Sinusitis

The sinuses are small, air-filled cavities behind your cheekbones and forehead. They are important to the flow of mucus within the nose and throat which helps maintain normal breathing and protect the nasal airways. The mucus produced by our sinuses usually drains into our nose through small channels and when they are working properly, we are not aware of them.

Sinusitis is a common condition in which these channels become blocked because the sinus linings are inflamed (swollen). As a result, pressure can build up within the sinus cavities causing facial pain or headaches usually accompanied by a sensation of nasal congestion.

Sinusitis is usually caused by a viral upper respiratory tract infection such as a cold or flu and symptoms will improve spontaneously within two or three weeks (“acute sinusitis”). However, the build-up of mucus within the sinuses can sometimes lead to a secondary bacterial infection requiring antibiotic treatment. Occasionally, sinusitis can become a recurrent or chronic condition (defined locally as symptoms persisting for > 3 months).

Symptoms
  • pain, swelling and tenderness around your cheeks, eyes or forehead
  • a blocked nose
  • a reduced sense of smell
  • green or yellow mucus from your nose
  • a sinus headache
  • a high temperature
  • toothache
  • bad breath

Signs of sinusitis in young children may also include irritability, difficulty feeding, and breathing through their mouth.

Selfcare and more information

Most people with sinusitis don’t need to see their GP. The condition is normally caused by a viral infection that clears up on its own.

Your symptoms will usually pass within two or three weeks (acute sinusitis) and you can look after yourself at home.

How you can treat sinusitis yourself:

Get plenty of rest

  • drink plenty of fluids
  • take over-the-counter painkillers such as paracetamol or Ibuprofen (do not give aspirin to children under 16)
  • avoid allergic triggers and not smoking
  • clean your nose with a saltwater solution to ease congestion (nasal douching)
Your pharmacist can help with sinusitis:

A pharmacist can advise you about medicines that can help, such as:

  • decongestant nasal sprays or drops to unblock your nose (decongestants should not be taken by children under 6)
  • saltwater nasal sprays or solutions to rinse out the inside of your nose

You can buy nasal sprays without a prescription, but they should not be used for more than 1 week.

Find your local pharmacy by clicking here.

When to contact your GP:

Under normal circumstances you should consult your GP if your symptoms don’t start to improve within 7 to 10 days and are getting worse.

Your GP may recommend additional treatment such as:

  • steroid nasal sprays or drops – to reduce the swelling & inflammation in your sinuses
  • antihistamines – if an allergy is causing your symptoms
  • antibiotics – if a bacterial infection is causing your symptoms and you’re very unwell or at risk of complications (but antibiotics are often not needed, as sinusitis is usually caused by a virus)

Your doctor might recommend using a steroid nasal spray or drops regularly for a few months. However, prolonged use of these medications can sometimes cause irritation, sore throats or nosebleeds.

You should consult your GP urgently if your symptoms are severe or atypical such as:

  • unilateral symptoms of nasal blockage with blood-stained discharge
  • facial swelling
  • numbness/pins & needles of cheek
  • loosening of teeth
  • a swollen red eye and acute sinusitis

Under these circumstances your GP may recommend early referral to a specialist to exclude a more serious cause.

Diagnosis:

Your GP can usually diagnose sinusitis from your symptoms.

Sinusitis is nearly always caused by a viral infection, such as the common cold or flu, and is diagnosed based on the presence of:

  • nasal blockage or runny nose with facial pain, and/or
  • a reduction or loss of sense of smell

Loss of smell is more common and facial pain less common in chronic (persistent) sinusitis.

At the moment, you should also be aware that loss of sense of smell could be coronavirus (COVID-19). If you have lost your sense of smell, you should follow all the advice on Gov.uk to get a test and stay at home. Anyone who lives with you or is in your support bubble must also self-isolate while you are waiting for your result.

If there is any doubt about the diagnosis, your GP may refer you to an ear, nose and throat (ENT) specialist who will carry out further tests to determine the underlying cause. These may include nasoendoscopy (using a flexible camera to look inside your nose), X-ray or CT scan (a series of X-rays are taken for a CT scan, to produce a detailed picture of your sinuses).

Referral to a specialist

If you have symptoms of sinusitis that are recurrent or have not responded to any of the treatments outlined above then your GP may recommend referral to an ear, nose and throat (ENT) specialist.

Under local clinical referral guidance your GP will only refer you to a specialist once you have tried at least 3 months of standard topical treatment including regular nasal corticosteroids AND nasal douching

However, if your symptoms are unusual then your GP may recommend earlier referral to a specialist to exclude a more serious cause.

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

Surgery

Surgery to treat chronic sinusitis is called functional endoscopic sinus surgery (FESS). FESS is carried out under general anaesthetic (where you’re asleep).

The surgeon can widen your sinuses by either:

  • removing some of the blocked tissue
  • inflating a tiny balloon in the blocked sinuses, then removing it

The ENT UK website has more information about FESS.

Waiting for a specialist opinion

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.