Sinusitis

Summary

Sinusitis is inflammation of the air-filled spaces around the nose, often following a cold. Symptoms can include nasal blockage, nasal or post-nasal discharge, facial pressure or headache and a reduced sense of smell. An ENT specialist assesses persistent symptoms through the medical history and examination, sometimes with nasal endoscopy or imaging. Treatment may include saline rinsing, nasal medication and, in selected persistent cases, surgery. Rare complications require urgent medical care.

Sinusitis

What are the paranasal sinuses? The sinuses are air-filled spaces in the bones above, between and beside the nose. They connect with the nasal cavity through small drainage openings.

What are the symptoms? Acute sinusitis often starts with cold-like symptoms. Swelling of the nasal lining causes blockage and mucus in the nose or throat. Smell and taste may be reduced, and cough, sore throat, facial pressure or pain can occur. Mucus trapped behind narrowed drainage openings can contribute to pressure around the forehead, cheeks or eyes.

Symptoms lasting 12 weeks or longer are generally described as chronic rhinosinusitis. Persistent, recurrent or severe symptoms may require assessment by an ENT specialist.

Rarely, infection spreads outside the sinuses. Seek urgent medical care for swelling or redness around an eye, impaired vision, severe or rapidly worsening headache, high fever, neck stiffness, confusion, unusual drowsiness or neurological symptoms.

Diagnosis The clinician considers the pattern and duration of symptoms and examines the nose. Nasal endoscopy uses a small camera to inspect deeper areas and look for inflammation, polyps, pus or structural narrowing. A CT scan is used in selected persistent or complicated cases, particularly when surgery is being considered; routine imaging is not usually needed for an uncomplicated acute episode. Blood or allergy testing may be useful when the history suggests another contributing condition.

Treatment Treatment aims to reduce inflammation, improve drainage and relieve symptoms. Saline nasal rinsing can help clear mucus. A corticosteroid nasal spray may be recommended for longer-term control, especially with chronic inflammation or nasal polyps.

Decongestant drops or sprays containing xylometazoline can provide short-term relief, but should only be used for the duration advised—usually no more than several days—because longer use can cause rebound congestion. Oral corticosteroids are reserved for selected cases and require medical supervision.

Antibiotics are not needed for most viral episodes. They may be prescribed when bacterial infection is strongly suspected, symptoms are severe or complications are a concern. The clinician will consider benefits, side effects and antibiotic resistance.

If appropriate medical treatment does not control chronic symptoms, endoscopic sinus surgery may be discussed to widen drainage pathways and improve access for topical treatment. The decision is based on symptoms, examination and imaging findings.