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Sinusitis

Expert reviewers, Mr Anil Banerjee, Ear, Nose and Throat Consultant and Dr Adrian Raby, General Practitioner
Next review due April 2024

Sinusitis is when the lining of your sinuses becomes inflamed and swollen. This is usually due to an infection. If you have sinusitis, you may have a blocked nose and pain in your face. Sinusitis usually goes away on its own after a few weeks. But if not, there are treatments which can help.

About sinusitis

Your sinuses are air-filled spaces behind your forehead and in your cheekbones. They’re connected to the inside of your nose. Doctors don’t know for sure why we have sinuses. There are probably lots of reasons. These include reducing the weight of your skull and keeping the air that you breathe in warm and moist.

You have four main pairs of sinuses. These 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 set deeply behind the upper part of your nose and between your eyes

An image showing the locations of the frontal, ethmoid and sphemoid sinuses

An image showing the location of the frontal and maxillary sinuses

Sinusitis (inflammation of the sinuses) is common, and you can get it at any age.

The lining of your sinuses makes mucus. Usually, this mucus drains away through your nose and throat. If the sinus lining swells up because of infection or allergy, this can cause a blockage. The mucus can’t drain away.

Sinuses can also get blocked by nasal polyps. These are fleshy swellings of the lining of your nose or sinuses. For more information about these, see our FAQ: What are nasal polyps?

Sinusitis can be very painful. It may also give you a feeling of pressure and a blocked nose. See our section on symptoms to find out how sinusitis may affect you.

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Types of sinusitis

Sinusitis can be acute (lasting for a short while) or chronic (lasting for a long time).

  • Acute sinusitis is sinusitis that gets completely better within 12 weeks. Most people, though, feel better within four weeks. Acute sinusitis may be triggered by a viral infection such as a cold.
  • Chronic sinusitis is usually sinusitis that lasts for longer than 12 weeks. It often starts off as acute sinusitis but doesn’t get better. It may be caused by an allergy.

Some people have repeated flare-ups of sinusitis – four or more in any year. This is called recurrent sinusitis.

Symptoms of sinusitis

The main symptoms of sinusitis are pain and a feeling of pressure in your face. If you have acute sinusitis, your pain may be much worse than if you have chronic sinusitis.

Where the pain and pressure appears depends on which of your sinuses is affected. You may notice the pain in:

  • 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
  • green or yellow mucus coming from your nose
  • changes to your sense of smell
  • fever (a raised temperature)
  • a cough
  • bad breath
  • feeling generally unwell

Viral and bacterial sinusitis often give the same symptoms. But you may be more likely to have bacterial sinusitis if:

  • your symptoms last for more than 10 days
  • you have coloured mucus from your nose
  • your pain is very bad and in one place (such as over your teeth and jaw)
  • you have a high temperature (fever)
  • your symptoms got better for a while and then came back again

Diagnosis of sinusitis

Your GP will ask you about your symptoms and examine you. They’ll feel for any tenderness over your sinuses. They may also look up into your nose for signs of inflammation or a blockage. This could be caused by nasal polyps. For information about these, see our FAQ: What are nasal polyps?

You don’t usually need any other tests for your GP to diagnose sinusitis.

Your GP may also check whether something else is causing your symptoms. This is because sinusitis symptoms can be like symptoms from other causes. These include an allergy or problems with your teeth.

Your GP may refer you to another doctor if:

  • you have chronic sinusitis and your treatment hasn’t worked
  • your acute sinusitis keeps coming back

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. They put a narrow, flexible, tube-like telescopic camera into your nose. This helps them to identify any blockages. If your doctor recommends this test, they’ll explain what’s involved.

Your doctor may ask you to have other tests too, such as a CT scan. This can help them rule out other problems and be sure you have sinusitis.

Self-help for sinusitis

Self-help for acute sinusitis

Acute sinusitis usually gets better on its own after two to three weeks. You may feel like you have a cold that’s taking longer than usual to clear up.

There’s a lot you can do yourself to ease your symptoms.

  • Take over-the-counter painkillers such as paracetamol or ibuprofen. These will ease the pain and any fever.
  • You can try using a decongestant nasal spray if your nose is very blocked. But you should only use this for three to four days at most.
  • Rinse your nose with a warm saltwater solution – your pharmacist can show you the best way to do this.
  • Drink plenty of fluids and get plenty of rest.

Some people try steam inhalation to clear their blocked sinuses or place a warm flannel on their face, but no one is sure if this really helps.

You can ask your pharmacist for advice on self-help for sinusitis.

