Sinusitis: Symptoms, Causes & Treatment

What Is Sinusitis and What Causes It?

Sinusitis is inflammation of the sinuses, usually occurring after a common cold. The sinuses become swollen, fluid accumulates, and this can cause facial pain, nasal congestion, and reduced sense of smell. Most cases are viral and resolve without antibiotics within 7-10 days.

Sinusitis, also known as rhinosinusitis, occurs when the mucous membranes lining your sinuses become inflamed and swollen. The sinuses are air-filled cavities located in the bones of your face, around your nose and eyes. When these passages become blocked due to swelling, fluid and mucus cannot drain properly, creating an environment where bacteria may sometimes grow.

The condition affects approximately 10-15% of adults each year, making it one of the most common reasons people seek medical care. Understanding the difference between viral sinusitis (which doesn't require antibiotics) and bacterial sinusitis (which may benefit from antibiotic treatment) is crucial for appropriate management.

The sinuses serve several important functions in the body. They help humidify the air we breathe, reduce the weight of the skull, provide resonance to the voice, and produce mucus that traps particles and pathogens before they reach the lungs. When functioning normally, mucus produced in the sinuses drains into the nasal cavity through small openings and is cleared by tiny hair-like structures called cilia.

Understanding the Sinuses

There are four pairs of sinuses in the human skull, each named for the bone in which they are located. The frontal sinuses are located in the forehead above the eyes. The maxillary sinuses are the largest and are found in the cheekbones on either side of the nose. The ethmoid sinuses consist of multiple small air cells between the eyes. The sphenoid sinuses are located deep behind the nose, near the center of the skull.

The size and development of sinuses vary considerably between individuals. Newborn babies have very small sinuses that gradually develop and expand throughout childhood, typically reaching adult size during the teenage years. The ethmoid sinuses develop first, while the frontal sinuses are the last to fully mature. This developmental timeline partly explains why sinusitis requiring treatment is less common in young children.

How Sinusitis Develops

Sinusitis typically begins when a viral upper respiratory infection (the common cold) causes the nasal passages and sinus membranes to swell. This swelling can block the small openings (ostia) that connect the sinuses to the nasal cavity, preventing normal mucus drainage. When mucus accumulates in the blocked sinuses, it creates an environment that can potentially support bacterial growth.

Most cases of sinusitis are caused by viral infections and resolve without specific treatment as the underlying cold improves. However, in some cases, bacteria may colonize the stagnant mucus and cause a secondary bacterial infection. Bacterial sinusitis is estimated to occur in only 2-10% of all sinusitis cases, though it tends to cause more severe and prolonged symptoms.

What Are the Symptoms of Sinusitis?

The main symptoms of sinusitis include facial pain or pressure (often worse on one side), nasal congestion, thick nasal discharge, reduced sense of smell, and pain in the upper teeth. Fever and fatigue may also occur. Symptoms typically worsen when bending forward.

Recognizing sinusitis symptoms helps you determine whether home care is appropriate or medical attention is needed. The symptoms of sinusitis result from inflammation of the sinus membranes, accumulation of mucus, and pressure changes within the affected sinuses.

The severity and combination of symptoms can vary significantly between individuals and depending on which sinuses are affected. Understanding the typical symptom pattern helps distinguish sinusitis from other conditions with similar presentations, such as allergic rhinitis, dental problems, or tension headaches.

Common Symptoms in Adults

Facial pain or pressure is one of the hallmark symptoms of sinusitis. The location of pain often corresponds to which sinuses are affected: pain in the forehead suggests frontal sinusitis, pain in the cheeks or upper jaw suggests maxillary sinusitis, and pain between or behind the eyes may indicate ethmoid sinusitis. Many patients describe the pain as a deep, dull ache that worsens when bending forward or lying down.

Nasal congestion is nearly universal in sinusitis. The swollen membranes and accumulated mucus make it difficult to breathe through the nose. This congestion may alternate between sides or affect both nostrils simultaneously. The blocked feeling often extends beyond the nose to include a sensation of fullness in the face.

