Overview
Acute sinusitis is short-term inflammation of the air spaces in the facial bones (sinuses). Symptoms last less than 4 weeks; it often develops after a cold.
It is very common. Most cases are viral and do not require antibiotics. Only 2-10% of cases develop into bacterial sinusitis.
Symptoms
- Nasal congestion
- Thick, yellow-green nasal discharge
- Postnasal drip
- Facial fullness and pain (forehead, around eyes, cheeks)
- Worsening facial pain when bending over
- Headache
- Toothache (upper teeth)
- Decreased sense of smell and taste
- Cough (especially at night)
- Weakness
- Fever
- Bad breath
- Ear fullness
Causes
Viral causes (most common, 90%):
- Common cold viruses
- Influenza
Bacterial causes:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Fungal infections: In immunocompromised individuals
Other triggers:
- Allergic rhinitis
- Nasal polyps
- Septum deviation
- Dental infection (upper molar)
- Facial trauma
- Cigarette smoke, air pollution
Risk Factors
- Common cold
- Allergic rhinitis
- Smoking, air pollution
- Structural nasal problems
- Dental infections
- Weakened immune system
- Obstructive sleep apnea
- Reflux
- Frequent air travel, diving
Complications (Rare But Serious)
- Progression to chronic sinusitis
- Orbital cellulitis (eye area infection)
- Vision problems
- Meningitis
- Brain abscess
- Cavernous sinus thrombosis
- Osteomyelitis (bone infection)
When to See a Doctor
Routine visits:
- When symptoms last more than 10 days
- If symptoms start to worsen ("double sickness" - improving and then worsening again)
- High fever
- Severe facial pain
- Recurrent sinusitis
Emergency:
- Swelling, redness around the eye
- Visual disturbance
- Severe, throbbing headache
- Neck stiffness
- Change in consciousness
- Redness or swelling on the face
Diagnosis and Treatment
Diagnosis:
- Detailed ENT examination
- Endoscopic nasal examination
- CT is not usually needed in acute sinusitis
- Imaging if there is fever, severe facial pain, or edema
Treatment:
Viral sinusitis (most cases):
- Symptom-relieving treatment is sufficient
- Nasal saline irrigation (most effective)
- Steam inhalation
- Plenty of fluids
- Rest
- Pain relievers (paracetamol, ibuprofen)
- Nasal decongestant sprays (short-term, 3-5 days)
- Nasal corticosteroids
- Antihistamines (if allergic)
Bacterial sinusitis:
- Antibiotics (5-10 days): Amoxicillin-clavulanate first choice
- Macrolides or doxycycline for penicillin allergy
- Started if symptoms last longer than 10 days or worsen
Severe cases:
- Hospitalization
- Intravenous antibiotics
- Sometimes surgical drainage
Prevention
- Avoid upper respiratory infections
- Wash your hands often
- Be careful with colds (to prevent progression)
- Do not smoke; avoid secondhand smoke
- Wear a mask in polluted areas
- Treat your allergic rhinitis
- Make nasal saline irrigation a habit
- Keep your home humid (especially in winter)
- Drink plenty of water
- Treat structural nasal problems
- Get regular flu and pneumococcal vaccines