Pain in the nasal passages can be a sign of sinusitis.
It can be acute or chronic, and it can be caused by viruses, bacteria, fungi, allergies, or even an autoimmune reaction.
Although uncomfortable and painful, sinusitis often goes away without medical intervention. However, if symptoms last more than 7 to 10 days, or if there is a fever or a bad headache, you should see your doctor.
In 2015, the Centers for Disease Control and Prevention (CDC) noted that 12.1 percent of adults surveyed in the United States (U.S.) had been diagnosed with sinusitis in the previous 12 months.
Here are some key points about sinusitis. More detail is in the main article.
- People have four pairs of sinuses, hollow spaces behind the bones of the face.
- Allergies, bacteria or a virus can cause inflammation of the sinuses, or sinusitis.
- It usually goes away without treatment, but sometimes medical attention is needed.
- Chronic sinusitis lasts more than 12 weeks.
What is sinusitis?
A sinus is a hollow space in the body. There are many types of sinus, but sinusitis affects the paranasal sinuses, the spaces behind the face that lead to the nasal cavity.
The paranasal sinuses have the same mucous membrane lining as the nose.They produce a slimy secretion called mucus. This keeps the nasal passages moist and traps dirt particles and germs.
Sinusitis occurs when mucus builds up and the sinuses become inflamed.
Sinusitis always involves nasal swelling and a buildup of mucus, but there are different types, and they can last for different lengths of time.
The different types are:
- Acute sinusitis: This lasts up to 4 weeks and is the most common type.
- Subacute sinusitis: Symptoms last longer than the normal acute period, for between 4 and 12 weeks.
- Chronic sinusitis: Symptoms persist, or continually return, after 12 weeks. It may need more invasive treatment, and possibly surgery.
Recovery time and treatment depend on the type of sinusitits.
Symptoms vary, depending on the length and severity of the infection.
If the patient has two or more of the following symptoms and thick, green or yellow nasal discharge, they may be diagnosed with acute sinusitis.
- facial pain and pressure
- blocked nose
- nasal discharge
- reduced sense of smell
In more advanced cases, the following symptoms may also be present:
If these symptoms continue for 12 weeks or longer, the doctor may diagnose chronic sinusitis.
Causes and risk factors
Sinusitis can stem from various factors, but it always results from fluid becoming trapped in the sinuses. This fuels the growth of germs.
- Viruses: In adults, 90 percent cases of sinusitis result from a virus
- Bacteria: In adults, 1 case in 10 is caused by bacteria
- Pollutants: Chemicals or irritants in the air can trigger a buildup of mucus
- Fungi: The sinuses either react to fungi in the air, as in allergic fungal sinusitis (AFS), or they are invaded by fungi, as in chronic indolent sinusitis. This is rare in the U.S.
The following may increase a person's risk of developing sinusitis:
- Previous respiratory tract infections, such as the common cold
- Nasal polyps, or small growths in the nasal passage that can lead to inflammation
- Weakened immunity, due, for example, to a health condition or some kinds of treatment
- An allergic reaction to substances such as dust, pollen, and animal hair
- Structural problems in the nose, for example, a deviated septum
The septum is the bone and cartilage that divides the nose into two nostrils. When this is bent to one side, either through injury or growth, it can lead to repeated infections and inflammation.
A doctor will carry out a physical examination and ask the patient about their symptoms. This is usually enough to make a diagnosis.
The doctor may visually examine the nasal cavity with a light source, or a small, handheld device with a light attached called an otoscope, which can also be used to examine the ears.
If symptoms persist, a doctor may refer a person with sinusitis to an ear, nose, and throat specialist (ENT) for a more in-depth examination. They may insert an endoscope into the nose, a small, thin, flexible tube with a light and camera attached. This can provide more detailed images.
In cases of persistent or severe sinusitis, a CT scan may be necessary.
Treatment options depend on how long the condition lasts.
Acute and subacute sinusitis
A nasal spray may relieve symptoms. This can be saline, ro irrigation, or medicated.
Most acute cases will resolve without treatment.
However, sinusitis can be uncomfortable, so people often use home remedies and over-the-counter (OTC) medications to relieve symptoms.
These can reduce pain and unblock the sinuses to allow proper drainage.
Nasal irrigation: Also known as sinus irrigation, sinus rinse, or sinus lavage,this home procedure involves rinsing and clearing the nasal passages with salt water or a saline solution.
Warm compress: Applying a warm compress gently to the affected areas of the face can relieve some swelling and discomfort.
Painkillers: These can reduce symptoms of pain and fever.
Steam inhalation: Breathing hot, moist air can provide relief from congestion.At home, steam from a bowl of hot water, possibly with some drops of essential menthol or eucalyptus oil, can help unblock the sinuses. Essential oils should not be applied directly or swallowed.
Decongestant tablets and sprays: These may reduce swelling and allow the sinuses to drain.Patients should not use sprays for more than 3 days.
Hydration and rest: Drinking fluids regularly and avoiding overexertion can help the symptoms to pass.
A doctor or pharmacist can advise about these options and how to use them.
In the following cases, the person should see a doctor:
- Symptoms persist longer than 7 to 10 days.
- There is a fever higher than 101.5° Fahrenheit, or around 38.6° Celsius.
- There is a bad headache that does not resolve with over-the-counter (OTC) drugs.
- Visual disturbances occur, or there is swelling around the eyes.
- Symptoms continue after taking antibiotics prescribed by a physician.
If the sinusitis has a bacterial cause, they may prescribe antibiotics. If symptoms remain after the course of medication is finished, the individual should return to the doctor.
Chronic sinusitis is not usually bacterial in nature, so antibiotics are unlikely to resolve symptoms. A fungal infection can be treated with antifungal drugs.
Corticosteroid sprays can help in recurrent cases, but these need a prescription and medical supervision.
In allergic sinusitis, treating allergies with shots or reducing and avoiding exposure to allergens like animal dander or mold can lessen the occurrence of chronic sinusitis.
Structural issues, such as a deviated septum, may need surgery. Surgery may also be advised if there are polyps, or if the sinusitis has resisted all other treatments.
Functional endoscopic sinus surgery (FESS) is the main procedure used for treatment, but other surgeries may be required as other parts of the nose are often affected. If a deviated septum is causing recurrent infections, for example, a septoplasty will be used to straighten out this bone and cartilage.
Treatment may still be required following surgery to prevent the return of sinusitis.
Surgery should always be the last resort on sinusitis in children, and obtaining a second opinion is recommended before proceeding.
Insurers may require patients to provide in-depth evidence to ensure that the surgery isfor sinusitis and not for cosmetic surgery, to improve the appearance of the nose.
The following may help prevent sinusitis: