Sinusitis
Introduction
Sinusitis is inflammation of the lining of the sinuses, caused by a viral or bacterial infection.
The sinuses are small, air-filled cavities behind your cheekbones and forehead (see below).
Sinusitis typically causes a high temperature, pain and tenderness in the face, and a blocked or runny nose (see symptoms of sinusitis).
It is a common condition and can affect people of any age.
The sinuses
You have four pairs of sinuses in your head:
- two sinuses behind your forehead
- two at either side of the bridge of your nose
- two behind your eyes
- two behind your cheekbones
Your sinuses open up into the cavity of your nose and help control the temperature and water content of the air reaching your lungs.
Usually, the mucus naturally produced by your sinuses drains into your nose through small channels. These channels can become blocked when the sinuses are infected and inflamed.
It is the sinuses behind the cheekbones( the largest ones) that are most commonly affected.
Acute and chronic sinusitis
Sinusitis is classed as either:
- Acute when it develops quickly (over a few days) following a cold or flu and clears up within 12 weeks, or
- Chronic when symptoms last for more than 12 weeks.
Chronic sinusitis is less common, and can sometimes last for many months.
Outlook
Sinusitis often clears up by itself, and about two thirds of those who get the condition do not need to see their GP.
On average, sinusitis takes about two-and-a-half weeks to clear.
Over-the-counter painkillers and decongestants can be used to relieve facial pain and a blocked nose. Antibiotics are unlikely to help unless the sinusitis becomes persistent.
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Symptoms
The most common symptoms of sinusitis include:
Other possible symptoms, include:
Children
Children with sinusitis may be irritable, breathe through their mouth and have difficulty feeding.
Their speech may sound nasal (like they have a stuffy cold) because their sinuses are blocked.
If you notice these symptoms in your child, take them to see your GP.
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Causes
There are a number of ways your sinuses can become inflamed and blocked.
Infections
The most common cause of sinusitis is a viral infection, usually the common cold or influenza (flu). The cold or flu virus spreads to the sinuses from the upper airways.
Sometimes, a secondary bacterial infection can develop, leading to swelling inside the sinuses.
An infected tooth may also cause the sinuses to become infected.
Other causes
There are a number of other factors that can make the sinuses more vulnerable to infection. These include:
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Substances that may irritate the sinuses, such as air pollution, smoke, chemicals (such as pesticides), disinfectants and household detergents.
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Allergies, such as allergic rhinitis, asthma and hayfever.
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Anything that causes narrowing of the nose passages, such as facial injuries or a nasal polyps (growths) inside the nose. Mucus can build up behind the narrowed areas, leading to sinus infection.
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Cystic fibrosis, a genetic condition that causes thick, sticky mucus to build up within the body, making you prone to infections.
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Diagnosis
Your GP will usually be able to diagnose sinusitis from your symptoms.
It is nearly always caused by a viral infection, such as the common cold or flu, and is diagnosed based on the presence of:
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nasal blockage or runny nose with facial pain, and/or
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a reduction or loss of sense of smell.
It is acute sinusitis if these symptoms last for less than 12 weeks, and chronic sinusitis if they last for longer than this.
Loss of smell is more common and facial pain less common in chronic (persistent) sinusitis.
Referral to a specialist
If your sinusitis is severe or keeps coming back, your GP may refer you to an ear, nose and throat (ENT) specialist who will carry out tests to determine the underlying cause.
You may have an X-ray or CT scan to find out the cause of your sinusitis (a series of X-rays are taken for a CT scan, to produce a detailed picture of your sinuses).
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Treatment
About two thirds of people who get sinusitis do not need to see their GP. Most cases are caused by a viral infection, which often clears up by itself.
Sinusitis takes about two-and-a-half weeks to clear, so it lasts longer than the common cold.
If you have mild sinusitis you can take over-the-counter painkillers and decongestants to relieve your symptoms (see 'Relieving your symptoms' below).
Seeking treatment from your GP
See your GP if your symptoms do not improve after seven days, if they are getting worse, or if the sinusitis keeps coming back.
In these cases, treatment options are:
- antibiotics
- steroid sprays or drops
- surgery (if other treatments have failed)
However, these treatments are only used for severe cases of sinusitis.
Your GP may refer you to an ear, nose and throat (ENT) specialist, who will carry out some tests to determine the underlying cause of your chronic (persistent) sinusitis. Chronic sinusitis may last for several months.
Antibiotics
If your symptoms are severe and your sinusitis has not cleared within seven days, your GP may prescribe you antibiotics. About one third of people with sinusitis will develop a bacterial infection that requires antibiotics.
Steroid sprays or drops
Steroid sprays drops or implants are usually prescribed if you are diagnosed with chronic sinusitis, as they can help to reduce your swollen sinuses.
Surgery
If your symptoms do not improve after a course of antibiotics, and you are still experiencing difficulties with your affected sinuses, functional endoscopic sinus surgery (FESS) may be recommended. This is the most common operation for sinusitis and can be successful in relieving the symptoms.
FESS is usually done under general anaesthetic (you are put to sleep), but it can also be done under local anaesthetic (where your nose is numbed).
The surgeon will insert an endoscope into your nose. This is a thin tube with a lens that magnifies the inside of your nose. They will then be able to see the opening of your sinus drainage channels.
The surgeon will either:
- remove any tissues, such as nasal polyps (growths), that are blocking the affected sinus, or
- inflate a tiny balloon inside your nose, to open up the drainage passages from your sinuses. This is called a balloon catheter dilation.
The operation will improve your sinus drainage and will help the sinus to function properly.
The surgeon may also insert a self-dissolving implant into your sinuses, which expands to prop the sinuses open and deliver the steroid drug mometasone directly to the sinus lining.
For more information, read ENT UK's leaflet on functional endoscopic sinus surgery and the 2008 guidelines from the National Institute for Health and Clinical Excellence (NICE) on balloon catheter dilation for chronic sinusitis.
Relieving your symptoms
Over-the-counter painkillers such as paracetamol, ibuprofen or aspirin can be used to relieve a headache, high temperature and any facial pain or tenderness. Children aged under 16 should not take aspirin, and ibuprofen is not recommended for people with asthma.
Decongestant nasal sprays or drops are available over the counter from pharmacies. They may be useful for relieving a blocked nose and for helping you to breathe more easily. However, decongestants will not speed up recovery from sinusitis and should not be used for more than a week at a time.
Not recommended
The following are not recommended as treatments for sinusitis:
- inhaling steam (due to the danger of burns),
- steroid tablets,
- complementary or alternative medicine (the benefits have not been proven),
- antihistamines, and
- mucolytics (drugs that thin the mucus).
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Complications
Complications in children
Complications of sinusitis are more common in children than in adults. If your child has had sinusitis and has swelling around the cheekbone or eyelid, it may be facial cellulitis (bacterial infection of the skin and soft tissue) or periorbital cellulitis (infection of the tissue surrounding the eye). Read about cellulitis for more information.
If you notice these symptoms, take your child to see your GP, who may refer them to an ear, nose and throat (ENT) specialist. Alternatively, you can call NHS Direct Wales on 0845 46 47 for further information and advice.
Infection of the bone
When the condition is severe, antibiotics are often able to control the spread of infection to the nearby bone. However, in very rare cases (about 1 in 10,000), infection can spread to the area surrounding your eye, the bones, the blood or the brain.
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