Sinusitis

Sinusitis is one of the common nasal and sinus problems I see regularly in practice. I assess and treat many patients with acute sinusitis, recurrent sinus infections, chronic sinusitis, nasal polyps, facial pressure, and blocked noses, both medically and surgically.

Sinus disease is not a single, straightforward condition. There are different types of sinus disease, and they do not all behave in the same way. In some patients the problem is mainly inflammatory sinus disease. In others, there may also be nasal polyps, rhinitis, dental problems, or a structural issue inside the nose. In some patients, especially those with nasal polyps, asthma is also part of the picture, and in a smaller number there may be a broader underlying condition that needs to be considered.

As a result, any information page like this can only ever be a simplified overview. In real practice, there are often several factors contributing at the same time, and the right treatment depends on understanding the overall pattern properly. That is why an ENT review and an individualised treatment plan are often important, particularly when symptoms are persistent, recurrent, one-sided, or not improving with standard treatment.

This page is intended as a general guide to the main principles and common treatment options, but it cannot cover every variation of sinus disease in detail.

What is sinusitis?

Sinusitis usually means inflammation affecting both the nose and the sinuses. In practice, the most important symptoms are usually nasal blockage, nasal discharge, postnasal drip, and reduced smell, rather than pain alone.

What is the difference between acute, recurrent acute, and chronic sinusitis?

Acute sinusitis comes on suddenly, often after a cold or viral infection, and lasts for less than 12 weeks.

Recurrent acute sinusitis means repeated separate attacks, with the patient feeling well in between.

Chronic sinusitis means symptoms that continue for 12 weeks or more. This is usually less about severe pain and more about ongoing blockage, discharge, postnasal drip, smell disturbance, and a feeling that the nose and sinuses are never quite clear.

What symptoms does sinusitis usually cause?

Typical symptoms include:

• nasal blockage or congestion

• nasal discharge

• postnasal drip

• reduced or altered sense of smell

• facial pressure or a feeling of fullness

• disturbed sleep

• fatigue

In acute sinusitis, pain and pressure can be more noticeable. In chronic sinusitis, the more typical pattern is persistent blockage, mucus, and smell loss. Facial pain can occur, but it is not usually the dominant feature on its own.

Is facial pain always sinusitis?

No — and this is a very important point.

Facial pain is commonly blamed on the sinuses when the sinuses are not actually the main problem. Many patients who are told they have “sinus pain” actually have another explanation, such as migraine, atypical facial pain, tension-type headache, dental problems, or jaw-related pain.

This is one reason specialist assessment can be so helpful. Not all facial pressure comes from the sinuses, and not all sinus symptoms are best treated with antibiotics.

How do I assess sinusitis?

I usually want to understand:

• how long the symptoms have been going on

• if the problem is acute, recurrent, or chronic

• the main symptoms — blockage, discharge, smell loss, or pain

• if symptoms flare up after colds

• any associated allergy or rhinitis

• if there are nasal polyps

• if asthma may be part of the picture

• if the teeth may be contributing

• what treatments have already been tried, and for how long

In clinic, I may examine the nose with a thin camera called a nasoendoscope. This allows a much clearer view of the nasal cavity, the sinus drainage areas, and whether there is swelling, discharge, or polyps. If symptoms are persistent, recurrent, difficult to explain, or surgery is being considered, a CT scan of the sinuses may also be needed.

Can the teeth cause sinus problems?

Yes, sometimes they can.

The roots of the upper back teeth sit very close to the maxillary sinuses, so dental problems or previous dental treatment can sometimes be the real cause of sinus disease. This is particularly important when symptoms are mainly on one side, there is unpleasant-smelling discharge, or the pattern is not typical of ordinary inflammatory sinusitis.

That is why I sometimes need to think about the teeth as part of the overall assessment rather than focusing only on the nose.

What are the main treatment options?

Treatment depends on whether the problem is acute sinusitis, recurrent acute sinusitis, chronic sinusitis, nasal polyps, dental disease, structural narrowing, or a combination of these.

