Sinusitis (rhinosinusitis)

What is sinusitis?

Sinusitis, also called rhinosinusitis, is swelling and inflammation of your sinuses, the small air-filled spaces behind your cheekbones and forehead. It's common, usually follows a cold, and most people recover within about 4 weeks.

What are the symptoms of sinusitis?

Sinusitis often follows a cold or flu. Symptoms can include:

• pain, swelling or tenderness around your cheeks, eyes or forehead, often worse when you bend forward
• a blocked or runny nose, sometimes with thick green or yellow mucus
• a reduced sense of smell
• a high temperature
• a headache, earache or toothache
• bad breath and a cough
• tiredness.

You may also snore, sound nasal when you speak, or feel pressure in your ears. Young children with sinusitis can become irritable, have trouble feeding, and breathe through their mouth.

What causes sinusitis and who is at risk?

Sinusitis usually starts when a cold or flu virus spreads to your sinuses, causing the lining to swell. This blocks the tiny channels that normally drain mucus into your nose, so mucus builds up and can become infected.

Only a small number of cases are caused by bacteria rather than a virus. Rarely, an infected tooth or a fungal infection can also cause sinusitis.

You may be more likely to get sinusitis, or to get it repeatedly, if you have:

• nasal allergies, such as hay fever
• asthma
• nasal polyps (small growths inside the nose)
• a deviated septum (where the wall inside your nose is not straight)
• a weakened immune system
• a habit of smoking.

It's not fully understood why sinusitis becomes long-lasting (chronic) in some people, but allergies and related conditions may play a part. Sinusitis itself is not contagious, though the viruses and bacteria that can cause it are.

Are there different types of sinusitis?

Yes. Doctors describe sinusitis by how long it lasts:

• Acute sinusitis: This lasts under 4 weeks and is usually caused by a virus
• Subacute sinusitis: This lasts 4 to 12 weeks
• Chronic sinusitis: This lasts 12 weeks or more, and is more often linked to bacteria or an underlying condition such as allergies
• Recurrent sinusitis: This is where acute episodes come back 4 or more times a year.

Sinusitis can also be caused by a virus, bacteria, or occasionally a fungus, and your treatment may depend on which of these is responsible.

How is sinusitis diagnosed?

Your GP can usually diagnose sinusitis from your symptoms and by examining the inside of your nose. They’ll sometimes use a small lighted instrument called an otoscope that’s usually used for ear examination, but can also be used to look at the front part of the nasal cavity.

If your sinusitis keeps coming back, lasts longer than three months, or only affects one side of your face, your GP may refer you to an ear, nose and throat (ENT) specialist. They’ll examine you with an endoscope (a long, thin, flexible or rigid tube with a light and a camera on the end), and they might arrange a CT scan, allergy tests, or a swab to check for infection.

How is sinusitis treated?

Most sinusitis clears up on its own. Treatment focuses on relieving your symptoms while your body fights the infection.

Non-surgical treatment

You can often manage mild sinusitis yourself by:

• getting plenty of rest and drinking plenty of fluids
• taking paracetamol or ibuprofen for pain (do not give aspirin to children under 16)
• rinsing your nose with a salt water solution
• avoiding smoking and things that trigger your allergies.

A pharmacist can offer the same treatments as a GP and advise you on decongestant sprays, though these should not be used for more than a week, as overuse can make congestion worse.

If symptoms persist, a GP may prescribe steroid nasal sprays or drops, which you might need to use for a few months, or antihistamines if an allergy is behind your symptoms. Antibiotics are only needed occasionally, since sinusitis is usually caused by a virus rather than bacteria.

Surgical treatment

If you have chronic sinusitis that hasn’t improved with medicine, an ENT specialist may recommend surgery, called functional endoscopic sinus surgery (FESS). This is carried out under general anaesthetic and widens your sinuses by either:

• removing some of the blocked tissue, or
• inflating a tiny balloon inside the blocked sinus, then removing it.

When should I see a doctor?

See a pharmacist if you think you have sinusitis, or if your child aged 12 or over has symptoms. See a GP if:

• you have not improved after seven days of pharmacy treatment
• your symptoms haven’t improved after 3 weeks of treating yourself
• you keep getting sinusitis
• your child is 11 or younger and has symptoms.

Ask for an urgent GP appointment, or call 111, if you are very unwell, painkillers are not helping or your symptoms are getting worse, or you have a weakened immune system, for example because of chemotherapy.

Go straight to A&E if you have a high fever, confusion, changes to your vision, a stiff neck, or swelling and pain around your eyes. These are rare, but can be signs of a more serious infection that needs urgent treatment.