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Sinusitis – Causes, Symptoms and Treatment

Sinusitis is an inflammation of the sinuses that can be acute or chronic. It causes facial pain, nasal congestion, and a feeling of pressure in the head.

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Things worth knowing about "Sinusitis"

Sinusitis is an inflammation of the sinuses that can be acute or chronic. It causes facial pain, nasal congestion, and a feeling of pressure in the head.

What is Sinusitis?

Sinusitis is an inflammation of the mucous membranes lining the paranasal sinuses -- air-filled cavities located in the bones around the nose and forehead. These sinuses connect to the nasal cavity and help regulate airflow and mucus drainage. Sinusitis can be acute (short-term) or chronic (lasting more than 12 weeks) and is one of the most common health conditions worldwide.

Causes

The most frequent causes of sinusitis include:

  • Viral infections: The majority of acute sinusitis cases follow a common cold, which inflames the nasal lining and blocks sinus drainage.
  • Bacterial infections: A secondary bacterial infection can develop after a viral episode, leading to more severe symptoms.
  • Allergies: Allergic rhinitis (hay fever) chronically irritates the nasal passages and increases the risk of developing chronic sinusitis.
  • Structural issues: A deviated nasal septum or nasal polyps can obstruct normal sinus drainage.
  • Fungal infections: Rare, but more likely in individuals with weakened immune systems.

Symptoms

Common symptoms of sinusitis include:

  • Facial pressure or pain, especially below the eyes, across the forehead, or at the bridge of the nose
  • Blocked or runny nose with thick, discolored (yellow or green) mucus
  • Reduced or absent sense of smell
  • Headaches
  • Fatigue and a general feeling of being unwell
  • Fever, particularly with bacterial infections
  • Pain that worsens when bending forward or lowering the head

Diagnosis

Sinusitis is typically diagnosed through:

  • Clinical evaluation: A doctor reviews the symptoms and presses on facial areas to check for tenderness.
  • Nasal endoscopy: A thin, flexible camera is inserted into the nasal passages to examine the sinus openings and mucous membranes.
  • Imaging (CT scan): Used in chronic or complicated cases to assess the extent of inflammation and any structural abnormalities.
  • Nasal swab: May be taken to identify bacterial pathogens in suspected bacterial sinusitis.

Treatment

Acute Sinusitis

Most cases of acute sinusitis resolve on their own without antibiotics. Recommended measures include:

  • Decongestant nasal sprays or drops (for short-term use only)
  • Saline nasal irrigation to clear mucus and soothe the lining
  • Pain relievers such as ibuprofen or paracetamol
  • Steam inhalation to ease congestion
  • Adequate rest and fluid intake

Bacterial Sinusitis

When a bacterial infection is confirmed or strongly suspected, antibiotics such as amoxicillin are prescribed. Treatment typically lasts between 5 and 10 days.

Chronic Sinusitis

Management of chronic sinusitis may include:

  • Corticosteroid nasal sprays to reduce inflammation
  • Allergy treatment when an allergic cause is identified
  • Functional endoscopic sinus surgery (FESS) when conservative treatments fail to provide relief

When to See a Doctor

Seek immediate medical attention if you experience:

  • Severe headache or stiff neck
  • Visual changes or swelling around the eyes
  • High fever above 39 degrees Celsius
  • Symptoms that persist for more than 10 days or worsen after initial improvement

References

  1. Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
  2. Rosenfeld RM et al. - Clinical Practice Guideline: Adult Sinusitis. Otolaryngology - Head and Neck Surgery. 2015;152(2 Suppl):S1-S39.
  3. World Health Organization (WHO) - Acute Respiratory Infections including Sinusitis. WHO Global Health Observatory, 2023.

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