Acute sinusitis

Date Updated: 08/27/2021

Overview

Acute sinusitis causes the spaces inside your nose (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.

With acute sinusitis, it might be difficult to breathe through your nose. The area around your eyes and face might feel swollen, and you might have throbbing facial pain or a headache.

Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve within a week to 10 days. Home remedies may be all you need to treat acute sinusitis. Sinusitis that lasts more than 12 weeks despite medical treatment is called chronic sinusitis.

Symptoms

Acute sinusitis signs and symptoms often include:

Thick, yellow or greenish mucus from the nose (runny nose) or down the back of the throat (postnasal drainage)
Blocked or stuffy nose (congestion) causing difficulty breathing through your nose
Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead that worsens when bending over

Other signs and symptoms include:

Ear pressure
Headache
Aching in your teeth
Altered sense of smell
Cough
Bad breath
Fatigue
Fever

When to see a doctor

Most people with acute sinusitis don't need to see a doctor.

Contact your doctor if you have any of the following:

Symptoms that last more than a week or so
Symptoms that worsen after seeming to improve
A persistent fever
A history of recurrent or chronic sinusitis

See a doctor immediately if you have signs or symptoms that may indicate a serious infection:

Pain, swelling or redness around your eyes
High fever
Confusion
Double vision or other vision changes
Stiff neck

Causes

Acute sinusitis is most often caused by the common cold, which is an infection with a virus. In some cases, an infection with bacteria develops.

Risk factors

You may be at increased risk of getting sinusitis if you have:

Hay fever or another allergic condition that affects your sinuses
A common cold that affects your sinuses
A nasal passage abnormality, such as a deviated nasal septum, nasal polyps or tumors
A medical condition such as cystic fibrosis or an immune system disorder such as HIV/AIDS
Exposure to smoke, either from smoking or through secondhand smoke exposure

Complications

Acute sinusitis complications are uncommon, and serious complications are rare. If they occur, complications might include:

Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis lasts longer than 12 weeks.
Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
Other infections. Uncommonly, an infection can spread to the bones (osteomyelitis) or skin (cellulitis).
Vision problems. If the infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Prevention

Take these steps to help reduce your risk of getting acute sinusitis:

Avoid upper respiratory infections. Try to stay away from people who have colds or who are sick with other infections. Wash your hands frequently with soap and water, especially before your meals.
Manage your allergies. Work with your doctor to keep symptoms under control.
Avoid cigarette smoke and polluted air. Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.
Use a humidifier. If the air in your home is dry, such as it is if you have forced-air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

Diagnosis

Your doctor may ask about your symptoms. He or she may feel for tenderness in your nose and face and look inside your nose. Your doctor can usually make the diagnosis based on the physical exam.

Other methods that might be used to diagnose acute sinusitis and rule out other conditions include:

Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
Imaging studies. A CT scan shows details of your sinuses and nasal area. It's not usually recommended for uncomplicated acute sinusitis, but imaging studies might help find abnormalities or suspected complications.
Nasal and sinus samples. Lab tests aren't generally necessary for diagnosing acute sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue samples (cultures) from your nose or sinuses might help find the cause, such as a bacterial infection.
Allergy testing. If your doctor suspects that allergies have triggered your acute sinusitis, he or she will recommend an allergy skin test. A skin test is safe and quick and can help pinpoint the allergen that's causing your nasal flare-ups.

Treatment

Most cases of acute sinusitis get better on their own. Self-care techniques are usually all you need to ease symptoms.

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms, including:

Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase Allergy Relief, Flonase Sensimist Allergy Relief, others), budesonide (Rhinocort Allergy), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).
Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Use nasal decongestants for only a few days. Otherwise they may cause the return of more-severe congestion (rebound congestion).
Allergy medications. If your sinusitis is due to allergies, using allergy medications may help lessen allergy symptoms.
OTC pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin.

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

Antibiotics

Antibiotics usually aren't needed to treat acute sinusitis, because it's usually caused by a virus and not by bacteria. Even if your acute sinusitis is bacterial, it may clear up without treatment. Your doctor might wait and watch to see if your acute sinusitis worsens before prescribing antibiotics.

However, severe, progressive or persistent symptoms might require antibiotics. If your doctor prescribes an antibiotic, be sure to take the whole course, even after your symptoms get better. If you stop taking them early, your symptoms may recur.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms.

Lifestyle and home remedies

These self-help steps can help relieve sinusitis symptoms:

Rest. This will help your body fight infection and speed recovery.
Drink fluids. Continue to drink plenty of fluids.
Use a warm compress. A warm compress on your nose and forehead may help relieve the pressure in your sinuses.
Moisten your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
Rinse your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses.

Alternative medicine

No alternative therapies have been proved to ease the symptoms of acute sinusitis. It's been suggested that products containing certain combinations of herbs may be of some help. These combination therapies contain cowslip, gentian root, elderflower, verbena and sorrel.

Possible side effects from these herbal products include stomach upset, diarrhea and allergic skin reactions. Check with your doctor before taking herbal or dietary supplements to be sure they're safe and that they won't interact with any medications you're taking.

Preparing for an appointment

When you see your doctor, expect a thorough examination of your sinuses. Here's information to help you get ready for your appointment.

What you can do

Make a list of:

Your symptoms, including any that seem unrelated to the reason for your appointment
Key personal information, including whether you have allergies or asthma, and family medical history
All medications, vitamins or other supplements you take, including the doses
Questions to ask your doctor

For acute sinusitis, questions to ask your doctor include:

What's likely causing my symptoms?
What are other possible causes for my symptoms?
What tests do I need?
Is my condition likely temporary or chronic?
What's the best course of action?
What are the alternatives to the primary approach you're suggesting?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Should I see a specialist?
Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

When did your symptoms begin?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Do you smoke or are you around smoke or other pollutants?