1. Saline rinses

Saline irrigation is one of the most useful starting points. It helps clear mucus, crusting, irritants, and discharge, and it can also help sprays and drops work more effectively.

A simple home saline rinse can be made using:

• 1 flat teaspoon of salt

• 1 flat teaspoon of bicarbonate of soda

• approximately 1 pint of cooled boiled water

A good practical routine is to use the saline rinse first and then use any prescribed nasal spray or drops afterwards.

In practical terms, NeilMed or a similar bottle-based rinse is usually the best way to wash the nose thoroughly. If that is not well tolerated, Sterimar or a similar saline spray can still be useful. Many pharmacies also sell their own versions of both rinse bottles and saline sprays.

2. Nasal steroid treatment

For chronic sinusitis and nasal polyps, nasal steroid treatment is often a key part of management. These treatments help reduce inflammation and swelling inside the nose and sinuses.

Long-term treatment is very common in patients with chronic sinus inflammation. In most patients, the aim is to control the condition with the lowest effective dose, and a low-dose nasal steroid spray is safe to use long term for the majority of patients when used properly.

Technique matters. I usually advise patients to:

• clear the nose first if possible

• keep the head upright

• use the opposite hand to the opposite nostril

• aim the spray towards the ear

• breathe in gently as you spray

• avoid sniffing hard afterwards

In some patients, stronger topical steroid treatment or a short course of steroid tablets may also need to be considered.

3. Pain relief and short-term symptom control

In acute sinusitis, many patients improve with time, hydration, pain relief, saline treatment, and supportive care.

Short-term decongestants may occasionally help during an acute episode, but they should not be used for long enough to create rebound congestion.

4. Antibiotics in selected cases

Antibiotics are not needed for most sinus infections. Many acute episodes are viral or post-viral and settle without them.

They are usually reserved for more severe cases, or for situations where the pattern suggests a bacterial infection rather than ordinary post-viral inflammation.

5. Inflammation and nasal polyps

Chronic sinusitis is often an inflammatory condition rather than a simple infection. Nasal polyps are part of that inflammatory process.

In many patients, inflammation and polyps can be managed medically with saline rinses, nasal steroid treatment, and, in selected cases, short courses of oral steroids or other targeted treatments.

In patients with nasal polyps, asthma is not uncommon. In a smaller number of patients with more severe or unusual disease, it may also be necessary to think about a broader airway or systemic condition.

6. Surgery

Surgery is not the starting point for most patients, but it can be very helpful in the right situation.

I treat many patients with sinus disease medically, but I also regularly manage patients surgically where that is the best option. Surgery is usually considered when symptoms remain troublesome despite appropriate medical treatment, when the diagnosis has been properly confirmed, and when there is clear evidence of sinus disease on examination or scanning.

Sometimes a deviated septum also needs to be taken into account, particularly if it is contributing to blockage or limiting access for sinus surgery. There is a separate page on this website with more information about septoplasty.

There is also a separate page on this website with more information about sinus surgery.

What can sinus surgery achieve?

The aim of sinus surgery is not simply to “cure sinusitis”.

In patients with chronic inflammatory sinus disease or nasal polyps, surgery is usually done to improve drainage, open the sinuses, remove obstructing inflammatory tissue where needed, and allow medication to reach the areas that were previously blocked.

That point is important. Inflammatory sinus disease and polyps can often be improved with surgery, but surgery does not switch off the underlying tendency to swelling. It usually works best as part of an overall long-term treatment plan.

In other words, surgery helps create better access for treatment. If medication is stopped completely afterwards, the inflammation and polyp disease will often return over time.

When is further assessment important?

I would usually want to assess patients more carefully if there are:

• symptoms lasting longer than expected

• repeated acute episodes

• persistent reduced smell

• symptoms not improving with well-used medical treatment

• mainly one-sided symptoms

• recurrent nosebleeds

• swelling around the eye

• visual symptoms

• severe frontal headache

• concern that the teeth may be contributing

• facial pain that does not fit the pattern of sinus disease

Helpful resources

• Oxford University Hospitals – Nasal douching

• NHS information on sinusitis

Disclaimer

This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.