Sinusitis

Whether you have acute or chronic sinusitis, the main symptom is a throbbing pain and pressure in the face, which is made worse by bending forward. If you have acute sinusitis, the pain is often more severe than if you have chronic sinusitis.

Depending on which of your sinuses is affected, the pain and pressure can appear in different places including:

• your forehead, top of the head or temples- this is due to the inflammation of the sphenoid sinus
• the top of your jaw, teeth and cheeks
• around and between your eyes – this is due to the inflammation of the ethmoid sinuses
• earache, neck pain or ache behind the eyes – this is due to the inflammation of the sphenoid sinus

Other symptoms of sinusitis can include:

• a blocked or stuffy nose
• a sore throat
• a cough
• changes to your sense of smell, loss of taste
• green or yellow mucus, which can drain down the back of your nose into your throat
• a fever
• weakness, tiredness
• bad breath (halitosis)

Your doctor will ask about symptoms and examine you by touching parts of your face to find any pain or swelling. He may use a technique called transillumination, where a bright light held against the cheek or forehead in a dark room. The light should pass through normal sinuses; if it does not, this suggests a blockage. If your symptoms have worsened after five days, or lasted longer than 10 days, your doctor may diagnose you with acute sinusitis.

If after 12 weeks your symptoms haven’t gone away completely, you may be diagnosed as having chronic sinusitis.

Your GP will always consider if something else is causing your symptoms. He may recommend X-rays, magnetic resonance imaging (MRI) or computerize tomography (CT scan). This is because the symptoms of sinusitis can be similar to symptoms from other causes such as an allergy or dental infection.

If you have chronic sinusitis and your treatment hasn’t worked or if your sinusitis keeps coming back, your GP may refer you to see another doctor. This is likely to be an ear, nose and throat (ENT) specialist.

Your ENT specialist may suggest you have a test called a nasal endoscopy. In this test, your doctor puts a narrow, flexible, tube-like telescopic camera (called an endoscope) into your nose and sinuses. This shows the lining of your sinuses and helps your doctor to see any blockages. You may need other tests too, such as a CT scan to find out what’s going on.

Most cold viruses only result in a blocked nose. However, if the mucous membrane lining the nasal passages and sinuses swells up, this can block off mucus drainage holes. Mucus builds up behind the blockage causing the pressure and pain of sinusitis. Bacteria or fungi are more likely to grow in sinuses that can’t drain properly, and bacterial infection often causes more inflammation and pain.

Doctors don’t yet know exactly what causes chronic sinusitis. However, it is linked to a number of conditions and factors including:

• grass and tree pollen
• cold air
• alcohol
• perfumes
• damp weather
• allergy to house dust mite, mould, and fungi
• smoking
• sports such as swimming and diving
• injuries to your teeth, nose or cheeks
• conditions that affect the way your body gets rid of mucus, such as cystic fibrosis.

 Treatment of acute sinusitis

Self-help

Acute sinusitis can often be treated with home treatments and gets better after two and half weeks.

• Take over-the-counter painkillers, such as paracetamol and ibuprofen, to ease the pain and fever if you have one.
• You can try using a decongestant nasal spray if your nose is blocked and causing you problems. But you should only take this for a week, and decongestants in tablet form aren’t recommended.
• Rinse your nose with a salt water solution – talk to your pharmacist about how to do this.
• Place a warm pack or flannel on your face to help relieve discomfort.
• Look after yourself by keeping hydrated and getting plenty of rest.

Medical help

If your symptoms are severe or lasting a longer time than expected, your GP may suggest a nasal corticosteroid spray.

If you have a condition that puts you at risk of complications or your infection is bacterial rather than viral, your GP may prescribe you with antibiotics.

If during a year, you get several bouts of sinusitis that need treating with antibiotics, your GP may refer you to an ear, nose and throat specialist.

Treatment of chronic sinusitis

Self-help

Chronic sinusitis can take a while to get better, may be several months. But rest assured, it will go and doesn’t usually need further referral to an ENT specialist.

If you get flare-ups of chronic sinusitis (where the symptoms get worse every now and then) you can try the same self-help measures as acute sinusitis to ease discomfort.

Medical help

If you have asthma, hay fever or a dental infection at the same time as chronic sinusitis, it’s really important to manage these to help reduce your symptoms.

Your doctor may prescribe a nasal corticosteroid spray if you have hay fever alongside chronic sinusitis. They may suggest you use this for up to three months. These are helpful in two ways.  If a long–term infection is present they help to reduce swelling of the nasal lining and open up the drainage holes, and if an allergy is involved they also reduce inflammation. Antihistamines such as loratidine (Clarityn) might also help. In severe cases, the doctor may recommend short courses of steroid tablets. These are only available on prescription.

Your doctor might suggest a short course of antibiotics, but it’s not likely they will prescribe these over the long-term. If these measures don’t work, your GP may then refer you to an ENT specialist

Surgery

If you have chronic sinusitis with severe symptoms and it doesn't get better with other treatments, your ENT specialist may suggest you have surgery. An operation can help to unblock your sinuses and improve how well any mucus drains. There are a number of different procedures that can do this.

In functional endoscopic sinus surgery (FESS), your surgeon uses a thin, flexible telescope called an endoscope to see inside your sinuses. Then they use special instruments to unblock the sinuses, by removing bone and mucus membrane. This can be done under local or general anaesthesia.

Balloon sinuplasty is another type of operation used to treat chronic sinusitis. Your surgeon puts a small, flexible tube into your sinus and inflates a balloon on the end of it. This unblocks the sinus and helps it to drain properly. You will need to have a general anaesthetic for this operation.

Ask your doctor for more information about the different types of surgery and what treatment is best for you.

A sinus infection could potentially spread to the bones in your face or your eye socket. The infection could also spread to your brain and cause meningitis. This is uncommon. However, if you have symptoms such as vomiting (being sick), a fever, severe headache or a stiff neck you should get medical help as soon as you can.

If your eyelid becomes red, painful and swollen while you have sinusitis, this can be a sign of an infection in the soft tissues around your eye. This is called orbital cellulitis and it can lead to severe infection and sight loss. If you develop these symptoms, you should see a doctor straightaway.

You may reduce your chances of developing sinusitis. Here are some things you can do, especially if you are prone to sinusitis:

• keep the air humid at home
• use an air-filtering vacuum cleaner
• remove pets
• have a course of anti-allergy injections
• stop smoking
• drink less alcohol
• use a decongestant spray or tablets before diving or swimming
• wash your hands well using soap, hot water or anti-bacterial hand rubs or gel. This is especially important if you’re in close contact with someone who is unwell.

1. Can I fly if I have chronic sinusitis?

Flying can cause sinus pain so you may not wish to fly if you're going through a bad patch with chronic sinusitis. However, using decongestants and nasal sprays may relieve your symptoms enough for you to be able to fly more comfortably.

When you go up in a plane the air pressure is lower than on the ground. You may have noticed that a bottle of water expands as the plane gets higher and will give a hiss of air escaping when you open it. This is because the air that was sealed inside when you were on the ground expands when the air pressure outside is reduced. The same thing happens to the air inside your sinuses. Usually the expanded air flows out through your sinuses so the air pressure inside them is the same as that of the surrounding air. This is called equalising. However, if your sinuses are inflamed, the air may be trapped inside and expand against the walls of your sinuses causing pain that can be very severe. You may get a headache or facial pain. In extreme circumstances the expanding air can cause bleeding inside your sinuses or may damage some nearby nerves.

If you have chronic sinusitis, you may also have problems when the plane lands. If air doesn't flow into your sinuses on landing, the air trapped inside takes up less space. This may cause painful 'sucking' on your sinus walls.

Using nasal decongestant drops or a spray such as oxymetazoline may help your sinuses to equalise. Oral decongestants may help too, however, you shouldn't use these if you have high blood pressure or heart disease. If you have allergies that make sinusitis worse, make sure they are under control. See your GP or pharmacist for advice. If you do fly but get ongoing pain afterwards for more than one or two days, or if your symptoms get worse, you should see a GP.

