Sinusitis
Acute sinusitis; Sinus infection; Sinusitis - acute; Sinusitis - chronic; RhinosinusitisSinusitis is present when the tissue lining the sinuses become swollen or inflamed. It occurs as the result of an inflammatory reaction or an infection from a virus, bacteria, or fungus.
Causes
The sinuses are air-filled spaces in the skull. They are located behind the forehead, nasal bones, cheeks, and eyes. Most of the time, mucus is able to drain out and air is able to flow through the sinuses.
When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.
Sinusitis can occur from one of these conditions:
- Small hairs (cilia) in the sinuses fail to properly move mucus out. This may be due to some medical conditions.
- Colds and allergies may cause too much mucus to be made or the associated inflammation may block the opening of the sinuses.
- A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.
Nasal polyps
Nasal polyps are soft, sac-like growths on the lining of the nose or sinuses.
Read Article Now Book Mark Article - Chronic infection can cause mucosal swelling and inflammation.
There are three types of sinusitis:
- Acute sinusitis is when symptoms are present for 4 weeks or less. It is caused by viruses or bacteria growing in the sinuses.
- Chronic sinusitis is when the symptoms and swelling of the sinuses is present for longer than 3 months. It may be caused by bacteria or a fungus.
- Subacute sinusitis is when the symptoms and swelling is present from 1 to 3 months.
The following may increase the risk that an adult or child will develop sinusitis:
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Allergic rhinitis or hay fever
Allergic rhinitis
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are ...
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Cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a disease that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of th...
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- Diseases that prevent the cilia from working properly
- Changes in altitude (flying or scuba diving)
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Large adenoids
Large adenoids
The adenoids are lymph tissues that sit in your upper airway between your nose and the back of your throat. They are similar to the tonsils. Enlarge...
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- Weakened immune system from HIV or chemotherapy
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
Read Article Now Book Mark Article - Abnormal sinus structures
Symptoms
The symptoms of acute sinusitis in adults very often follow a cold that does not get better or that gets worse after 7 to 10 days. Symptoms include:
- Bad breath or loss of smell
- Cough, often worse at night
- Fatigue and general feeling of being ill
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Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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- Nasal stuffiness and discharge
- Sore throat and postnasal drip
Symptoms of chronic sinusitis are the same as those of acute sinusitis. However, the symptoms tend to be milder and last longer than 12 weeks.
Symptoms of sinusitis in children include:
- Cold or respiratory illness that has been getting better and then begins to get worse
- High fever, along with a darkened nasal discharge, that lasts for at least 3 days
- Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving
Exams and Tests
The health care provider will examine you or your child for sinusitis by:
- Looking in the nose for signs of polyps
- Shining a light against the sinus (transillumination) for signs of inflammation
- Tapping over a sinus area to find tenderness that may be due to infection
The provider may view the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) to diagnose sinusitis. This is often done by doctors who specialize in ear, nose, and throat problems (ENTs).
Endoscopy
Endoscopy is a way of looking inside the body using a flexible tube that has a small camera and light on the end of it. This instrument is called an...
Read Article Now Book Mark ArticleImaging tests that may be used to decide on treatment are:
- A CT scan of the sinuses to help diagnose sinusitis or view the bones and tissues of the sinuses more closely
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
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Most of the time, regular x-rays of the sinuses do not diagnose sinusitis well.
If you or your child has sinusitis that does not go away or keeps returning, other tests may include:
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Allergy testing
Allergy testing
Allergy skin tests are used to find out which substances cause a person to have an allergic reaction. These substances are called allergens....
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- Ciliary function test
- Nasal culture
- Nasal cytology
Cytology
Cytologic evaluation is the analysis of cells from the body under a microscope. This is done to determine what the cells look like, and how they for...
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Sweat chloride tests for cystic fibrosis
Sweat chloride tests
Sweat electrolytes is a test that measures the level of chloride in sweat. Sweat chloride test is the standard test used to diagnose cystic fibrosis...
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Treatment
SELF-CARE
Try the following steps to reduce stuffiness in your sinuses:
Following steps to reduce stuffiness
Your sinuses are chambers in your skull around your nose and eyes. They are lined by a mucous membrane and filled with air. Sinusitis is an infecti...
Read Article Now Book Mark Article- Apply a warm, moist washcloth to your face several times a day.
- Drink plenty of fluids to thin the mucus.
- Inhale steam 2 to 4 times per day (for example, while sitting in the bathroom with the shower running).
- Spray with nasal saline several times per day.
- Use a humidifier.
- Use a Neti pot or saline squeeze bottle to flush the sinuses.
Be careful with use of over-the-counter spray nasal decongestants such as oxymetazoline (Afrin) or phenylephrine (Neosynephrine). They may help at first, but using them for more than 3 to 5 days can make nasal stuffiness worse and lead to dependence.
To help ease sinus pain or pressure:
- Avoid flying when you are congested.
- Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
- Try acetaminophen, ibuprofen, or naproxen.
MEDICINE AND OTHER TREATMENTS
Most of the time, antibiotics are not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time it takes for the infection to go away. Antibiotics are more likely to be prescribed sooner for:
- Children with nasal discharge, possibly with a cough, that is not getting better after 2 to 3 weeks
- Fever higher than 102.2°F (39°C)
- Headache or pain in the face
- Severe swelling around the eyes
Acute sinusitis should be treated for 5 to 10 days. Chronic sinusitis should be treated for 3 to 4 weeks.
At some point, your provider will consider:
- Other prescription medicines
- More testing
- Referral to an ear, nose, and throat or allergy specialist
Other treatments for sinusitis include:
- Allergy shots (immunotherapy) to help prevent the disease from returning
- Avoiding allergy triggers
- Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies
- Oral corticosteroids
Surgery to enlarge the sinus opening and drain the sinuses may also be needed. You may consider this procedure if:
- Your symptoms do not go away after 3 months of treatment.
- You have more than 2 or 3 episodes of acute sinusitis each year.
Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.
Outlook (Prognosis)
Most sinus infections can be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.
Possible Complications
Although very rare, complications may include:
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Abscess
Abscess
An abscess is a collection of pus in any part of the body. In most cases, the area around an abscess is swollen and inflamed.
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Osteomyelitis
Osteomyelitis is a bone infection. It is caused by bacteria or other germs.
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Meningitis
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
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Orbital cellulitis
Orbital cellulitis is an infection of the fat and muscles around the eye. It affects the eyelids, eyebrows, and cheeks. It may begin suddenly or be...
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When to Contact a Medical Professional
Contact your provider if:
- Your symptoms last longer than 10 to 14 days or you have a cold that gets worse after 7 days.
- You have a severe headache that is not relieved by over-the-counter pain medicine.
- You have a fever.
- You still have symptoms after taking all of your antibiotics properly.
- You have any changes in your vision during a sinus infection.
A green or yellow discharge does not mean that you definitely have a sinus infection or need antibiotics. Many people with this symptom recover fully without taking antibiotics.
Prevention
The best way to prevent sinusitis is to avoid colds and flu or treat problems quickly.
- Control your allergies if you have them.
- Get an influenza vaccine each year.
- Reduce stress.
- Wash your hands often, particularly after shaking hands with others.
Other tips for preventing sinusitis:
- Avoid smoke and pollutants.
- Drink plenty of fluids to increase moisture in your body.
- Take decongestants during an upper respiratory infection.
- Treat allergies quickly and appropriately.
- Use a humidifier to increase moisture in your nose and sinuses.
References
DeMuri GP, Wald ER. Sinusitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 62.
Murr AH, Pletcher SD. Approach to the patient with nose, sinus, and ear disorders. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 394.
Pappas DE, Boggs SR. Sinusitis. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 429.
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39. PMID: 25832968 pubmed.ncbi.nlm.nih.gov/25832968/.
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Sinuses - illustration
The sinuses are hollow cavities within the facial bones. Sinuses are not fully developed until after age 12. When people speak of sinus infections, they are most frequently referring to the maxillary and ethmoid sinuses.
Sinuses
illustration
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Sinusitis - illustration
Sinusitis refers to inflammation of the sinus cavities, which are moist, hollow spaces in the bones of the skull. There are four pairs of sinuses. They are thefrontal sinuses, maxillary sinuses, ethmoid sinuses, and sphenoid sinuses (not shown in illustration). If the opening from a sinus cavity becomes plugged, the flow of mucus is blocked and pressure builds up, causing pain and inflammation.
Sinusitis
illustration
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Chronic sinusitis - illustration
The sinuses are surrounded by bone and cartilage and lined with a mucous membrane. Sinusitis occurs when the membranes becomes inflammed and painful, which may be a result of a blocked sinus opening. Chronic sinusitis is often caused by inflammation and blockage due to physical obstruction such as a deviated septum, misformed bone or cartilage structures such as the nasal conchae (turbinates), or blockage by nasal cysts or polyps.
Chronic sinusitis
illustration
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Allergic reactions - illustration
Allergic reaction can be provoked by skin contact with poison plants, chemicals and animal scratches, as well as by insect stings. Ingesting or inhaling substances like pollen, animal dander, molds and mildew, dust, nuts and shellfish, may also cause allergic reaction. Medications such as penicillin and other antibiotics are also to be taken with care, to assure an allergic reflex is not triggered.
Allergic reactions
illustration
-
Sinuses - illustration
The sinuses are hollow cavities within the facial bones. Sinuses are not fully developed until after age 12. When people speak of sinus infections, they are most frequently referring to the maxillary and ethmoid sinuses.
Sinuses
illustration
-
Sinusitis - illustration
Sinusitis refers to inflammation of the sinus cavities, which are moist, hollow spaces in the bones of the skull. There are four pairs of sinuses. They are thefrontal sinuses, maxillary sinuses, ethmoid sinuses, and sphenoid sinuses (not shown in illustration). If the opening from a sinus cavity becomes plugged, the flow of mucus is blocked and pressure builds up, causing pain and inflammation.
Sinusitis
illustration
-
Chronic sinusitis - illustration
The sinuses are surrounded by bone and cartilage and lined with a mucous membrane. Sinusitis occurs when the membranes becomes inflammed and painful, which may be a result of a blocked sinus opening. Chronic sinusitis is often caused by inflammation and blockage due to physical obstruction such as a deviated septum, misformed bone or cartilage structures such as the nasal conchae (turbinates), or blockage by nasal cysts or polyps.
Chronic sinusitis
illustration
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Allergic reactions - illustration
Allergic reaction can be provoked by skin contact with poison plants, chemicals and animal scratches, as well as by insect stings. Ingesting or inhaling substances like pollen, animal dander, molds and mildew, dust, nuts and shellfish, may also cause allergic reaction. Medications such as penicillin and other antibiotics are also to be taken with care, to assure an allergic reflex is not triggered.
Allergic reactions
illustration
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Sinusitis
(Alt. Medicine)
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Sinusitis - InDepth
(In-Depth)
Review Date: 5/2/2024
Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.