Acute sinusitis

Acute sinusitis is a short-term inflammation of the sinuses, the air-filled cavities in the facial bones around the nose. It most often develops from a common cold or other viral upper respiratory infection, causing the sinus linings to swell and mucus to build up. Symptoms typically last less than four weeks.

Signs and symptoms

The symptoms of acute sinusitis can be similar to a common cold, but they often persist longer and are accompanied by facial pain and pressure.

Common symptoms:

  • Thick nasal discharge: Mucus is often yellow or greenish.

  • Nasal congestion: A stuffy or blocked nose can make it difficult to breathe.

  • Facial pain and pressure: This sensation can be located around the eyes, cheeks, forehead, and nose and often worsens when bending over.

  • Headache: Pain from inflamed sinuses can cause headaches.

  • Postnasal drip: Mucus drips down the back of the throat, causing a sore throat and cough.

  • Reduced sense of smell: Inflammation can affect your ability to smell and taste.

  • Fatigue: A general feeling of tiredness and weakness.

  • Fever: While common in acute sinusitis, its presence may also indicate a more severe infection.

  • Dental pain: Maxillary sinusitis (behind the cheeks) can cause pain in the upper teeth.

  • "Double sickening": You might feel like you are getting better from a cold, and then your symptoms suddenly worsen.

Diagnosis

A diagnosis of acute sinusitis is typically made based on symptoms and a physical exam. Further tests are usually not necessary for most cases.

Typical diagnostic steps include:

  • Medical history and physical exam: A doctor will ask about your symptoms and how long they have lasted. They may also press on your face to check for tenderness over the sinuses and look inside your nose for signs of infection.

  • Imaging studies (rarely): For uncomplicated cases, imaging is generally not needed. A computed tomography (CT) scan may be used if the diagnosis is unclear, the infection is severe, or complications are suspected.

  • Nasal endoscopy (rarely): For persistent or difficult-to-diagnose cases, a doctor may use a thin, flexible tube with a camera to view the nasal passages and sinus openings.

Treatment

Since most cases of acute sinusitis are viral, they often resolve with supportive care. The goal of treatment is to manage symptoms and, in rare bacterial cases, eliminate the infection.

At-home care

  • Pain relievers: Over-the-counter medications like acetaminophen or ibuprofen can help reduce pain and fever.

  • Nasal saline irrigation: Rinsing the nasal passages with a salt water solution, using a neti pot or squeeze bottle, can help clear thick mucus.

  • Hydration: Drinking plenty of fluids helps to thin mucus secretions.

  • Steam inhalation: Inhaling steam from a hot shower or a bowl of hot water can help loosen mucus and soothe nasal passages.

  • Warm compress: Applying a warm, damp towel to the face can help ease sinus pressure.

Medications

  • Decongestants: Nasal sprays can help relieve congestion but should not be used for more than a few days to avoid "rebound congestion." Oral decongestants are also available.

  • Intranasal corticosteroids: These nasal sprays can reduce inflammation and are often recommended for those with underlying allergies or recurrent sinusitis.

  • Antibiotics: Antibiotics are ineffective against viral sinusitis and are not prescribed unless a bacterial infection is suspected. This is typically the case if symptoms are severe, worsen after initial improvement, or last longer than 10 days.

When to see a doctor

You should see a healthcare provider if:

  • Symptoms last longer than 10 days.

  • Your symptoms seem to get better and then suddenly worsen.

  • You have a high fever; 100.4°F or more that lasts for more than 3 to 4 days.

  • Your facial pain or headache is severe.

Seek immediate medical care if you experience any signs of a serious infection, such as:

  • Redness or swelling around your eyes

  • High fever

  • Confusion

  • Double vision or other vision changes

  • Stiff neck





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