Sinusitis
Sinusitis is inflammation of the sinus cavities behind the cheeks, forehead, and around the eyes. It commonly follows a cold and causes facial pressure, congestion, and thick nasal discharge.
Table of Contents
Quick Facts
- Type: Sinus inflammation
- ICD-10: J01, J32
- Acute: Up to 4 weeks
- Chronic: 12+ weeks
Overview
Sinusitis (also called rhinosinusitis) is inflammation of the paranasal sinuses — the air-filled spaces in the bones around the nose. When the lining swells and mucus can't drain normally, pressure, pain, and infection can develop.
It is classified by duration:
- Acute sinusitis — up to 4 weeks; usually viral and follows a cold.
- Subacute — 4–12 weeks.
- Chronic sinusitis — 12 weeks or longer.
Symptoms
- Facial pain or pressure, especially around the cheeks, forehead, or eyes
- Nasal congestion
- Thick yellow or green nasal discharge
- Postnasal drip
- Reduced sense of smell and taste
- Headache, often worse when leaning forward
- Cough, often worse at night
- Bad breath
- Fatigue
- Fever (more common in bacterial cases)
Causes
- Viral infections — most acute sinusitis follows a cold.
- Bacterial infections — can develop after a prolonged viral illness.
- Fungal infections — uncommon, mostly in people with weakened immunity.
- Allergies (especially allergic rhinitis).
- Nasal polyps or a deviated septum that blocks drainage.
- Irritants (smoke, pollution).
Diagnosis
Most acute sinusitis is diagnosed by symptoms alone. Additional evaluation may include:
- Nasal endoscopy
- CT of the sinuses (especially for chronic or complicated cases)
- Allergy testing
- Nasal culture in unusual or recurrent infections
Treatment
Self-care for acute sinusitis
- Saline nasal sprays or rinses
- Steam inhalation or warm compresses
- Decongestants (limit to a few days)
- Pain relievers (acetaminophen or ibuprofen)
- Rest and adequate fluids
Medications
- Intranasal corticosteroids (first-line for chronic sinusitis)
- Antibiotics — only when bacterial infection is suspected (symptoms more than 10 days or worsening after improvement)
- Antihistamines if allergies contribute
Procedures
- Functional endoscopic sinus surgery for chronic, treatment-resistant cases
- Removal of nasal polyps
Prevention
- Hand hygiene to reduce colds
- Annual flu vaccination
- Avoid smoking and secondhand smoke
- Manage allergies effectively
- Use a humidifier in dry climates
When to See a Doctor
See a doctor for:
- Sinus symptoms lasting more than 10 days without improvement
- Symptoms that worsen after initial improvement
- Severe headache, high fever, or facial swelling
- Vision changes or swelling around the eye (urgent)
- Frequent recurrent episodes
Frequently Asked Questions
Bacterial sinusitis is more likely if symptoms last more than 10 days without improvement, if they worsen after initial improvement (the 'double-worsening' pattern), or if there is high fever with severe facial pain and purulent nasal discharge. Most short-duration cases are viral and don't need antibiotics.
No. Most acute sinusitis is viral and improves on its own. Antibiotics are reserved for likely bacterial cases.
Rarely, infection can spread to the eye socket, surrounding bone, or brain. Warning signs include vision changes, severe headache with fever, or swelling around the eye — these need urgent care.
Surgery can significantly improve symptoms in many people with chronic sinusitis, particularly those with anatomical blockages or polyps. It typically supplements medical therapy rather than replacing it.
References
- American Academy of Otolaryngology. Clinical Practice Guideline: Adult Sinusitis.
- Infectious Diseases Society of America. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis.