What is sinusitis and how common is it?
Sinusitis is inflammation of the mucous membrane lining the sinuses – air-filled cavities within the facial bones that are connected to the nasal cavity by narrow channels. For a healthy sinus to stay ventilated and for its secretions to drain into the nose, these connecting channels must remain open. When the channels narrow or become blocked for any reason, secretions build up inside the sinus, pressure rises, and this environment becomes fertile ground for bacteria or viruses to multiply. Sinusitis is a very common condition: it affects a large proportion of adults at some point in their lives and is among the leading reasons for visiting ENT outpatient clinics.
Sinusitis is classified by duration. When symptoms last less than four weeks it is called acute sinusitis; when they last from four to twelve weeks, subacute sinusitis; and when they last longer than twelve weeks and keep recurring, chronic sinusitis. When four or more acute attacks occur in a year, the term recurrent acute sinusitis is used. This distinction matters, because the treatment approach and the underlying causes can differ from group to group.
What are the symptoms?
The most characteristic features of sinusitis are a feeling of fullness and pressure in the face, nasal obstruction, discoloured or thick nasal discharge, post-nasal drip and a reduced sense of smell. Facial pain that worsens on bending the head forward, and pressure felt particularly in the forehead, around the eyes, in the cheeks or in the upper teeth, are also common complaints. Acute sinusitis usually appears after a common cold; bacterial sinusitis is suspected when a condition that began in its first days as a viral upper respiratory tract infection worsens after five to seven days or has still not improved after ten days.
In chronic sinusitis the symptoms are generally milder than in an acute attack but persist continuously; patients may complain of long-standing nasal obstruction, post-nasal drip, fatigue and difficulty concentrating. Fever is rare in the chronic form and is seen mainly during acute flare-ups. In some patients loss of smell may be the most prominent complaint; this is encountered more often especially when nasal polyps are also present.
Causes and risk factors
The most common underlying cause of sinusitis is blockage of the sinus ostia (drainage openings). Structural and functional causes that can lead to this blockage include a deviated septum, turbinate hypertrophy (enlargement of the turbinates), nasal polyps, allergic rhinitis and, in children, enlarged adenoids. These structural problems narrow the natural drainage pathways of the sinuses, setting the stage for secretions to accumulate and for infection.
Allergic rhinitis markedly increases the risk of sinusitis by causing chronic swelling of the mucosa and increased secretion production; for this reason, an underlying allergic background should always be looked for in recurrent sinusitis attacks. Exposure to cigarette smoke, air pollution, spending long periods in dry and air-conditioned environments, activities such as swimming and diving that let water into the nose, dental root infections (especially of the upper molars) and conditions that suppress the immune system are other factors that make sinusitis more likely to develop. In rare conditions such as cystic fibrosis and primary ciliary dyskinesia, the mucociliary clearance mechanism is impaired, so recurrent and treatment-resistant sinusitis may be seen.
How does the diagnostic process work?
The diagnosis of sinusitis relies largely on the complaints the patient describes and on the examination findings. After a detailed history is taken, the inside of the nose is assessed with anterior and posterior rhinoscopy; however, the most valuable information is usually obtained with nasal endoscopy. Using a thin, lighted endoscope, the inside of the nose and the sinus openings are examined closely; inflamed secretions, polyps, turbinate enlargement or a deviated septum can be seen clearly during this examination.
In simple, non-recurrent cases of acute sinusitis, imaging is generally not needed; the diagnosis is made on clinical findings. In contrast, in cases where chronic sinusitis is suspected, where there is no response to treatment or where surgery is planned, computed tomography (CT) of the paranasal sinuses is the gold-standard imaging method. This test shows in detail the anatomy of the sinuses, the site of the blockage and the extent of the disease. When an allergic background is suspected, allergy tests can be performed, and in recurrent or resistant cases a culture can be taken to choose the appropriate antibiotic.
In terms of differential diagnosis, conditions that can cause facial pain – such as infections originating from dental roots, tension-type headache and migraine – also need to be considered, because these conditions can sometimes be confused with sinusitis. An accurate diagnosis is very important for avoiding unnecessary antibiotic use and for drawing up an appropriate treatment plan.
Treatment options
Conservative (non-surgical) treatment
The first step in treating acute sinusitis is supportive care: drinking plenty of fluids, nasal rinses with isotonic or hypertonic saline and, when needed, short-term decongestant sprays help to ease the symptoms. In cases where a bacterial infection is suspected, or where symptoms last longer than ten days or get worse, antibiotic treatment is started; the choice is usually an amoxicillin-based agent.
The mainstay of chronic sinusitis treatment is long-term intranasal corticosteroid sprays and regular saline irrigation; these treatments reduce mucosal inflammation and make drainage easier. If allergic rhinitis is also present, antihistamines and allergen control are added to the treatment. In chronic sinusitis the treatment period generally ranges from weeks to months, and the response is assessed at regular intervals.
