Acute sinusitis

Also known as rhinosinusitis

Sinusitis means infection or inflammation of the sinuses – tiny spaces located in your cheeks and forehead and around your eyes. It causes a heavy, full feeling in your head that can be painful and uncomfortable.

Key points

  1. Sinusitis frequently occurs when you've had a cold, or hay fever or another allergy.
  2. It usually gets better on its own after 1 to 2 weeks.
  3. Home remedies and pain-relieving medication may provide some relief. Over-the-counter nasal sprays containing oxymetazoline can be used with caution.
  4. Antibiotics are seldom needed to treat sinusitis because sinus infections are usually caused by viruses and only occasionally by bacteria. Antibiotics are not effective against killing viruses because they work on bacterial infections.
  5. In chronic sinusitis symptoms continue for 3 months or more.

What causes sinusitis?

Paranasal sinuses (tiny air spaces around your nose) make mucous that drains out through your nose. Sometimes the lining of the sinuses become inflamed or infected. This usually happens after you’ve had an infection of your upper airways such as a cold, or when you've had hay fever or another allergy. Some people get sinusitis after every cold, while others get it rarely.

Viral sinusitis is the most common cause for sinusitis. Bacterial or fungal infection is much less common as the cause. Only 0.5% to 2% of cases are estimated to be complicated by a bacterial rhinosinusitis (sinusitis).

Other things that can increase your risk of getting sinusitis include:

  • smoking
  • regular use of some nasal decongestants
  • nasal polyps (swellings in the linings of your nose or sinuses)
  • dental disease
  • deviated nasal septum (where the wall between your nostrils has been displaced sideways by an injury)
  • changes in air pressure such as during an airplane flight or scuba diving
  • conditions that weaken your immune system such as chemotherapy treatment
  • ciliary dysmotility such as cystic fibrosis or Kartagener’s syndrome.

What are the symptoms of sinusitis?

People who have sinusitis often describe their face as feeling heavy or full, or as if they have a cold they can’t get rid of. Symptoms commonly experienced include:

  • headache or pain around your eyes, forehead, cheeks or teeth which gets worse when leaning forward
  • feeling of pressure around your face and inside your head
  • a blocked or stuffy nose
  • a runny nose
    a post-nasal drip (when mucus from the sinus area drips down the inside of your throat)
  • loss of sense of smell or taste
  • headache that usually affects your cheeks or front of your face.

In addition to the above, you may also get high temperature (fever), feel generally unwell and tired, get bad breath, toothache or a cough, or have a feeling of pressure or fullness in your ears.

How is sinusitis diagnosed?

Your doctor can usually diagnose acute sinusitis from the symptoms you describe. They may also check to see if you have a temperature or if you have tenderness around your sinuses. They may also examine your nose, as often the lining of your nose swells up when you have acute sinusitis.

Occasionally, they may also ask you to do a CT scan if the diagnosis is not clear.

How is sinusitis treated?

The following self-care treatments and medications can help relieve your pain and discomfort. Sinus infections are usually caused by a viral infection, so antibiotics are not usually effective. However, there are certain situations when you may be prescribed antibiotics.

Self-care

To help relieve the pain and discomfort caused by sinusitis, try the following home treatments:

  • Rest to help your body to heal faster.
  • Keep hydrated and drink lots of fluids to help thin the mucus.
  • Hold a hot compress or warm face pack over the painful area.
  • Consider using saline nasal spray or drops, or a sinus rinse of home-made saline solution to relieve congestion and blockage in your nose.
  • The home-made saline solution is made up with 1/4 teaspoon non-iodised salt, 1/4 teaspoon baking soda and 1/4 teaspoon sugar, dissolved in 250 mL (1 cup) of warm water. You can buy a sinus rinse bottle or pot from your pharmacy. Read more about saline nasal sprays, drops and rinses.

Steam inhalation is a traditional remedy but is not recommended. This is because there is little evidence that it helps. Also, there is a risk you might burn yourself. However, some people say that their nose feels clearer for a short while after a hot shower.

Medications

  • Pain relief medication: take pain relief medications such as paracetamol, or non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen, to reduce pain and discomfort. Read more about the safe use of NSAIDs
  • Antihistamines can help to dry up nasal secretions and relieve a post-nasal drip if your symptoms are as a result of hay fever or an allergy. If you need to be alert during the day, such as for driving, use antihistamines with little or no sedating side effects. In some people, antithistamines can make the mucous more thick. Read more about antihistamines
  • Decongestant nasal sprays or drops, such as oxymetazoline, can be helpful to reduce congestion and swelling within your nose and sinuses. But, use these with caution because overuse can make your symptoms worse. They can cause rebound congestion if used for more than 3 days. Read more about nasal decongestants.
  • Decongestant tablets: if you are still being bothered by a stuffy nose after 3 days, decongestant tablets may be helpful. For example, phenylephrine, which can be bought from your pharmacy, or pseudoephedrine (you need to see your doctor for a controlled drug form to get this).
  • Steroid nasal sprays: your doctor may recommend the use of steroid nasal sprays such as Flixonase to relieve your symptoms. You will usually feel better after using them for 2 to 3 days.

Do I need antibiotics?

Antibiotics are seldom needed to treat sinusitis because sinusitis is mostly caused by viruses (a viral infection). Antibiotics only work against bacteria (a bacterial infection) but not viruses. 

Using antibiotics when they are not needed can lead to antibiotic resistance. This is when overuse of antibiotics encourages the growth of bacteria that can’t be controlled easily with drugs. That makes you more at risk of antibiotic-resistant infections in the future and makes antibiotics less effective for everyone.

  • Antibiotics are considered when symptoms last longer than 10 days, start to improve but then worsen again, or are very severe such as a fever over 38.6°C, extreme pain and tenderness over your sinuses, or signs of a skin infection, such as a hot, red rash that spreads quickly.
  • If you are given antibiotics, finish the full course.
  • Read more about antibiotics for sinusitis Choosing Wisely, NZ

When can I expect to feel better?

Most people recover from sinusitis caused by colds in about a week, but symptoms can take anywhere from 10 days up to 8 weeks to clear up. If symptoms persist for 3 months or more, it is called chronic sinusitis. This condition is a bit more complex where inflammation of the mucous takes much longer to heal. Read more about chronic sinusitis.

Learn more  

The following links have more information on sinusitis.

Acute sinusitis Mayo Clinic
Acute sinusitis Patient.co.uk
Treating sinusitis NHS Choices UK

References

  1. Antibiotic Guide: choices for common infections BPAC, 2017
  2. Adult sinusitis: plain language summary American Academy of Otolaryngology, 2015

Reviewed by

Dr Andrew Cho works in private at Robot Head and Neck Surgery and as an otolaryngologist, and head and neck surgeon at Counties Manukau DHB, Auckland. He has previously worked at Starship Hospital in Auckland and undertook a prestigious American Head and Neck Society Fellowship at the University of California in head and neck oncological surgery and microvascular reconstruction. His area of expertise includes general ENT, paediatric ENT, sinusitis, and head and neck surgery.
 
Credits: Health Navigator Editorial Team. Reviewed By: Dr Andrew Cho, specialist head and neck surgeon and otolaryngologist Last reviewed: 31 Jul 2018