Fact sheet: Acute sinusitis
It usually starts in autumn: more and more colleagues call in sick and stay at home in bed with a feverish cold. Sometimes a common cold can develop into sinusitis, which can last a few days or even weeks. Sinusitis makes people feel weak and sick, and besides the symptoms of a cold, they often have severe pain around the face. In this fact sheet we will inform you about the causes and symptoms of acute sinusitis, as well as the treatment options.
What is sinusitis and what causes it?
Sinusitis is an inflammation of the paranasal sinuses. The medical term is "rhinosinusitis" ("rhino-" meaning "nose"), because it affects the mucous membranes lining the nose and the sinuses.The paranasal sinuses are part of the upper airways, and are connected to the nasal cavity. They are made up of several cavities in the skull found from the forehead down to the teeth of the upper jaw. Depending on where they are, these cavities are known as the frontal sinuses, the sphenoid sinus, the ethmoid cells and the maxillary sinuses. Sinusitis mostly affects the maxillary sinuses. The paranasal sinuses are lined with mucous membranes that have tiny hairs on them (ciliated epithelium). These mucous membranes produce a secretion that runs down through the nostrils.
Sinusitis is often brought on by a cold. Colds are usually caused by respiratory viruses, and only rarely by bacteria. Additional bacterial infection may develop after a viral infection, however. Viruses or bacteria trigger an inflammation, which causes the mucous membranes to swell up. This may prevent fluid from draining from the sinuses. If that happens, the fluid becomes thicker and the sinuses fill up with the viscous, often yellow-green mucus. Allergies, nasal polyps, a deviated nasal septum (when the wall between the two nostrils is bent to one side) or a weakened immune system can all make sinusitis more likely.
Sinusitis may be acute or chronic. Acute sinusitis can occur several times a year, but usually goes away again after a few weeks at the most. In chronic sinusitis the symptoms are more persistent and do not go away for a long time. Sometimes they are worse and sometimes they are better. This fact sheet is not about the treatment of chronic sinusitis. You can read more about that condition in the fact sheet “Chronic sinusitis”.
What are the symptoms of sinusitis and what consequences can it have?
Sinusitis is an infection that is often associated with the following typical symptoms:
- stuffed-up nose
- the build-up of pus
If someone has sinusitis, their nose becomes stuffed-up due to the swelling and build-up of secretions. This makes it more difficult for them to breathe through their nose, which feels stuffy. The yellowish or greenish color of the discharge is a sign of disease-causing germs.
Sinusitis often causes pain in the forehead, the jaw and around the eyes and – less commonly – toothache. The pain usually gets worse if you lean forward, for example when getting up out of bed. Sense of smell is often impaired or may even disappear completely. Many people also feel pressure in their face.
Sinusitis usually has no other symptoms apart from the ones described above. But if acute sinusitis is not completely cured it can become chronic. In very rare cases sinusitis can lead to complications, with the inflammation spreading to nearby parts of the body like the eyes or brain, for example. Signs of such a serious form of sinusitis include high fever, swelling around the eyes, inflammatory redness of the skin, severe facial pain, sensitivity to light and a stiff neck. If you have symptoms like this it is important to see a doctor immediately. You might need to take antibiotics.
How is sinusitis diagnosed?
The first thing a doctor will do is ask about symptoms such as pain, fever, coughing, coughed-up phlegm and loss of smell, and about your general wellbeing. To diagnose sinusitis it is not absolutely necessary to do specific tests. But the doctor might do various examinations. With the help of a tube-like device with a small lamp on it (endoscope), he or she can take a closer look at the inside of your nose and see whether, for instance, the membranes are swollen or what color the secretions are. In some rare cases, the doctor might also take a sample (swab) of the secretion by putting a tube through the nose into the sinus. The sample taken is then tested for germs in a lab. Sometimes ultrasound is used, too.
Generally speaking, finding out whether sinusitis is caused by bacteria or viruses can end up involving quite a lot of effort. And having this information does not usually influence the course of the disease. People with acute sinusitis typically recover within one or two weeks.
Do antibiotics help?
Antibiotics only work against bacteria. Sinusitis is usually caused by viruses, so antibiotics often do not work. But even when a more accurate diagnosis is made and people who have a bacterial infection are given antibiotics, only few people will benefit from this treatment. That is because sinusitis usually clears up just as quickly on its own without drugs: in 83 out of 100 people with maxillary sinusitis, symptoms improve on their own within two weeks. In people who take antibiotics, this number increases to 90 out of 100 – this means that about an extra 7 out of 100 people who are affected get better sooner.