Nasal discharge in sinusitis tends to be thick and may be clear, white, yellow, or green. Contrary to popular belief, the color of mucus does not reliably indicate whether an infection is bacterial or viral. Post-nasal drip, where mucus drains down the back of the throat, frequently accompanies nasal discharge and can cause throat irritation, coughing, and a hoarse voice.

• Facial pain or pressure: Often worse on one side and when bending forward
• Nasal congestion: Difficulty breathing through the nose
• Thick nasal discharge: May be clear, yellow, or green
• Reduced or lost sense of smell: Often with altered taste
• Upper tooth pain: Especially when leaning forward
• Ear pressure or fullness: Due to eustachian tube congestion
• Fever: More common in bacterial sinusitis
• Fatigue and general malaise: Feeling unwell
• Bad breath (halitosis): From post-nasal drip and bacteria

Symptoms in Children

Children with sinusitis may present differently than adults. While true bacterial sinusitis requiring treatment is relatively uncommon in children, it should be considered when cold symptoms persist longer than expected or include specific warning signs.

In children, sinusitis most commonly affects the ethmoid sinuses, which can cause redness and swelling around the nose bridge and eyes. Young children may not be able to describe facial pain accurately and may instead appear irritable or have difficulty sleeping. Persistent nasal discharge lasting more than 10 days, especially if thick and discolored, may indicate sinusitis in children.

Parents should watch for signs that distinguish sinusitis from a routine cold in children, including persistent symptoms beyond 10 days without improvement, high fever accompanied by purulent nasal discharge, or symptoms that initially improve but then worsen again (suggesting bacterial superinfection).

When Should You See a Doctor for Sinusitis?

See a doctor if sinusitis symptoms persist beyond 10 days without improvement, if symptoms initially improve then worsen, or if you have severe symptoms like high fever with facial swelling, severe headache, vision changes, or stiff neck. These may indicate bacterial infection or rare complications.

Most cases of sinusitis resolve on their own with supportive care, making it important to understand when medical evaluation becomes necessary. Appropriate timing of medical care ensures that bacterial infections receive treatment while avoiding unnecessary antibiotic use for viral infections.

The decision to seek medical care depends on the duration and severity of symptoms, the presence of warning signs suggesting complications, and individual risk factors that may predispose to more serious infections. Understanding these criteria helps patients make informed decisions about when home care is sufficient and when professional evaluation is warranted.

Signs That Warrant Medical Attention

Duration of symptoms provides one of the most reliable indicators for distinguishing viral from bacterial sinusitis. Viral sinusitis typically improves within 7-10 days, even without specific treatment. If symptoms persist beyond 10 days without any improvement, or if symptoms that initially improved suddenly worsen, bacterial sinusitis becomes more likely and medical evaluation is appropriate.

Severity of symptoms also guides the decision to seek care. Mild to moderate symptoms that are tolerable and gradually improving usually do not require medical attention. However, severe symptoms that significantly impact daily functioning or fail to respond to home remedies warrant professional evaluation.

Emergency Warning Signs

While serious complications of sinusitis are rare, they require immediate medical attention when they occur. Orbital cellulitis, an infection that spreads to the tissues around the eye, can cause rapid swelling, redness around the eye, and potentially vision-threatening complications if not treated promptly.

Intracranial complications, though very rare, represent the most serious potential outcome of sinusitis. Signs that may indicate spread of infection toward the brain include severe persistent headache, high fever, stiff neck, confusion, or neurological symptoms. These require emergency evaluation.

What Can You Do at Home to Relieve Sinusitis?

Home treatments for sinusitis include saline nasal irrigation, decongestant sprays (for up to 10 days), elevating your head while sleeping, staying hydrated, using a humidifier, and taking over-the-counter pain relievers. These measures help relieve symptoms while the infection resolves.

Self-care measures form the foundation of sinusitis treatment, particularly for viral cases that will resolve without antibiotics. These interventions aim to reduce swelling, promote drainage, and relieve discomfort while the body's immune system clears the underlying infection.

The effectiveness of home treatments depends on consistent application and appropriate technique. Understanding how each intervention works helps patients use them optimally and set realistic expectations for symptom improvement.

