Everyone gets a runny nose now and then, but if you have severe symptoms including headache, facial pain or pressure, and nasal congestion for several days, you may have sinusitis. This occurs when the sinuses—the hollow spaces behind the eyes, cheekbones, and forehead—become infected or inflamed.

The sinuses make mucus. When you are healthy, mucus drains easily out of the nose and helps clean the nasal passages. But when the sinuses swell, this mucus can get trapped and become infected.   

There are two main types of sinusitis: acute and chronic. Acute sinusitis usually resolves in a few days or weeks, while chronic sinusitis can last for several months or years and be extremely debilitating.

Causes of Sinusitis

Sinusitis can be triggered by a virus or a bacterial infection. The most common cause of acute sinusitis is usually the common cold. If a viral infection persists, it can develop into a bacterial sinus infection. Viral sinusitis will resolve on its own, while a bacterial infection requires antibiotics.

Chronic sinusitis results from a combination of factors, explains Dr. Alissa McInerney, a member of Summit Health’s Allergy and Immunology team. These include inflammation, allergies, irritation from environmental factors, and anatomic reasons. Individuals with a weakened immune system are also more susceptible to sinusitis.

Some individuals have physical abnormalities that prevent the mucus from draining properly. Nasal polyps, for example, are growths in the lining of the nose and sinuses that create obstructions. Another common problem that blocks the mucus from draining is a deviated septum, which means the nasal passages are uneven.

How to Diagnose Sinusitis

Most cases of acute sinusitis can easily be diagnosed by your primary care physician, allergist, or ENT provider.  First, your doctor will ask about your symptoms and press both above and below your eyes to see if there is any tenderness in the sinus cavities. They will examine other parts of your head, neck, and lungs as needed. Often, this is all that is needed.

If the diagnosis is not clear or symptoms don’t resolve with usual treatments, you may be sent to an ENT to take a closer look at the nasal and sinus passages. A nasal endoscope, a thin, flexible tube with a camera, can be inserted into the nostrils to better visualize your sinuses. If swelling or thick secretions are found, a nasal swab may be inserted into the nose to collect a sample of mucus. The sample is then sent to the lab to identify the type of infection. This is helpful because the strain can be matched with the appropriate treatment, typically an antibiotic. Other important diagnostic tools are imaging tests, such as CT and MRI. These scans can show chronic inflammation, nasal polyps, and a deviated nasal septum.

Individualized Treatment

Since most acute sinus infections are caused by viruses and resolve quickly, antibiotics are usually not needed. Symptoms of pain and pressure can typically be relieved with over-the-counter medications. Antibiotics may be prescribed if bacterial sinusitis is suspected.

Chronic sinusitis, however, is different. Dr. McInerney says the goal is to best control the symptoms as it will not be cured on its own. Patients will need prescription medication.

“Since chronic sinusitis is multifactorial, it can be difficult to treat,” she explains. “Treatment is very individualized—what works in one person may not work in another. There is some trial and error. We tend to start with the least invasive treatment and work our way up.”

First-line treatments include both over-the-counter and prescription medications.

• Decongestants, which are available over the counter at the drugstore, can help reduce swelling and alleviate congestion.
• Nasal sprays, including intranasal steroids and antihistamines, decrease inflammation of the turbinates, the internal nasal structures, and decrease nasal itching
• Over-the-counter painkillers like acetaminophen and other fever-reducers can help with symptoms like headaches, facial pain, chills, and body aches.
• Nasal irrigation – A neti pot or spray bottle is a sinus rinse that is used to flush out the mucus and nasal passageways. It is important to use bottled water that has been distilled or sterilized.
• Antibiotics – Some patients will need antibiotics. Remember, antibiotics do not fight viruses like the common cold. They will only work if you have a bacterial infection. If your physician prescribes an antibiotic, it is important to take the entire course of medication even if you start feeling better.

The second tier of treatments are more aggressive and include both medical and surgical options.

• Oral or injected steroids can relieve inflammation and help with drainage.
• Immunotherapy or allergy shots may be used in patients with severe allergies that are contributing to chronic sinusitis.
• Biologics are a group of targeted medications that are injected usually in the arm, abdomen, or thigh and work systemically to block the molecules that cause inflammation leading to chronic rhinitis and polyps. These are currently used for patients with nasal polyps, but clinical trials are currently underway on the use in chronic sinusitis without polyps as well.
• Surgery is used to remove blockages, enlarge the nasal passages, and improve the flow of air. It is typically considered when medical management does not provide enough relief.

Surgical Options

Surgical solutions are particularly helpful in patients who have anatomic abnormalities. Nasal polyps can be removed or shaved away, while narrow sinus openings can be enlarged when there is a deviated septum. The goal of these surgeries is to increase drainage, so mucus does not become trapped.

Endoscopic sinus surgery is a minimally invasive technique used to access the sinuses through the nostrils rather than with an incision. Patients who have endoscopic surgery have fewer sinus infections, breathe easier, and have a better sense of smell. They also experience fewer side effects and a faster recovery time.

Over the last decade there have been numerous advancements in minimally invasive techniques for sinusitis. Today, there are several procedures that can be performed in-office. For example, balloon sinuplasty is an innovative procedure that uses a small balloon to open the passageways. Cryotherapy can also stop nasal dripping by using cold temperatures to interrupt the nerve in the back of the nose.

Your doctor can help

If you are suffering from nasal congestion, facial pain or pressure, headaches, or thick nasal discharge, your primary care physician can help you figure out the cause and best course of treatment. Often, sinusitis can be treated with over-the-counter nose sprays and decongestants. If needed, your doctor can prescribe steroids or antibiotics. And if it seems that the infection or inflammation is becoming chronic, they can refer you to an allergy or ENT specialist to get you feeling better quickly.

Katharine Miao, a Regional Medical Director at CityMD says, "While maintaining vigilance and taking care to see your ENT doctor regularly, sometimes it's not always possible to squeeze in a timely visit. If you think you have an acute sinus infection and over-the-counter remedies have not improved your symptoms, it may be helpful to stop by a CityMD to be seen by a board-certified physician who can properly diagnose and treat you.”