About your sinuses
Your sinuses are connected to the inside of your nose. They’re lined with a mucous membrane and this produces mucus, which covers the inside of your sinuses. Doctors don’t know exactly what your sinuses do, but it’s thought that they help to lighten the weight of your skull, control pressure and keep the air you breathe in warm and moist.
You have four main pairs of sinuses, which are:
- 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
Types of sinusitis
There are two main types of sinusitis.
- Acute sinusitis is defined by doctors as sinusitis that gets completely better within 12 weeks. On average, most people feel better after two and a half weeks. It’s often triggered by an infection and often comes on after a cold.
- Chronic sinusitis is either sinusitis that lasts for longer than 12 weeks, or repeated bouts of sinusitis – three or more in any year. It sometimes starts as acute sinusitis which doesn’t get better.
The medical words ‘acute’ and ‘chronic’ are about how long you have a condition for, not how severe it is.
Symptoms of sinusitis
Whether you have acute or chronic sinusitis, the main symptoms are pain and a feeling of pressure. If you have acute sinusitis, the pain is often more severe than if you have chronic sinusitis.
Depending on which of your sinuses is affected, the pain and pressure can appear in different places including:
- your forehead
- the top of your jaw, teeth and cheeks
- between and behind your eyes
Other symptoms of sinusitis can include:
- a blocked or stuffy nose
- a sore throat
- a cough
- changes to your sense of smell
- green or yellow mucus, which can drain down the back of your nose into your throat
- a fever
- bad breath (halitosis)
Diagnosis of sinusitis
Your GP will ask you some questions about your symptoms and examine you. You might also have an anterior rhinoscopy. This is when your doctor uses an instrument with a light on it to look up your nose and into your sinuses. If your symptoms have worsened after five days or have lasted longer than 10 days, your doctor may diagnose you with acute sinusitis.
If after 12 weeks, your symptoms haven’t gone away completely, you may be diagnosed as having chronic sinusitis.
Your GP will always consider if something else is causing your symptoms. This is because the symptoms of sinusitis can be similar to symptoms from other causes such as an allergy or dental infection.
If you have chronic sinusitis and your treatment hasn’t worked or if your sinusitis keeps coming back, your GP may refer you to see another doctor. This is likely to be an ear, nose and throat (ENT) specialist.
Your ENT specialist may suggest you have a test called a nasal endoscopy. In this test, your doctor puts a narrow, flexible, tube-like telescopic camera (called an endoscope) into your nose and sinuses. This shows the lining of your sinuses and helps your doctor to see any blockages. You may need other tests too, such as a CT scan to find out what’s going on.
Treatment of acute sinusitis
On average, acute sinusitis gets better after two and half weeks and you can usually manage your symptoms yourself.
- Take over-the-counter painkillers, such as paracetamol and ibuprofen, to ease the pain and fever if you have one.
- You can try using a decongestant nasal spray if your nose if blocked and causing you problems. But you should only take this for a week, and decongestants in tablet form aren’t recommended.
- Rinse your nose with a salt water solution – talk to your pharmacist about how to do this.
- Place a warm pack or flannel on your face to help relieve discomfort.
- Look after yourself well by keeping hydrated and getting plenty of rest.
If your symptoms are severe or lasting a longer time than expected, your GP may suggest a nasal corticosteroid spray.
If you have a condition that puts you at risk of complications or your infection is bacterial rather than viral, your GP may prescribe you with antibiotics.
If, during a year, you get several bouts of sinusitis that need treating with antibiotics, your GP may refer you to an ear, nose and throat specialist.
Treatment of chronic sinusitis
Chronic sinusitis can take a while to get better, may be several months. But rest assured, it will go and doesn’t usually need further referral to an ENT specialist.
If you get flare-ups of chronic sinusitis (where the symptoms get worse every now and then) you can try the same self-help measures as acute sinusitis to ease discomfort.
If you have asthma, hay fever or a dental infection at the same time as chronic sinusitis, it’s really important to manage these to help reduce your symptoms. Your doctor may prescribe a nasal corticosteroid spray if you have hay fever alongside chronic sinusitis. They may suggest you use this for up to three months.
Your doctor might suggest a short course of antibiotics, but it’s not likely they will prescribe these over the long-term.
If these measures don’t work, your GP may then refer you to an ENT specialist.
If you have chronic sinusitis with severe symptoms and it doesn't get better with other treatments, your ENT specialist may suggest you have surgery. An operation can help to unblock your sinuses and improve how well any mucus drains. There are a number of different procedures that can do this.
In functional endoscopic sinus surgery (FESS), your surgeon uses a thin, flexible telescope called an endoscope to see inside your sinuses. Then they use special instruments to unblock the sinuses, by removing bone and mucus membrane. This can be done under local or general anaesthesia.
Balloon sinuplasty is another type of operation used to treat chronic sinusitis. Your surgeon puts a small, flexible tube into your sinus and inflates a balloon on the end of it. This unblocks the sinus and helps it to drain properly. You will need to have a general anaesthetic for this operation.
Ask your doctor for more information about the different types of surgery and what treatment is best for you.
Causes of sinusitis
Acute sinusitis is caused by an infection of the mucous membranes. This is usually because of a virus, such as the cold or flu virus, but bacteria can also cause an infection.
Doctors don’t yet know exactly what causes chronic sinusitis. However, it is linked to a number of conditions and factors including:
- conditions that affect the way your body gets rid of mucus, such as cystic fibrosis
- sports such as swimming and diving
- injuries to your teeth, nose or cheeks
Complications of sinusitisA sinus infection could potentially spread to the bones in your face or your eye socket. The infection could also spread to your brain and cause meningitis. This is uncommon. However, if you have symptoms such as vomiting (being sick), a fever, severe headache or a stiff neck you should get medical help as soon as you can.
If your eyelid becomes red, painful and swollen while you have sinusitis, this can be a sign of an infection in the soft tissues around your eye. This is called orbital cellulitis and it can lead to severe infection and sight loss. If you develop these symptoms, you should see a doctor straightaway.
Prevention of sinusitis
You may be able to reduce your risk of developing sinusitis, or of getting further bouts of it. The main things you can do are listed here.
- Wash your hands well using soap and hot water or anti-bacterial hand rubs or gels. This is especially important in you’re in close contact with someone who is unwell.
- Don’t smoke and try not to spend too much time in smoky places.
- If you have allergies that may trigger sinusitis, try to steer clear of them.
- Treat any colds, flu and chest infections quickly. You can usually treat these yourself using medicines from your pharmacist.
If you keep getting sinusitis, it may be helpful to have allergy tests, which a specialist usually organises for you.
Flying can cause pain in your sinuses. When you’re in an aeroplane, the pressure inside changes and air inside your sinuses expands and shrinks.
If your sinuses are blocked or inflamed, the air inside them gets trapped, which can be painful.
Using a decongestant spray or drops just before the flight, and just before the plane starts to descend for landing, may help to relieve your symptoms.
- ENT UK
020 7404 8373
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- ENT UK
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Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, May 2016.
Peer reviewed by Mr Anil Banerjee, Ear, Nose and Throat Consultant.
Next review due May 2019.
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