Saline Nasal Irrigation

Saline nasal irrigation is one of the most effective and well-studied treatments for sinusitis symptoms. By flushing the nasal passages with salt water, irrigation physically removes mucus, allergens, and inflammatory mediators while helping to reduce swelling of the nasal membranes.

Multiple research studies have demonstrated that regular nasal irrigation can reduce sinusitis symptoms, decrease medication use, and improve quality of life. The technique can be performed using various devices including neti pots, squeeze bottles, or powered irrigation systems. The key is using sterile or distilled water (not tap water) and appropriate salt concentration.

For optimal results, perform nasal irrigation one to three times daily during active sinusitis. The solution should be lukewarm and made with sterile water mixed with non-iodized salt. Pre-made saline packets simplify preparation and ensure proper concentration. Some patients find that adding a small amount of baking soda makes the solution more comfortable.

Decongestant Medications

Decongestant nasal sprays (such as oxymetazoline or xylometazoline) provide rapid relief from nasal congestion by constricting blood vessels in the nasal membranes, reducing swelling and improving airflow. However, these medications should be used for no more than 10 days consecutively, as longer use can cause rebound congestion (rhinitis medicamentosa).

Oral decongestants (such as pseudoephedrine) offer a longer-lasting but less targeted effect. They may be helpful for patients who cannot use nasal sprays or who experience both nasal and sinus congestion. However, oral decongestants can raise blood pressure and heart rate, making them unsuitable for some patients with cardiovascular conditions.

Additional Self-Care Measures

Sleeping with your head elevated on extra pillows reduces blood pooling in the nasal membranes, which can decrease overnight congestion and morning symptoms. Staying upright and active during the day, rather than lying down, similarly helps reduce swelling and promote drainage.

Adequate hydration helps thin mucus secretions, making them easier to drain. Warm beverages like tea or broth may provide additional comfort and help loosen congestion. Using a humidifier, especially during winter months when indoor air is dry, helps maintain moisture in the nasal passages.

• Saline irrigation: 1-3 times daily with sterile water and salt solution
• Decongestant spray: Maximum 10 days to avoid rebound congestion
• Corticosteroid nasal spray: Safe for longer use, especially helpful for allergies
• Pain relievers: Acetaminophen or ibuprofen for pain and fever
• Warm compresses: Applied to face for comfort
• Steam inhalation: From shower or bowl of hot water
• Adequate rest: Support immune function
• Avoid smoking: Cigarette smoke irritates membranes and delays healing

How Is Sinusitis Diagnosed?

Sinusitis is usually diagnosed based on symptoms and physical examination. Your doctor will examine your nose, throat, and face for signs of inflammation. Additional tests like nasal endoscopy or CT scan may be needed for persistent or severe cases to assess the extent of inflammation and rule out complications.

The diagnosis of sinusitis relies primarily on clinical assessment, including careful evaluation of symptoms and physical examination findings. In most cases of acute sinusitis, laboratory tests and imaging studies are not necessary for diagnosis or treatment decisions.

Understanding the diagnostic process helps patients know what to expect during medical evaluation and why certain tests may or may not be recommended for their specific situation.

Clinical Examination

During the physical examination, your doctor will examine the inside of your nose using a light and speculum to look for swelling, discharge, and polyps. The examination includes inspection of the throat and mouth for signs of post-nasal drip. Your doctor may also press on your face over the sinuses to check for tenderness, though this finding is not always reliable for localizing the infection.

Sometimes doctors use fiberoptic nasal endoscopy, which involves passing a thin flexible tube with a camera into the nose. This allows detailed visualization of the nasal passages, sinus openings, and areas not visible with standard examination. Endoscopy is particularly helpful for evaluating chronic or recurrent sinusitis and can reveal polyps, structural abnormalities, or purulent drainage from specific sinus openings.

When Additional Testing Is Needed

Imaging studies are generally not needed for uncomplicated acute sinusitis but become important in specific situations. CT scanning provides detailed images of the sinuses and is recommended when sinusitis fails to respond to initial treatment, when chronic sinusitis is suspected, when surgery is being considered, or when complications are suspected.