Contact your GP if:

  • your symptoms aren’t getting better after three weeks
  • your symptoms keep getting worse
  • you feel very unwell

Self-help for chronic sinusitis

If you have chronic sinusitis, it may take a while for you to get better, sometimes several months.

You may find your symptoms get worse every now and then in an acute flare-up. If so, you may find the self-help measures for acute sinusitis will ease them. You can find these listed above: Self-help for acute sinusitis. If these don’t help to reduce your symptoms, contact your GP.

Other self-help measures for chronic sinusitis include the following.

  • Stopping smoking – ask your pharmacist for advice on quitting smoking.
  • Staying away from places where other people smoke.
  • Avoiding things you’re allergic to.
  • Taking care of your teeth, because chronic sinusitis can be linked to a dental infection.
  • Avoiding alcohol, which can make your symptoms worse.

Treatment for sinusitis

Medicines

Acute sinusitis

Your doctor may suggest you try a nasal corticosteroid spray if:

  • your symptoms last for 10 days or more
  • your symptoms don’t improve over time

You’ll usually use the spray for two weeks. Your pharmacist can show you how to use it properly.

Sinusitis is usually caused by a viral infection, so antibiotics are unlikely to help. Even bacterial sinusitis often clears up on its own without antibiotics. Your doctor will only recommend an antibiotic if:

  • you have symptoms for more than 10 days, with no improvement
  • your symptoms get much worse
  • you are very unwell
  • you have a low immune system or a high risk of complications

Chronic sinusitis

If you have medical conditions linked to chronic sinusitis, it’s important to treat them. These conditions include asthma, hay fever and dental infections. This should help your sinusitis symptoms.

A nasal corticosteroid spray may help your symptoms, especially if you have hay fever too. You may use this for up to three months.

Your doctor may suggest a course of antibiotics lasting three to four weeks. The aim is to treat the infection and reduce the risk of it returning.

If these measures don’t work, your GP may refer you to an ear, nose and throat (ENT) specialist.

Surgery for chronic sinusitis

Most people with chronic sinusitis don’t need surgery. Your ENT specialist may suggest you have an operation if other treatments haven’t worked. An operation aims to unblock your sinuses so the mucus drains out of your nose more easily.

There are two main types of surgery for chronic sinusitis.

  • Functional endoscopic sinus surgery (FESS). Your surgeon uses a thin, flexible endoscope to see inside your sinuses. They unblock your sinuses by removing some of your bone and mucus lining.
  • Balloon sinuplasty. Your surgeon puts a small, flexible tube into your sinus and inflates a balloon on the end of it. This unblocks your sinus.

If nasal polyps are causing a blockage in your nose or sinuses, you may need to have surgery to remove them. For more information on these, see our FAQ: What are nasal polyps?

If your doctor recommends an operation, you can ask them to discuss the benefits and risks.

Causes of sinusitis

Acute sinusitis is caused by an infection of the lining of your sinuses. Most people with acute sinusitis have an underlying viral infection such as a cold or flu. Only around two in every 100 people with acute sinusitis have a bacterial infection.

Chronic sinusitis often starts off as acute sinusitis. But it may also be linked to:

  • allergies
  • a blockage in your nose or sinuses (such as nasal polyps)
  • smoking
  • asthma
  • infections in your teeth and gums
  • sports (such as swimming and diving)
  • injuries to your teeth, nose or cheeks
  • conditions that affect the way your body gets rid of mucus (such as cystic fibrosis)

Complications of sinusitis

Acute sinusitis usually goes away on its own without causing any problems. But sometimes the symptoms don’t go away and it becomes chronic sinusitis.

Rarely, an acute sinus infection can spread. Rare complications of acute sinusitis include the following.

  • Infection of the soft tissue around your eye. Your eyelid may become red, painful and swollen.
  • Infection of the bones in your face. You may have pain and your face may feel tender.
  • Infection in or around your brain. You may get a bad headache, stiff neck, high temperature or be sick (vomit).

These complications are serious. If you feel very unwell or think you may have one of these complications, get medical help right away.

Having chronic sinusitis can affect your quality of life. You may have problems sleeping and feel very tired. You may find it difficult to work or enjoy social activities. Some people get depression. Speak to you doctor if you are finding it hard to cope with chronic sinusitis.

Prevention of sinusitis

You may be able to lower your risk of getting sinusitis by following a few simple measures.

  • Wash your hands well, especially after being in close contact with someone who is unwell.
  • Don’t smoke and avoid smoky places or areas with heavy air pollution.
  • Try to steer clear of any allergy triggers you have.