One option might be to wait for 7 to 10 days and see whether the symptoms get better on their own. However, research has not shown that treatment with antibiotics has any benefits after 7 to 10 days. Sinusitis can be very persistent despite antibiotic treatment, and may only clear up after several weeks. If there is no improvement, it may be advisable to see a doctor again.
Antibiotics can have adverse effects, including stomach and bowel problems and fungal infections, but these are usually not severe. They affect between 2 and 23 out of 100 people who take antibiotics. The overuse of antibiotics in the treatment of less serious illnesses can have negative outcomes for the population as a whole. In recent years there has been an increase in bacteria that are resistant to antibiotics. This means that some illnesses can no longer be treated as effectively as they used to. You can read more about the dangers and prevention of antibiotic resistance in our feature “Using antibiotics”.
In the rare cases when sinusitis becomes severe, it is essential that antibiotics are used quickly to prevent serious complications such as meningitis from developing. You can read more about the research on antibiotic treatment for sinusitis in the research summary “Acute sinusitis: Can antibiotics help?”
What other treatment options are there?
Nasal steroid sprays aim to reduce the inflammation and thereby reduce the swelling of the mucous membranes in the sinuses. Research has shown that these nasal sprays can relieve sinusitis symptoms, although it often takes a few days before they start working, and they only work for some people. Steroid sprays reduce the production of secretions, clear the nose and relieve pain. After two to three weeks, symptoms had improved considerably
- in 73 out of 100 people who had been using a steroid spray, and
- in 66 out of 100 people who had been using fake medication (placebo).
In other words: symptoms improved in 7 out of 100 people because of the drug. The disadvantages of these nasal sprays: they can sometimes cause nosebleeds and headaches.
Steroid tablets can also relieve the symptoms. Trials showed that, after 3 to 6 days, symptoms got better
- in 70 out of 100 people who were taking steroid tablets, and
- in 58 out of 100 people who took fake medication.
In other words: symptoms improved in about 12 out of 100 people because of the tablets. Side effects were not more common with steroid tablets. All participants in these trials also got antibiotics, however. So we do not know what benefits steroid tablets have when taken on their own.
Painkillers and decongestant nasal sprays
There are several medications that can relieve symptoms, but do not speed up recovery. These include acetylsalicylic acid (ASA, or ASS in German – the drug in “Aspirin”), acetaminophen (also called paracetamol) and nasal sprays/drops to reduce swelling (decongestants). Unlike steroid sprays, decongestants start to work straight away. Overall, their use in the treatment of sinusitis has not been well studied. They aim to reduce the swelling of the mucous membranes and to rapidly make it easier to breathe through the nose. Such a short-term effect might help to sleep better at night. These nasal drops and sprays do not have an anti-inflammatory effect, however.
But after a short time, decongestants can have the opposite effect: after a few hours the membranes in the nose already swell up again. This is known as rebound effect. The longer the drugs are taken, the stronger this effect is. It is therefore advised not to take these drugs for longer than a few days at a time. There are many different medications with different active ingredients that can also cause unpleasant side effects. It can be helpful to find out about these beforehand and watch out for possible symptoms while using them – headaches or dizziness, for example.
Saline solutions and inhalations
As well as medication, some people use saline (salt) solutions to relieve the swelling of the membranes and loosen up secretions. Saline solutions come in the form of ready-made nasal sprays. You can also rinse your nose with salt water. Another option is to heat up water and inhale the vapor. Some people add chamomile or peppermint, for example. Many people try these kinds of home remedies, but there is no scientific research on their advantages and disadvantages. There are also no good studies on the use of infrared radiation.
Although there is not much people can do to speed up their recovery from sinusitis, there are several things that can be done to prevent it from developing in the first place. You can read more about how to protect yourself and your family from colds and other respiratory infections which can trigger sinusitis in our fact sheet.
Author: Institute for Quality and Efficiency in Health Care (IQWiG)
Next planned update: March 2015. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced"
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IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews”. These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in the category “Evidence-based medicine”. We also have our health information reviewed to ensure medical and scientific accuracy.
Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H et al. Antibiotics for acute maxillary sinusitis. Cochrane Database of Syst Rev 2008; (2). CD000243. [Summary]
Ah-See K. Acute Sinusitis. BMJ Clinical Evidence 2011; 12: 511. [PubMed summary]
Shaikh N, Wald Ellen R, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database of Syst Rev 2012; (9). CD007909. [Summary]
Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ et al. Systemic corticosteroids for acute sinusitis. Cochrane Database of Syst Rev 2011; (12). CD008115. [Summary]
Trestioreanu AZ, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Syst Rev 2009; (4). CD005149. [Summary]