Standard X-rays are no longer recommended for sinusitis diagnosis because they lack the detail needed for accurate assessment. CT scanning has largely replaced plain radiography due to its superior ability to visualize the sinuses and surrounding structures.

Allergy testing may be recommended for patients with recurrent sinusitis, particularly when symptoms suggest allergic rhinitis as a contributing factor. Identifying and treating underlying allergies can help reduce the frequency of sinusitis episodes.

How Is Sinusitis Treated?

Treatment depends on the cause and duration of sinusitis. Most viral cases resolve with symptom management (decongestants, saline irrigation, pain relievers) within 7-10 days. Bacterial sinusitis may require antibiotics, typically amoxicillin as first-line treatment. Chronic sinusitis may need longer treatment with corticosteroid sprays or surgery.

The treatment approach for sinusitis varies significantly depending on whether the infection is viral or bacterial, acute or chronic, and whether any complications are present. The goal of treatment is to relieve symptoms, eradicate infection when bacterial, prevent complications, and reduce the likelihood of recurrence.

Modern treatment guidelines emphasize conservative management for most cases of acute sinusitis, reserving antibiotics for situations where bacterial infection is likely. This approach reflects evidence that most sinusitis improves without antibiotics and that inappropriate antibiotic use contributes to resistance.

Antibiotic Treatment

Antibiotics are indicated for acute bacterial sinusitis, which is suggested by symptoms persisting beyond 10 days without improvement, worsening symptoms after initial improvement, or severe symptoms including high fever with purulent nasal discharge. When antibiotics are needed, amoxicillin or amoxicillin-clavulanate is typically the first choice.

The standard course of antibiotics for acute bacterial sinusitis is 5-10 days, though some guidelines now support shorter courses for uncomplicated cases. If symptoms don't improve within 48-72 hours of starting antibiotics, your doctor may consider switching to a different antibiotic or investigating for other causes.

For patients allergic to penicillin, alternative antibiotics include doxycycline, respiratory fluoroquinolones, or macrolides, though local resistance patterns influence the specific choice. Your doctor will consider your allergy history, local antibiotic resistance patterns, and previous antibiotic use when selecting the most appropriate medication.

Surgical Treatment

Surgery is reserved for chronic sinusitis that fails to respond to medical treatment or for cases with structural abnormalities that prevent adequate drainage. The most common procedure is functional endoscopic sinus surgery (FESS), performed through the nose using small instruments and a camera.

During FESS, the surgeon removes diseased tissue, polyps if present, and widens the natural drainage openings of the sinuses. This allows the sinuses to drain and ventilate normally, reducing inflammation and the likelihood of recurrent infection. The procedure is typically performed under local or general anesthesia and most patients return home the same day.

Recovery from sinus surgery involves several weeks of healing during which nasal irrigation and follow-up visits are important. Post-operative care often includes corticosteroid sprays to reduce inflammation and prevent polyp recurrence. Most patients experience significant improvement in symptoms following successful surgery.

What Increases the Risk of Sinusitis?

Risk factors for sinusitis include allergies, smoking, respiratory infections, nasal polyps, deviated septum, immune system problems, and dental infections. Understanding these factors helps identify people who may benefit from preventive measures or more aggressive treatment.

Several factors can increase susceptibility to sinusitis or predispose to more severe or chronic disease. Understanding these risk factors helps guide prevention strategies and may influence treatment decisions for individual patients.

Some risk factors, like allergies and smoking, are modifiable and represent opportunities for prevention. Others, like structural abnormalities, may require specific interventions to reduce sinusitis frequency.

Modifiable Risk Factors

Smoking significantly increases sinusitis risk by impairing the function of cilia (the tiny hairs that sweep mucus out of the sinuses), causing chronic inflammation, and reducing immune function. Smoking cessation can substantially reduce sinusitis frequency and improve response to treatment. Secondhand smoke exposure also increases risk, particularly in children.

Allergic rhinitis causes chronic inflammation and swelling of the nasal membranes, which can block sinus drainage and predispose to sinusitis. Effective allergy management through avoidance measures, medications, or immunotherapy can reduce sinusitis episodes in allergic individuals.

