Sinusitis

Sinusitis is inflammation of the sinuses — the air-filled spaces around the nose — most often triggered by a viral upper respiratory infection, though a proportion of cases become bacterial.

• Facial pain or pressure, often over the cheeks, forehead, or around the eyes
• Nasal congestion and thick nasal discharge, which may be clear, yellow, or green
• Reduced sense of smell
• Headache, worse when bending forward
• Symptoms lasting beyond 10 days, or worsening after initially improving, suggest a bacterial cause

• Most commonly follows a viral upper respiratory infection (common cold), causing temporary blockage and inflammation of the sinus drainage pathways.
• A bacterial infection can develop secondarily in a minority of cases, particularly when symptoms persist or worsen.
• Allergies and structural nasal problems can contribute to recurrent or chronic sinusitis.

• Mainly a clinical diagnosis based on the pattern and duration of facial pain, nasal congestion, and discharge.
• Viral sinusitis typically improves within 7–10 days; symptoms persisting beyond this, or a "double sickening" pattern (initial improvement followed by worsening), suggest bacterial infection.
• Imaging is not usually needed for routine diagnosis and is reserved for recurrent, chronic, or complicated cases.

Most cases are viral and managed with supportive care — pain relief with paracetamol or an NSAID, saline nasal irrigation or sprays, and adequate fluids — as they resolve without antibiotics.

An oral antibiotic, such as amoxicillin, is reserved for cases with symptoms lasting more than about 10 days without improvement, severe symptoms, or the double-sickening pattern suggesting bacterial infection.

Warm compresses over the face and steam inhalation may provide symptomatic relief.

Patients with facial swelling, visual changes, severe headache, or altered consciousness are referred urgently, as these can indicate rare but serious spreading complications.

• Practise good hand hygiene to reduce the frequency of colds that can trigger sinusitis.
• Manage underlying allergies where relevant, as they can contribute to recurrent sinus symptoms.
• Stay well hydrated and use saline nasal rinses during colds to help keep sinuses clear.
• Avoid smoking, which irritates the nasal and sinus lining.