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Sinusitis

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Acute sinusitis is a common condition caused by inflammation of the sinuses and is usually associated with inflammation of the nasal passages too (rhinitis). There are 4 groups of sinuses which are hollow cavities in the facial bones around the nose and drain into the nasal passages. These are the frontal, maxillary, sphenoidal and ethmoidal sinuses. 

80% of cases will resolve within 14 days without antibiotics, therefore it is advised to use over-the-counter (OTC) medication as first-line treatment from your pharmacy. 

If your symptoms are worsening or not improving within this duration then we may prescribe antibiotics if clinically appropriate.

Treatments we may prescribe:

Please see Common Treatments below for further information.


Common Symptoms

Symptoms that you may experience include:

  • pain and tenderness around the sinus areas (in the cheeks, around the eyes and the forehead)
  • a runny nose
  • sneezing
  • a blocked nose
  • a mild headache
  • a low-grade fever
  • congestion
  • loss of smell

Most symptoms are at their worst after 2 to 3 days then will gradually start to improve, usually within 7 to 10 days. 

Common Treatments

Most Sinus Infections are viral, do not require antibiotics, and will improve within a week on their own. Common treatments for the symptoms include paracetamol, ibuprofen, and decongestants which can help with the pains and fever. You can seek further advice about such over the counter treatments from your local pharmacy.

Possible treatments we prescribe if clinically appropriate:


*Prices shown are the cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

Please click on the medication above to read the Patient Information Leaflet for important information about each drug. We use national prescribing guidelines to select which treatment would be most appropriate for your condition. 

What is Acute Sinusitis?

Acute sinusitis is usually caused by a viral infection, bacteria or an allergy. The infection starts after something blocks the opening to the sinuses, most commonly caused by a viral infection such as a cold.

During a cold, the mucous membranes (lining) of the nasal passage tend to block the opening of the sinuses. The air that usually fills the sinuses is absorbed into the bloodstream, and the pressure in the sinuses reduces, drawing fluid into the sinuses and causing pain. This fluid then may become a breeding ground for bacteria.

Your white cells (immune cells) and more fluid enter into the sinuses to fight the bacteria. This increase in fluid then causes the pressure to increase in the sinuses resulting in more pain. The infection, however, will often remain viral before clearing. It can less frequently become bacterial, where bacteria add on to the infection caused initially by a virus. This tends to cause the symptoms to become worse and to last longer. 

Infrequently the infection may spread from a dental abscess to the sinus in the cheekbone (maxillary sinus).

Risk Factors

Some circumstances may increase a person's chances of developing sinusitis. These include:-

  • Nasal Allergy 
  • Nasal Polyps
  • Previous facial trauma or surgery
  • Deviated nasal septum
  • Asthma
  • Poor immune system
  • Pregnancy
  • Smoking
Self-Help for the symptoms

There are certain treatments you can try at home which may help you to manage your symptoms.

Pain medication:

  • such as paracetamol or ibuprofen. Read the leaflet that comes with the medication to check its suitability. This can help with the sinus pain and fever.

Over-the-counter Decongestant nasal sprays or drops:

  • these may help with a blocked nose to allow you to breathe through it better. Check with the pharmacist first to ensure they are suitable for you. Do not use them for more than a week. 

Saline (salt water) nasal drops:

  • can help reduce the nasal discharge and unblock your nose.

Warm face packs:

  • may help ease the sinus pain and help drain the mucus.

Drinking plenty of water to keep hydrated.

Symptoms unsuitable for i-GP

There are certain symptoms that may be present with an episode of Acute Sinusitis that suggests you should see a doctor in person, as soon as possible, for a physical assessment and you may require further investigations.

  • severe pain and/or swelling affecting your forehead
  • swelling or redness around the eye or swelling of the face
  • visual problems
  • blood-stained discharge coming from the nose

If you develop any of the following symptoms, then you must seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111) or call an ambulance if the symptoms are severe:-

  • difficulty in breathing
  • chest pain
  • a severe headache
  • drowsiness or confusion
  • persistent vomiting
  • neck stiffness
  • non-blanching rash
Complications

Serious complications of Acute Sinusitis are rare and occur in around 1 in 10,000 people with the infection. Examples of complications include infection spreading from a sinus to around an eye, into bones, into the blood, or into the brain. 

Antibiotic Resistance

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

References

Acute Sinusitis: www.patient.info

Acute Sinusitis: NICE CKS, October 2013

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