptoms of sinusitis. The main ones are listed below.

• A warm flannel or cloth put onto your face can help to ease pain and discomfort.
• Salt water sprays or drops that you can put into your nose may help to ease the feeling of a blocked nose.
• If you feel tired or have a fever, 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 may help to reduce the swelling and inflammation caused by sinusitis. You should only use these for a short period of time (several days) because using them for a long time can actually cause sinus congestion. If you have acute or chronic sinusitis, your GP may prescribe a steroid nasal spray.

If you develop an infection caused by bacteria, your GP may prescribe antibiotics. You’re more likely to be given antibiotics if:

• you’re generally unwell with a fever
• you have other health problems that put you at extra risk from an infection, such as cystic fibrosis or heart disease
• your symptoms are severe

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

Surgery

If you have chronic sinusitis that doesn't get better with other treatments, your specialist may suggest surgery. An operation may help to unblock your sinuses and widen the openings into your nose. There are a number of different procedures available.

In functional endoscopic sinus surgery (FESS) the surgeon washes out your sinuses and widens the drainage holes using an endoscope. This can be done under local anaesthesia 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 unblocks the opening and helps your sinuses to drain properly.

Ask your doctor for more information about the different types of surgery.

Produced by Rebecca Canvin, Bupa Health Information Team, March 2012

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

For sources and links to further information, see Resources.