Surgical treatment
Endoscopic sinus surgery comes into consideration in chronic sinusitis whose symptoms persist despite appropriate medical treatment, when nasal polyps are present, or when there are structural causes of obstruction such as a deviated septum or severe turbinate hypertrophy. The operation is performed through the nose with the help of a camera and fine surgical instruments; it requires no external incision. The aim is to widen the natural drainage openings of the sinuses so that ventilation and the flow of secretions are permanently restored. Where necessary, septoplasty or turbinate reduction can be performed in the same session.
Possible risks of sinus surgery
Endoscopic sinus surgery is performed through the nose, without external incisions, and is generally a safe operation. As with any surgical procedure, there are some risks.
Common and usually temporary problems: Mild blood-stained discharge, nasal blockage and crusting are expected in the first days. Adhesions (synechiae) may form inside the nose; they are prevented or removed by cleaning at follow-up visits. Rarely, infection or bleeding that requires nasal packing can occur after surgery.
Sense of smell and recurrence: Smell usually improves as healing progresses and only rarely decreases. Particularly in chronic sinusitis with nasal polyps, the disease may recur over time, which is why regular follow-up and nasal care remain important after surgery.
Rare but serious risks: Because the sinuses lie next to the eye and the skull base, there may very rarely be bruising or swelling around the eye, or watery eyes due to involvement of the tear duct, and even more rarely problems with vision or eye movement, or a cerebrospinal fluid (CSF) leak. Most of these complications can be treated when recognised early.
After surgery, contact us without delay if you have nasal bleeding that does not stop, increasing swelling around the eye, a change in vision, clear watery discharge from the nose or a severe headache.
Complications of sinusitis
Sinusitis usually heals without complications; complications are rare and are mostly seen in acute sinusitis that is left untreated or assessed late. Because the sinuses lie next to the eye and the membranes surrounding the brain, the infection can rarely spread to these areas.
Complications around the eye (orbital): This is the most common group of complications, especially in children. It shows itself as swelling and redness of the eyelid, pain on moving the eye, double vision or reduced vision. It can range from infection limited to the eyelid to an abscess inside the eye socket.
Intracranial complications: These are very rare. Meningitis or an abscess between the membranes of the brain or in the brain itself can develop. Severe headache, neck stiffness, high fever, a change in consciousness or seizures are warning signs.
Bone complications: Infection of the frontal sinus can rarely spread to the frontal bone and cause a soft swelling on the forehead.
Problems associated with chronic sinusitis: Long-standing blockage can lead to a fluid-filled sac within a sinus (mucocele), and it can make asthma harder to control.
These conditions usually require treatment in hospital: intravenous medication, imaging and, if necessary, surgical drainage. If you notice swelling around the eye, a change in vision, a severe headache or confusion, you need to be assessed without delay.
Recovery and follow-up
In most patients acute sinusitis clears up completely within one to two weeks. In chronic sinusitis recovery is more gradual; the response to medical treatment is usually assessed within a few weeks, and the treatment period is extended if necessary. After surgery, mild crusting, discharge and temporary blockage inside the nose lasting a few weeks are expected findings; regular saline rinses during this period speed up healing. Endoscopic cleaning sessions performed under the doctor’s supervision are recommended in the first weeks to support healthy healing of the operated area.
In patients prone to chronic sinusitis, keeping an underlying allergic rhinitis or structural problems under control in the long term reduces recurrence. For this reason, regular follow-up after surgery as well, and continuation of preventive intranasal treatment when necessary, are recommended. Avoiding cigarette smoke, using a humidifier in dry environments and, in patients with seasonal allergies, reducing allergen exposure can markedly lower the frequency of attacks.
In monitoring the response to treatment, repeat endoscopic examination when needed is as useful a guide as the complaints the patient reports. In cases where symptoms recur or regress more slowly than expected, an underlying allergic background, treatment-resistant polyp disease or, rarely, an immune-related condition may be investigated. This approach allows the treatment plan to be continually updated for the individual.
Frequently asked questions
Is sinusitis contagious? Sinusitis itself is not contagious, but the viral upper respiratory tract infections that set the stage for it can be.
Are antibiotics needed for every sinusitis attack? No. Most cases of acute sinusitis are viral in origin and resolve on their own with supportive treatment; antibiotics are used only when signs of bacterial infection become evident.
Do saline nasal rinses really work? Yes. Regular saline irrigation is an evidence-based treatment with few side effects in both acute and chronic sinusitis, and it helps to clear secretions from the mucosa.
Is surgery a definitive cure? Endoscopic sinus surgery opens the drainage pathways and substantially reduces symptoms, but because the underlying allergic or inflammatory tendency may persist, preventive treatment and regular follow-up remain important after the operation too.
When does sinusitis need urgent assessment? Findings such as swelling around the eyes, visual disturbance, severe headache, high fever or a change in consciousness may be signs of rare but serious complications and therefore require immediate medical assessment.
For the summary:
Back to the short articleThis article is for general information purposes only; please consult your physician for diagnosis and treatment.