Frontal sinusitis is inflammation or infection of the sinuses located just behind the eyes and in the forehead. The sinuses are a system of connected hollow cavities in the face that contain air and a thin layer of mucus. All sinuses produce mucus that moisturizes the airways and drains into the nasal passages.
If the frontal sinuses are inflamed or infected, they cannot drain mucus efficiently, and this can make breathing difficult. It can also lead to a feeling of increased pressure around the eyes and forehead.
In this article, we examine the many causes of frontal sinusitis, along with its symptoms and treatment options.
Frontal sinusitis develops when certain germs make it past the body's natural defenses, or when other factors are responsible for inflammation.
The most common causes of frontal sinusitis are:
Infections caused by viruses, such as the common cold, often block the sinus airways. This increases the amount of mucus in the frontal sinuses, leading to pain and inflammation.
Viral infections of the upper respiratory tract can also lead to frontal sinusitis.
A healthy adult may get a few viral infections of the upper respiratory system a year. A healthy child may get as many as six of these infections a year because the immune system is less developed in childhood.
Bacterial sinus infections last longer than viral infections in the area, and a person with a bacterial infection may require antibiotics.
In some cases, a bacterial infection follows a viral infection. This occurs when a person's immunity is lower after fighting the first infection, and the nasal and frontal sinuses are more vulnerable.
If an infection lasts longer than 10–14 days, it is more likely to be bacterial than viral.
Allergies (allergic rhinosinusitis)
Exposure to certain allergens, such as dust, pollen, and animal dander, can cause sneezing and itching, which can lead to inflammation and a buildup of mucus. This buildup can block the sinuses and prevent mucus from draining smoothly.
Allergies can often cause symptoms that are very similar to a frontal sinus infection. However, allergies require different treatments, so a correct diagnosis is important.
Deviated nasal septum
The nasal septum is a thin wall of tissue and cartilage that divides the nasal cavity in two. An ideal nasal septum divides the nasal cavity into equal-sized passageways.
According to the American Academy of Otolaryngology-Head and Neck Surgery, 80 percent of people have a nasal septum that is off-center, but this is often hardly noticeable and does not affect how the nose works.
A deviated nasal septum becomes a problem when it regularly makes breathing difficult or causes other blockages. It may also increase the frequency of infections, such as frontal sinusitis.
A nasal polyp is a soft, painless growth on the inner lining of the nose or sinuses. Nasal polyps are linked with inflammation, and they affect 1–4 percent of adults in the United States. They may develop due to:
- recurring infections
- allergies to environmental irritants or medicines
- chronic respiratory conditions, such as asthma
In most cases, nasal polyps are harmless. However, a polyp can block or restrict the flow of air and mucus through the sinuses.
The most common signs and symptoms of frontal sinusitis include:
- nasal discharge
- a feeling of "heaviness" or pressure behind the eyes
- a headache
- a sore throat
- muscle aches
- facial congestion or a blocked nose
- a reduced ability to smell
- unpleasant or poor breath
- a mild or high fever
The symptoms of frontal sinusitis differ slightly, depending on the cause. Tiredness, fever, muscle aches, and a sore throat are more likely to signal a viral infection than a bacterial infection.
A person most likely has acute viral sinusitis if symptoms have lasted for fewer than 10 days and are not getting worse.
A person most likely has bacterial sinusitis if symptoms do not improve or get worse after 10 days.
If symptoms last longer than a few months, frontal sinusitis more likely results from a structural issue, such as a deviated septum or nasal polyps.
A doctor, often an ear, nose, and throat (ENT) specialist, diagnoses frontal sinusitis after performing a physical examination and taking note of a person's symptoms and medical history.
Imaging techniques, such as CT and MRI scans, can show the extent of sinusitis and, in some cases, the most likely underlying cause.
Scans are not usually required for cases of acute frontal sinusitis. Doctors may use them to find out how well a course of treatment is working, in cases of chronic sinusitis, or to help diagnose other problems affecting the sinuses.
If frontal sinusitis occurs frequently, a nasal endoscopy can be a useful diagnostic procedure, during which the doctor uses a thin tube with a light and imaging source to capture pictures of the inner sinuses. The doctor can then view these pictures on a computer screen and recommend appropriate treatment.
The goal of frontal sinusitis treatment is to improve mucus drainage and keep the sinuses clear. Treatment options vary, depending on the cause of the blockage.
Viral infections are responsible for many cases of frontal sinusitis. The treatment plan usually involves rest, drinking plenty of fluids, and using over-the-counter nasal sprays or decongestants.
If a bacterial infection is the underlying cause, a course of antibiotics can usually clear the infection.
If frontal sinusitis results from allergies, doctors typically recommend avoiding the allergen and using corticosteroid nasal sprays and antihistamines.
Some people benefit from using over-the-counter medicines that dry and shrink the mucous membranes, such as decongestants and nasal sprays that contain phenylephrine or oxymetazoline.
Ask the doctor if these drugs should be part of the treatment plan. It is important to use them only as directed, for short periods. They can cause discomfort and complications if a person uses them in the long term.
Medicines containing phenylephrine or oxymetazoline can also interact with prescription medications and complicate ongoing issues, such as high blood pressure.
A person with a deviated septum or nasal polyps may benefit from surgery. Surgery can resolve these issues permanently and improve the health and functioning of the sinuses.
Steam inhalation can provide quick relief and clear the sinuses in the short term.
Flushing a saline solution through the nasal passages can relieve long-term symptoms. Many of these solutions are available over the counter, or a person can make their own at home, with:
- 4 cups of boiled, filtered, or distilled water
- 1 teaspoon of baking soda
- 1 teaspoon of non-iodized salt
If using boiled water, boil it for 3–5 minutes before making the solution.
Nasal saline solutions are also available to purchase online.
Chronic frontal sinusitis is the term for the condition if symptoms last longer than 12 weeks. The underlying cause is more likely to be ongoing inflammation than an infection.
It is important to see a doctor to determine the cause of long-term frontal sinusitis, as tumors and cancers can develop in the sinus cavities.
Bacterial sinus infections get worse rather than better with time. Symptoms can include increased discharge, pain, and a fever.
If a person does not receive treatment, a bacterial infection that causes frontal sinusitis could spread to other organs of the head and neck, including the brain, and cause deep tissue infections that may be life-threatening.
Monitor symptoms closely and consult a doctor immediately if the following signs or symptoms are present:
- severe, persistent headaches
- pain or stiffness in the neck
- a high fever
- difficulty focusing
- sudden vision problems
- swelling or redness of the face, eye, or eyelids
Good personal hygiene is essential in reducing the risk of sinus infections. This includes regular hand-washing, especially:
- before and after eating
- while cooking
- while taking care of children
- after using the bathroom
Avoid common allergens, such as tobacco products, smoke, pollution, and dust, as these can trigger respiratory reactions.
Maintaining a healthful lifestyle that includes regular physical activity and well-balanced meals goes a long way toward keeping the immune system healthy and reducing the risk of sinus infections.
Many sinus infections clear within 1–2 weeks, either on their own or with the help of medications.
It may take several weeks for the sinuses to clear completely. It is always important to take a full course of medication as instructed, even if symptoms seem to be improving.
A person with frequent sinus infections or chronic sinusitis may benefit from developing a treatment plan with an allergy or ENT specialist. Proper management helps to prevent complications and improve the quality of life.