Sinusitis

Sinusitis occurs when the lining of the nasal passages and sinuses becomes inflamed. The sinuses are air-filled spaces in the bones around the nose, eyes, and forehead. They produce mucus that normally drains through small openings into the nasal cavity. When inflammation causes the lining to swell, mucus may not drain normally. This can lead to congestion, pressure, nasal discharge, and difficulty breathing through the nose. Sinusitis can be caused by a viral infection, a bacterial infection, or persistent inflammation. Although people commonly use the term “sinus infection,” not every case of sinusitis is caused by bacteria, and antibiotics are not appropriate for every patient.

Sinusitis is classified according to how long symptoms last and whether they recur.

Acute Sinusitis

Acute sinusitis is a short-term episode of sinus inflammation, often associated with a cold or other respiratory infection. Symptoms generally last less than four weeks. Most acute cases improve without antibiotics because viruses cause many of these infections. A healthcare professional may suspect bacterial sinusitis when symptoms persist for at least 10 days without improvement or worsen after initially getting better.

Chronic Sinusitis

Chronic sinusitis, also called chronic rhinosinusitis, involves persistent inflammation lasting at least 12 weeks. Symptoms may include ongoing nasal blockage, drainage, facial pressure, and reduced smell.

Chronic sinusitis is often driven by inflammation rather than a continuous bacterial infection. Nasal polyps, allergies, anatomical factors, and other medical conditions may contribute. Diagnosis generally requires both an appropriate symptom history and objective evidence of inflammation, obtained through an examination, nasal endoscopy, or imaging when indicated.

Recurrent Acute Sinusitis

Recurrent acute sinusitis refers to repeated episodes of acute sinusitis with periods of improvement between episodes. Frequent episodes may warrant an evaluation for contributing factors, including allergies, nasal obstruction, or immune system problems.

Sinusitis symptoms vary depending on the cause, duration, and severity of inflammation. Common symptoms include:

• Nasal congestion or a blocked nose
• Thick nasal drainage or mucus dripping down the back of the throat
• Facial pain, pressure, or fullness around the cheeks, forehead, or eyes
• Reduced or lost sense of smell
• Headache or a sensation of pressure in the head
• Cough, particularly when lying down
• Upper tooth discomfort
• Bad breath
• Fatigue or difficulty sleeping

Not everyone experiences all of these symptoms. Facial pressure and headache can also occur with migraines and other conditions that are not sinusitis.

When should you see an ENT for sinus symptoms?

Consider an evaluation if your symptoms last 10 days or longer without improvement, become worse after initially improving, or repeatedly return. Symptoms that persist for 12 weeks or more should be assessed for possible chronic sinusitis. Seek urgent medical attention if sinus symptoms are accompanied by swelling or redness around an eye, changes in vision, a severe or unusual headache, confusion, or a stiff neck with fever. These can indicate a potentially serious complication.

Sinusitis can develop when infection, inflammation, or structural problems interfere with normal sinus drainage.

Viral Infections

Colds and other respiratory viruses commonly cause acute sinus inflammation. Swelling of the nasal and sinus lining can temporarily block drainage pathways and produce congestion and facial pressure.

Bacterial Infections

Some cases of acute sinusitis are bacterial. A clinician may suspect a bacterial infection when symptoms persist without improvement for at least 10 days, become substantially worse after an initial improvement, or present with severe symptoms such as high fever and purulent nasal drainage or facial pain for several consecutive days. Colored mucus alone does not establish that an infection is bacterial.

Allergies

Environmental allergies can inflame the nasal lining and contribute to congestion, drainage, and impaired sinus ventilation. Identifying and managing relevant allergies may help patients with recurring or persistent symptoms.

Nasal Polyps

Nasal polyps are soft, noncancerous growths associated with chronic inflammation. Depending on their size and location, they can obstruct airflow and sinus drainage and may contribute to chronic rhinosinusitis and loss of smell.