If you keep getting sinusitis because of an allergy, you may find it useful to have allergy tests. Your GP or ear, nose and throat (ENT) specialist may be able to refer you to an allergy clinic.

Frequently asked questions

  • Your sinuses are air-filled spaces around your nose and eyes. They are found:

    • inside your cheekbones
    • behind your forehead above your eyes
    • behind the bridge and upper part of your nose and between your eyes
    • set deeply behind the upper part of your nose and between your eyes

    An image showing the locations of the frontal, ethmoid and sphemoid sinuses

  • Sinusitis is caused by an infection of the lining of your nose. This is usually a viral infection, though it can be bacterial. For more information, see our section: Causes of sinusitis.

  • The main symptoms of sinusitis are pain and a feeling of pressure in your face. You may also get a blocked or stuffy nose, green or yellow mucus coming from your nose, a raised temperature, a cough and a general feeling of being unwell. For more information, see our section: Symptoms of sinusitis.

  • Flying can cause pain in your sinuses. When you’re in an aircraft, the pressure inside the cabin changes. So, the air inside your sinuses expands or shrinks according to the pressure. If your sinuses are blocked or inflamed, the air inside them gets trapped, which can be painful.

    You may wish to delay your flight until your symptoms have gone away. If you have to fly, using a decongestant spray or drops may help to relieve your symptoms. Use this just before the flight and just before the plane starts to descend for landing. You may also find it helps to do a Valsalva manoeuvre. This is when you hold your nose and try to breathe out through a closed mouth.

  • Nasal polyps are fleshy swellings of the lining of your nose and sinuses. They look like small grapes, or clusters of grapes, in your nose. We aren’t sure why people get nasal polyps, but it has been suggested that they’re linked to an allergy or infection.

    The polyps can cause a blocked nose as well as sneezing, itching, a runny nose, and a poor sense of taste and smell. They can also block your sinuses, so you may be more likely to have sinus infections too.

    Nasal polyps can be treated with a nasal corticosteroid spray. You would use this for three months at first, to see if it eases your symptoms. If it works, you can keep using it, with a check-up every six months.

    If the nasal spray doesn’t work, your doctor may recommend surgery to remove your nasal polyps. Surgery should improve your symptoms, but the polyps may come back.

  • Doctors usually recommend a nasal decongestant spray rather than tablets. Oral decongestants (tablets or capsules) act on the whole body but a spray can target the medicine to just the lining of your nose.



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Related information

    • Sinusitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2018
    • Acute sinusitis. BMJ Best practice. bestpractice.bmj.com, last reviewed January 2021
    • Chronic sinusitis. BMJ Best practice. bestpractice.bmj.com, last reviewed January 2021
    • Peri-orbital and orbital cellulitis. BMJ Best practice. bestpractice.bmj.com, last reviewed January 2021
    • Nasal polyps. BMJ Best practice. bestpractice.bmj.com, last reviewed January 2021
    • Acute sinusitis. Medscape. emedicine.medscape.com, updated March 2018
    • Chronic sinusitis. Medscape. emedicine.medscape.com, updated July 2019
    • Nasal endoscopy. Medscape. emedicine.medscape.com, updated February 2016
    • Functional endoscopic sinus surgery. Medscape. emedicine.medscape.com, updated December 2020
    • Balloon sinuplasty. Medscape. emedicine.medscape.com, updated December 2020
    • Nasal polyp surgery. Medscape. emedicine.medscape.com, updated January 2019
    • Barosinusitis. Medscape. emedicine.medscape.com, updated June 2019
    • Sinusitis. Patient. patient.info, last edited May 2019
    • Meningitis. Patient. patient.info, last edited July 2019
    • Osteomyelitis. Patient. patient.info, last edited August 2016
    • Nasal polyps. Patient. patient.info, last edited February 2017
    • Sinusitis. MSD Manuals. msdmanuals.com, last full review/revision June 2020
    • Nasal polyps. MSD Manuals. msdmanuals.com, last full review/revision June 2020
    • Sinusitis (acute): antimicrobial prescribing. National Institute for Health and Care Excellence (NICE), October 2017. www.nice.org.uk
    • Personal communication, Mr Anil Banerjee, Ear, Nose and Throat Consultant, February 2021
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, April 2021
    Expert reviewers, Mr Anil Banerjee, Ear, Nose and Throat Consultant and Dr Adrian Raby, General Practitioner
    Next review due April 2024

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