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Acute sinusitis | Pokenga pakohu ihu
Also known as rhinosinusitis
Key points about acute sinusitis in adults
Sinuses are air-filled spaces in the skull, located behind your forehead, eyes, nose and cheeks.
Sinusitis (pokenga pakohu ihu) means infection or inflammation of the sinuses. It causes a heavy, full feeling in your head that can be painful and uncomfortable.
Sinusitis can happen when you've had a cold, or hay feveror another allergy.
It usually gets better on its own after 1 to 2 weeks.
Home remedies and pain-relieving medicines may provide some relief.
Antibiotics aren't usually needed to treat sinusitis.
In chronic sinusitis symptoms continue for 3 months or more.
Paranasal sinuses (tiny air spaces around your nose) make mucous that drains out through your nose. Sometimes the lining of the sinuses become inflamed or infected. This usually happens after you’ve had an infection of your upper airways (eg, a cold) or when you've had hay fever or another allergy. Some people get sinusitis after every cold, while others get it rarely.
Sinusitis can be caused by different kinds of germs – viruses, bacteria or, rarely, a fungus. Viral sinusitis is the most common cause. Bacterial or fungal infection is much less common. It's estimated that only 0.5% to 2% of cases are complicated by a bacterial infection.
Some things that can increase your risk of getting sinusitis include:
smoking
regular use of some nasal decongestants
nasal polyps (swellings in the linings of your nose or sinuses)
dental disease
a deviated nasal septum (where the wall between your nostrils has been shifted sideways by an injury)
changes in air pressure, eg, during an airplane flight or scuba diving
conditions that weaken your immune system, eg, chemotherapy treatment
ciliary dysmotility (eg, with cystic fibrosis or Kartagener’s syndrome) where the tiny hairs (called cilia) that move mucus through your sinuses and airways don't work as they should.
The image below shows the location of the paranasal sinuses behind the forehead, eyes, nose and cheeks.
Image credit: Canva
People who have sinusitis often describe their face as feeling heavy or full, or as if they have a cold they can’t get rid of. Symptoms commonly experienced include:
headache or pain around your eyes, forehead, cheeks or teeth which gets worse when leaning forward
feeling of pressure around your face and inside your head
a blocked or stuffy nose
a runny nose
a post-nasal drip (when mucus from the sinus area drips down the inside of your throat)
loss of sense of smell or taste
a headache that usually affects your cheeks or front of your face.
As well as the symptoms listed above, you may also:
have a high temperature (fever)
feel generally unwell and tired
get bad breath, toothache or a cough
have a feeling of pressure or fullness in your ears.
Your healthcare provider can usually diagnose acute sinusitis from the symptoms you describe. They may also check to see if you have a temperature or if you have tenderness around your sinuses. They may also examine your nose, as often the lining of your nose swells up when you have acute sinusitis.
Occasionally, they may also ask you to have a CT scan if the diagnosis isn't clear. X-rays of your sinuses aren't helpful.
The following self-care treatments and medications can help relieve your pain and discomfort. Sinus infections are usually caused by a viral infection, so antibiotics aren't usually effective. However, there are certain situations when you may be prescribed antibiotics.
Self-care
To help relieve the pain and discomfort caused by sinusitis, try the following home treatments:
Rest to help your body to heal faster.
Keep hydrated and drink lots of fluids to help thin the mucus.
Hold a hot compress or warm face pack over the painful area.
Consider using saline (salt water) nasal spray or drops, or a sinus rinse to relieve congestion and blockage in your nose.
The following video demonstrates how to do a sinus rinse. It may take a few moments to load.
(Mayo Clinic, US, 2020)
Important note
Breathing in hot steam is a traditional remedy but is not recommended because there's little evidence that it helps. Also, there is a risk you might burn yourself. However, some people find that their nose feels clearer for a short while after a hot shower.
Medicines
Pain relief medication: take pain relief medicines (eg, paracetamol), or non-steroidal anti-inflammatories (NSAIDs, eg, ibuprofen) to reduce pain and discomfort. Read more about how to use NSAIDs safely.
Antihistamines can help to dry up nasal secretions and relieve a post-nasal drip if your symptoms are caused by hay fever or an allergy. There's no evidence that they'll work if your congestion is cased by viruses or bacteria. Some antihistamines can make you sleepy so if you need to be alert during the day, (eg, for driving) use one that won't have this effect. Examples are loratadine or cetirizine. For some people antihistamines can make the mucous thicker. Read more about antihistamines.
Decongestant nasal sprays or drops (eg, oxymetazoline) can help to reduce congestion and swelling within your nose and sinuses. But you need to use them carefully because using them too much can make your symptoms worse. They can actually increase congestion if used for more than 3 days. Read more about nasal decongestants.
Steroid nasal sprays: your healthcare provider may recommend the use of steroid nasal sprays (eg, Flixonase) to relieve your symptoms. You will usually feel better after using them for 2 to 3 days, but they may take a few weeks to work fully.
Decongestant tablets: Although these have been used a lot in the past, there is little recent evidence that these medicines work and they can be expensive to buy.
Do I need antibiotics?
Antibiotics are seldom needed to treat sinusitis because sinusitis is mostly caused by viruses (a viral infection). Antibiotics only work against bacteria (a bacterial infection) but not viruses.
Using antibiotics when they are not needed can lead to antibiotic resistance. This is when overuse of antibiotics encourages the growth of bacteria that can’t be controlled easily with drugs. That can make it harder in the future to treat any infections you might get, and make antibiotics less effective for everyone. Antibiotics can also cause serious side effects so it’s important to only use them when they’ll help.
Antibiotics are considered when symptoms last longer than 10 days, start to improve but then worsen again, or are very severe. Severe symptoms could include:
a fever over 39°C
extreme pain and tenderness over your sinuses
signs of a skin infection, eg, a hot, red rash that spreads quickly.
If you are given antibiotics, finish the full course.
Many people recover from sinusitis caused by colds in about a week, but symptoms can take anywhere from 10 days up to 8 weeks to clear up. If symptoms persist for 3 months or more, it's called chronic sinusitis. This condition is a bit more complex where inflammation of the mucous membranes takes much longer to heal. Read more about chronic sinusitis.
Most cases are not bacterial – consider inhaled nasal steroid.
Consider antibiotics when symptoms that persist for more than 10 days, severe symptoms or fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms after initial improvement.
Antibiotic treatment is not required in the majority of cases.
More than 90% of patients with sinusitis will not have a bacterial infection. Even in the small minority that do, symptoms are self-limiting and antibiotics only offer a marginal benefit.
Antibiotics may be considered for patients with symptoms that persist for more than 10 days, onset of severe symptoms or fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms after initial improvement.
