Sinusitis

Also called Sinus infection, Rhinosinusitis

Usually viral, usually better in two to three weeks, and one of the most common reasons antibiotics are prescribed when they do nothing.

What it is

Inflammation of the sinuses, the air spaces in the bones around the nose. Most cases follow a cold and are viral.

The mismatch between how bad it feels and how little treatment helps is the source of most of the frustration. Facial pain and pressure, a blocked nose and thick discharge are miserable, and antibiotics make almost no difference in the first ten days because there is usually no bacterial infection to treat.

Acute sinusitis lasts up to four weeks. Beyond twelve weeks it is chronic, which is a different problem with different treatment, usually steroid nasal spray used properly and for months. See chronic obstructive nasal and sinus disease.

Nasal sprays fail mostly because of technique. Spraying towards the middle of the nose hits the septum and does nothing; the spray should be aimed outwards, towards the same-side ear, with the opposite hand.

Serious complications are rare but real, and they involve the eye and the brain.

Signs you might notice

Blocked or runny nose, thick discharge, facial pain or pressure, reduced sense of smell.

Pain worse on bending forwards, toothache in the upper teeth, headache.

A cold that seemed to improve and then got worse again after five days.

999 or A and E: swelling or redness around the eye, a bulging eye, double vision, reduced vision, severe headache, neck stiffness, confusion, or swelling of the forehead. These suggest spread beyond the sinus and are emergencies.

A GP appointment for symptoms lasting more than ten days without improvement, or for one-sided symptoms with bleeding, which need proper examination.

How it can affect day-to-day life

Chronic sinusitis is genuinely disabling and consistently under-rated. Constant blockage, loss of smell and poor sleep affect mood and concentration as much as many conditions taken more seriously.

Losing the sense of smell affects appetite and safety, and it is a common cause of low mood that people do not connect to their nose.

Sinusitis frequently accompanies asthma and hay fever; treating the nose often improves the chest, which surprises people.

Repeated courses of antibiotics for what is a chronic inflammatory problem is one of the commonest patterns in primary care and helps nobody.

Supporting someone well

First ten days: paracetamol or ibuprofen, steam, saline rinses, and time. No antibiotics.

Learn nasal spray technique and check it. Aim outwards, towards the ear on the same side, using the opposite hand, and do not sniff hard afterwards.

For chronic symptoms, use a steroid spray daily for at least three months before judging it. Most people stop after a fortnight and conclude it failed.

Saline rinsing with a proper rinse bottle helps more than most people expect, and costs very little.

Treat the hay fever or allergy underneath it.

Learn the eye and brain warning signs above. They are the only urgent part of this entry.

Where to get help

A pharmacist first, including through Pharmacy First for acute sinusitis in adults.

A GP practice for symptoms beyond ten days, for one-sided symptoms, or for chronic sinusitis needing longer-term treatment.

A and E immediately for eye swelling, vision change, severe headache or confusion.

ENT UK publish clear patient information on acute and chronic sinusitis.