It may be hard for you or your GP to know for sure whether your sinusitis is going to be a problem when flying. If you know that you have difficulty equalising the pressure in your sinuses, you may decide that it's better not to fly.

2. Is sinusitis contagious?

No, sinusitis isn't contagious.

Sinusitis isn't contagious, but the cause of it can be. The most common cause of sinusitis is a cold or flu. When you have a cold or the flu virus, your sinuses can get inflamed and this can stop mucus draining properly away from them. This can then lead to a secondary bacterial infection, which can cause further inflammation and swelling.

If you or a member of your family has a cold, try to avoid spreading the virus by:

• covering your mouth when you cough or sneeze
• washing your hands frequently and drying them properly
• putting used tissues in the bin straight away

You may also want to discourage your children from sharing toys if one of them has a cold or the flu and wash any toys in soapy water after use.

3. I've had sinusitis for a few days and have noticed the area around my eye is getting red and puffy. What should I do?

If you have an infection in your sinuses, particularly ethmoid sinusitis, it can spread to your eye socket and the surrounding area. This can be a serious complication of acute sinusitis and you should seek medical treatment as soon as possible.

Mostly sinusitis gets better without any problems, often without any specific treatment. However, more serious problems can develop if the infection spreads to the parts of your face and skull that are nearby, including the eye sockets and brain. The infection can also spread into surrounding bone and blood.

If you have sinusitis and develop swelling or redness around your eye, your eye appears to be bulging, or your vision gets worse (such as seeing double), this could be a sign that the area around your eyeball has become infected. This is called orbital cellulitis. If you don't get treatment quickly, it could lead to serious problems, including blindness and meningitis. Treatment may include an antibiotic injection or surgery to drain the swelling if it's likely to permanently affect your vision.

The sinuses are very close to the protective coatings of your brain and infection can spread there. This is called meningitis. Seek urgent medical attention if you develop any of the following symptoms in addition to your sinusitis:

• a severe headache with a stiff neck
• confusion and drowsiness
• sensitivity to light
• co-ordination problems
• vomiting and diarrhoea

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Further information

• ENT UK 020 7404 8373 www.entuk.org

Sources

• Sinusitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2013
• Paranasal sinuses. Stedman’s Medical Dictionary. Lippincott Williams & Wilkins. www.medicinescomplete.com, accessed 11 February 2016
• Sinusitis. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2013
• Chronic sinusitis. Medscape. emedicine.medscape.com, updated 4 May 2016
• Acute sinusitis. Medscape.emedicine.medscape.com, updated 6 May 2016
• Evaluation of the patient with nasal and pharyngeal disorders. The MSD Manuals. www.msdmanuals.com, last full review/revision September 2013
• Acute sinusitis. BMJ Best Practice. bestpractice.bmj.com, last updated January 2015
• Ear, nose and throat. Oxford Handbook of General Practice. Oxford Medicine Online. oxfordmedicine.com, published April 2014
• Chronic sinusitis. BMJ Best Practice. bestpractice.bmj.com, last updated August 2015
• What interventions are safe and effective for adults with chronic sinusitis? Evidence-Based Practice 2013; 16(6):10–11. mospace.umsystem.edu
• About functional endoscopic sinus surgery (FESS). ENTUK. entuk.org, published November 2012
• Balloon catheter dilation of paranasal sinus ostia for chronic sinusitis. National Institute for Health and Care Excellence (NICE) 2008. www.nice.org.uk
• Sinusitis. PatientPlus. www.patient.info/patientplus, last checked May 2014
• Meningitis overview. BMJ Best Practice. bestpractice.bmj.com, last updated January 2015
• Peri-orbital and orbital cellulitis. BMJ Best Practice. bestpractice.bmj.com, last updated October 2014
• International travel and health. World Health Organisation. 2010. Chapter 2, p12–13 www.who.int
• Flying with medical conditions. PatientPlus. www.patient.info/patientplus, last checked November 2015