Deviated Septum and Other Anatomical Factors

A deviated nasal septum or other structural variations may contribute to nasal obstruction or impaired drainage in some patients. An examination can help determine whether an anatomical issue is relevant to a person’s symptoms.

Other Contributing Conditions

Some patients with persistent or recurrent sinus problems may have asthma, immune system disorders, or other inflammatory conditions. Environmental irritants, smoke exposure, and certain forms of reflux may also contribute to symptoms in selected cases. Identifying the factors that apply to each patient is an important part of treatment planning.

An ENT specialist evaluates the pattern and duration of symptoms, medical history, and findings from a physical examination. Depending on the situation, the assessment may include:

Medical history and symptom review: The physician asks about congestion, drainage, facial pain, changes in smell, previous infections, allergies, and response to earlier treatments.

Nasal examination: The physician examines the nasal passages for swelling, drainage, structural abnormalities, or possible nasal polyps.

Nasal endoscopy: A small endoscope may be used to examine the nasal cavity and sinus drainage areas more closely. This can help identify inflammation, polyps, or drainage that is not apparent during a routine examination.

CT scan of the sinuses: Imaging may be appropriate when chronic sinusitis is suspected, symptoms persist despite treatment, surgery is being considered, or complications or alternative diagnoses need to be assessed. Imaging is not routinely necessary for uncomplicated acute sinusitis.

Additional testing: Depending on the patient’s history and examination, allergy testing, immune evaluation, or selected cultures may be considered. The goal is to confirm the diagnosis, identify relevant contributing factors, and select treatment based on the findings.

The best treatment for sinusitis depends on whether the condition is acute or chronic, what is causing the inflammation, and how severe the symptoms are.

Saline Nasal Irrigation

Saline irrigation helps flush mucus and irritants from the nasal passages. It is commonly recommended for symptom relief in chronic rhinosinusitis and may also help during acute episodes. Use distilled, sterile, or previously boiled and cooled water when preparing nasal rinses, and clean the irrigation device according to its instructions.

Nasal Corticosteroid Sprays

Intranasal corticosteroids reduce inflammation in the nasal lining. They are commonly used for chronic sinusitis, particularly when inflammation or nasal polyps contribute to symptoms. A clinician can advise on the appropriate product and how to use it correctly.

Allergy Management

When allergies contribute to nasal inflammation, treatment may include allergen avoidance, appropriate allergy medications, or other allergy-directed care. The choice depends on the symptoms and evaluation findings.

Antibiotics

Antibiotics treat bacterial infections, not viral infections or inflammation alone. Many acute sinus infections improve without antibiotics. A clinician may recommend antibiotics when the history and examination support a bacterial infection. The decision should take account of symptom severity, duration, medical history, and the risks and benefits of treatment.

Evaluation of Contributing Conditions

For persistent or recurrent sinusitis, treatment may also involve evaluating nasal polyps, structural obstruction, asthma, immune dysfunction, or other relevant conditions. Addressing these factors may be important when symptoms do not respond adequately to routine measures.

For additional information, see our sinus treatment options.

Sinus surgery may be considered for selected patients with chronic rhinosinusitis when appropriate medical treatment has not provided sufficient relief and examination or imaging findings support a surgical approach. Surgery is not necessary for most uncomplicated acute sinus infections.

Endoscopic Sinus Surgery

Endoscopic sinus surgery uses a small camera and specialized instruments inserted through the nostrils. The surgeon treats obstructed sinus drainage pathways and removes selected tissue or other obstructions when indicated. The aim is to improve sinus drainage and ventilation and, in appropriate patients, make ongoing topical treatments more effective.

Balloon Sinus Dilation

Balloon sinus dilation uses a small balloon to widen selected sinus openings. It may be appropriate for certain patients, but it is not suitable for every type of sinus disease or every sinus. The choice between continued medical treatment, balloon dilation, endoscopic sinus surgery, or another approach depends on the patient’s diagnosis, anatomy, disease extent, prior treatment, and preferences. Your physician can explain the potential benefits, limitations, risks, and alternatives before a treatment decision is made.