Patient information from BMJ

Sinusitis

Last published:Dec 06, 2021

Sinusitis can be very painful but it usually clears up on its own. If your symptoms bother you a lot there are treatments that might help.

You can use our information to talk to your doctor or pharmacist and decide which treatments are best for you. 

What is sinusitis?

Sinuses are small spaces in your skull that are filled with air. You have them in your cheek bones, behind and between your eyes, and in your forehead. They make mucus, which normally drains through small openings into the nose.

If you have sinusitis your sinuses are inflamed (swollen), so the mucus can't drain away. The sinuses in your cheeks are most often affected.

People often get sinusitis after they've had a viral infection such as a cold or the flu. Hay fever and other allergies can also cause sinusitis.

Sinusitis that lasts a long time is called chronic sinusitis.

Short attacks that last for four weeks or less are called acute sinusitis. Here, we look at treatments for acute sinusitis, which is the most common type

What are the symptoms?

Sinusitis can be very painful. The symptoms often start just as you think you're getting better from an infection. If your nose feels blocked you may think you have a cold, but you may have acute sinusitis.

With sinusitis you may get some of these symptoms as well as a blocked nose:

• pain in your forehead, upper jaw, teeth, cheeks, or around your eyes

• loss of your sense of smell

• a headache that is worse when you lean forward (it might start when you get up in the morning)

• toothache or pain when you eat

• large amounts of green or yellow mucus in your nose

• feeling generally unwell

• a sore throat, which is caused by the mucus dripping down from your nose into your throat.

Your doctor will usually be able to tell if you have sinusitis by your symptoms. If your sinusitis is very bad, or if it keeps coming back, you may need to see a specialist or have tests such as CT (computerised tomography) scan.

What treatments work?

Sinusitis usually gets better on its own, but there are treatments that can help relieve the symptoms.

Simple painkillers like paracetamol or ibuprofen, or tablets that combine paracetamol with codeine, help ease the pain for many people. But if your symptoms are very bad it's best to see your doctor.

Steroid nasal sprays

Steroid nasal sprays are used to reduce inflammation (swelling) in the nose. The full name for these steroids is corticosteroids. They are not the same as the anabolic steroids used by some bodybuilders and athletes.

Some steroid nasal sprays are available over the counter. For others you'll need a prescription from your doctor. There are several different steroid sprays.

You breathe these sprays in through your nose once or twice a day. You'll probably need to use them for several weeks.

These sprays can cause side effects. For example, some people who use a steroid nasal spray get a headache or a nosebleed.

Decongestants

These are available from pharmacies without a prescription. But the research on how well they work for sinusitis isn't very clear.

Decongestants come as tablets, nasal sprays, and drops. The idea is that they relieve a blocked nose so you can breathe more easily.

These medicines are not suitable for some people. If you have heart disease, diabetes, or a thyroid condition, check with your doctor before using a decongestant.

You should not use decongestant nasal sprays for longer than a week. After that they can cause 'rebound congestion'. This means you get a blocked nose again after you stop taking them.

Antibiotics

Antibiotics are medicines that treat bacterial infections. They are not often used for sinusitis because most sinusitis is caused by viruses, not by bacteria.

If you have sinusitis caused by bacteria then antibiotics might help clear up your symptoms more quickly. But most people with bacterial sinusitis get better without antibiotics.

Other treatments

Some people inhale steam to help relieve blocked sinuses, but there is a danger of scalding.

Another option is rinsing your nose with salt water spray. It might help to reduce swelling and make mucus thinner.

What will happen to me?

About two-thirds of people with acute sinusitis get better without having any treatment from their doctor, usually within five to 10 days. But some people get repeat attacks.

There's also a chance that after one attack you will get chronic sinusitis (sinusitis that lasts more than three months). If this happens to you, see your doctor. You may need to see a specialist doctor for tests and treatment.

In rare cases sinusitis can cause serious problems that affect the brain and eyes. Always see a doctor straight away if:

• you have a very bad headache or a stiff neck

• bright light causes you pain

• you have double vision

• you have swelling around the eyes

• you have a high fever, or

• you feel confused or unusually drowsy.