Environmental factors including air pollution, dry air, and occupational exposures can irritate the nasal passages and increase sinusitis risk. Using a humidifier, avoiding known irritants, and maintaining good indoor air quality may help reduce risk.

Structural and Medical Risk Factors

Anatomical variations such as deviated nasal septum, nasal polyps, or narrow sinus openings can impair drainage and increase sinusitis susceptibility. These structural factors may be addressed surgically if they contribute to recurrent or chronic sinusitis.

Dental infections in the upper teeth can spread to the adjacent maxillary sinus, causing a distinctive form of sinusitis that requires treatment of both the dental source and the sinus infection. Signs suggesting dental origin include unilateral symptoms, foul-smelling discharge, and jaw pain.

Immune deficiencies, whether from medical conditions or immunosuppressive medications, increase susceptibility to all infections including sinusitis. Patients with recurrent severe sinusitis may warrant evaluation for underlying immune problems.

Are There Serious Complications of Sinusitis?

Serious complications of sinusitis are rare but can include orbital cellulitis (eye infection), meningitis, brain abscess, and bone infection. Warning signs include severe headache, high fever, visual changes, facial swelling, or confusion. Seek immediate medical care if these develop.

While the vast majority of sinusitis cases resolve without complications, understanding potential serious outcomes helps patients recognize warning signs that require urgent medical attention. Complications occur when infection spreads beyond the sinuses to adjacent structures.

The risk of complications is higher in certain populations, including immunocompromised patients, young children, and those with delayed or inadequate treatment of bacterial sinusitis. Prompt recognition and treatment of complications is essential for preventing permanent damage.

Orbital Complications

Because the sinuses are located adjacent to the eye sockets, infection can potentially spread to the orbital tissues. This is most common with ethmoid sinusitis, particularly in children. Early orbital involvement may cause swelling of the eyelid, which can progress to more serious orbital cellulitis affecting the tissues behind the eye.

Signs of orbital complication include swelling and redness around the eye, eye pain with movement, protrusion of the eyeball, double vision, or decreased vision. These require immediate medical evaluation and typically treatment with intravenous antibiotics. In some cases, surgical drainage may be necessary.

Intracranial Complications

Very rarely, sinusitis can lead to intracranial complications such as meningitis, brain abscess, or infection of blood vessels in the brain. These complications are medical emergencies that can be life-threatening if not treated promptly.

Warning signs of intracranial involvement include severe persistent headache, high fever, stiff neck, confusion, lethargy, seizures, or focal neurological symptoms. These require emergency evaluation with imaging and often hospitalization for intravenous antibiotics and possible surgical intervention.

Sinusitis During Pregnancy

Pregnant women may be more susceptible to sinusitis due to hormonal changes that cause nasal swelling. Treatment focuses on safe options like saline irrigation, acetaminophen for pain, and certain nasal corticosteroid sprays. Antibiotics may be used when necessary but some types are avoided. Always consult your doctor or midwife.

Pregnancy brings physiological changes that can increase susceptibility to sinusitis. Hormonal changes cause swelling of the nasal membranes, while alterations in immune function may affect infection susceptibility. These factors make sinusitis relatively common during pregnancy.

Treatment during pregnancy requires careful consideration of medication safety for both mother and developing baby. Many standard sinusitis treatments are safe during pregnancy, but some should be avoided or used with caution.

Safe Treatment Options

Saline nasal irrigation is completely safe during pregnancy and should be a first-line treatment. Staying well-hydrated, using a humidifier, and sleeping with elevated head position are also safe and helpful measures.

Acetaminophen (paracetamol) is generally considered safe for pain and fever during pregnancy. Certain intranasal corticosteroid sprays, particularly budesonide, are considered low-risk and may be used for congestion. Oral decongestants should generally be avoided, especially during the first trimester.

When antibiotics are necessary, penicillin and cephalosporin antibiotics are generally considered safe during pregnancy. Certain other antibiotics should be avoided. Always consult with your healthcare provider before taking any medication during pregnancy.