Sinusitis in adults

Overview

Sinusitis is inflammation or swelling of the tissue lining the sinuses – the small, air-filled spaces inside your skull behind your forehead, cheeks, and eyes. It often happens after a cold or allergy and can cause a blocked or runny nose, facial pain, and pressure.

Yes, sinusitis is one of the most common reasons people visit their doctor. Almost everyone will have at least one bout in their lifetime.

Sinusitis can affect anyone, but it is more common in adults. People with allergies, asthma, a weakened immune system, or those who smoke are at higher risk.

Symptoms

Common symptoms

• Blocked or stuffy nose
• Runny nose with thick yellow or green mucus
• Pain, tenderness, or pressure around your cheeks, eyes, or forehead
• Headache that feels worse when you lean forward
• Reduced sense of smell or taste
• Cough (often worse at night)
• Bad breath (halitosis)
• Fever (temperature above 37.8°C / 100°F)
• Feeling tired or unwell

Symptoms in children

• Similar symptoms as adults, but children may be fussy, have trouble feeding, or pull at their ears.
• Fever may be higher.
• Nasal discharge may be thick and discoloured.

Symptoms in older adults

• Older adults may have less typical symptoms, like a vague headache, fatigue, or a feeling of confusion.
• Facial pain might be less noticeable.
• A persistent cough or postnasal drip can be a main symptom.

Causes

Main causes

• Viral infection – most often after a cold or flu
• Bacterial infection – when sinuses remain inflamed and mucus gets trapped
• Allergies – hay fever or allergic rhinitis can cause swelling
• Nasal polyps – small growths in the nose that block sinus openings
• Deviated nasal septum – a crooked wall inside the nose that affects drainage

Risk factors

• Having a common cold or flu
• Allergic rhinitis (hay fever)
• Asthma
• Smoking or exposure to secondhand smoke
• A weakened immune system (from conditions like diabetes or HIV, or medications)
• Structural problems in the nose (polyps, deviated septum)
• Frequent swimming or diving

When to see a doctor

See a doctor urgently if:

• If you have symptoms listed in 'urgent' or 'callEmergency' above

Book a routine appointment if:

• If your symptoms have lasted more than 10 days
• If you have a fever above 38°C (100.4°F) that lasts more than 3 days
• If you've had several episodes of sinusitis in a year
• If your symptoms are severe or affecting your daily life

Diagnosis

A doctor can usually diagnose sinusitis by asking about your symptoms and examining you. They may press gently on your face to check for tenderness and look inside your nose with a small light.

Tests that may be done

• Usually no tests are needed.
• If sinusitis is chronic or keeps returning, the doctor might refer you for a nasal endoscopy (a thin, flexible tube with a camera) to see inside the sinuses.
• Sometimes a CT scan (detailed X-ray) is used to look for blockages or polyps.
• Rarely, a sample of fluid from the sinuses is taken to check for infection.

What to expect at your appointment

The doctor will explain what is likely causing your symptoms and recommend self-care or treatments. They may suggest a follow-up if symptoms don't improve.

Treatment

Treatment aims to relieve symptoms and help your sinuses drain. Most cases of sinusitis are caused by viruses, so antibiotics will not help. Antibiotics are only used if a bacterial infection is likely. Always follow your doctor's advice.

Self-care at home

• Rest and drink plenty of fluids (water, herbal tea).
• Moisten the air in your room with a humidifier or steam from a warm shower.
• Use a saline (saltwater) nasal spray or rinse to clear mucus.
• Apply a warm, damp cloth to your face to ease pain and pressure.
• Elevate your head with an extra pillow at night to help drainage.
• Take over-the-counter pain relievers like paracetamol or ibuprofen (follow the instructions on the pack).

Medical treatments

If symptoms are severe or suspected bacterial, a doctor may prescribe a course of antibiotics (usually for 5 to 7 days). They may also recommend a nasal spray containing corticosteroids to reduce swelling. Always use medications exactly as prescribed.

When is surgery considered?

Surgery is rarely needed but may be considered for chronic or recurrent sinusitis that does not improve with other treatments. It involves widening the sinus openings to improve drainage. This is done by an ear, nose, and throat specialist (ENT).

Living with this condition

Most people recover fully from acute sinusitis within a few weeks. For chronic sinusitis, managing triggers like allergies can help. Use a saline rinse daily if your doctor advises.

Lifestyle tips

• Avoid smoking and secondhand smoke.
• Manage allergies with antihistamines or allergy shots if recommended by your doctor.
• Wash your hands often to reduce the chance of catching colds.
• Use a humidifier in dry indoor air.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains to support your immune system. Gentle exercise like walking can help you feel better, but rest if you have a fever or are very tired.

Mental health and emotional wellbeing

Chronic sinusitis can be frustrating because of ongoing symptoms like pain, fatigue, and poor sleep. It may affect your mood or concentration. Talk to your doctor if you feel anxious or depressed.

Prevention

You cannot always prevent sinusitis, but you can lower your risk. Keep your immune system strong with good sleep, nutrition, and exercise. Avoid close contact with people who have colds or flu. Manage allergies and avoid smoking.

Vaccines

Getting the annual flu vaccine and the pneumococcal vaccine (if recommended) can help reduce the chance of infections that may lead to sinusitis. Ask your doctor about vaccines that are right for you.

Screening programmes

There is no routine screening for sinusitis. See your doctor if you have frequent or severe symptoms.

Complications

If left untreated

• Spread of infection to nearby areas – such as the eye socket (orbital cellulitis) or bones of the face (osteomyelitis)
• Meningitis – a rare but serious infection of the lining of the brain and spinal cord
• Blood clot in the sinus veins (cavernous sinus thrombosis) – very rare but life-threatening

Long-term outlook

The outlook for sinusitis is excellent. Most people recover fully within 2 to 3 weeks without any long-term problems. Even chronic cases can be managed well with the right care. If you follow your treatment plan and see your doctor as needed, you can keep symptoms under control and enjoy a normal life.

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