Introduction

Sinusitis is an inflammation of the membranes lining the air-filled spaces around the nose (paranasal sinuses) and the nose itself. It is also known as "rhinosinusitis." "Rhino-" means nose, and "sinus" means a space in the body.

The sinuses are part of the upper airways, and are connected to the nasal cavity. They are made up of several spaces in the skull that are found from the forehead down to the teeth of the upper jaw. Depending on where they are, these spaces are known as the frontal sinuses, the sphenoid sinus, the ethmoid sinus and the maxillary sinuses. The sinuses are lined with a layer of soft tissue that has tiny hairs on it (ciliated epithelium). Known as mucous membrane, this tissue produces a fluid that drips down through the nose and throat.

At a glance

• Sinusitis is an inflammation of the air-filled spaces around the nose.
• It is painful and makes it harder to breathe through your nose.
• Steroid nasal (nose) sprays can relieve the symptoms.
• Painkillers and nasal rinses sometimes help too.
• Surgery is only considered if you have severe, chronic symptoms and if no other treatment has worked.

Paranasal sinuses

Sinusitis can be acute or chronic: The acute form may occur several times a year, but it always goes away within several weeks at the latest. It is considered to be chronic sinusitis if the symptoms continue for more than three months.

Symptoms

Sinusitis usually causes the following symptoms:

• a stuffy nose
• difficulty breathing through the nose
• a reduced sense of smell
• pain and pressure in your face

Sometimes it leads to a fever and headache too.

Sinusitis causes your nasal passages to become blocked due to the swelling and build-up of fluid. This makes it more difficult to breathe through the nose, which feels stuffy. Yellowish or greenish mucus (snot) is a sign of bacteria.

Sometimes the pain radiates from the sinuses to other parts of the head. It is often felt around the forehead, the upper jaw, the eyes and – less commonly – the teeth (toothache). The pain and stuffy feeling usually gets worse if you lean forward, for example when getting up out of bed. Your sense of smell is often reduced or may even disappear completely.

Causes

Acute sinusitis is often brought on by a cold or flu. Colds are usually caused by respiratory viruses, and only rarely by bacteria. But people who have a cold that’s caused by a virus may get a bacterial infection on top of that.

Viruses or bacteria trigger an inflammation, which causes the mucous membranes to swell up. This may prevent fluid from draining from the sinuses. If that happens, the fluid becomes thicker and the sinuses fill up with thick, often yellow-green mucus.

It is often not known what exactly has caused chronic sinusitis. Sometimes it develops from acute sinusitis that has not cleared up properly. Other factors can increase the risk of developing chronic sinusitis or make it worse. They include:

• Allergic rhinitis (an allergy-related inflammation inside the nose)
• Asthma
• A deviated nasal septum (where the wall between the two nostrils is bent to one side) or other abnormalities in or near the nose
• Taking acetylsalicylic acid (the drug in medications like Aspirin) – if you have an intolerance to it

Chronic sinusitis is also more likely to develop in people who have a weakened immune system, for instance as a result of taking certain medications. Environmental factors such as chemicals or cigarette smoke can play a role too.

Effects

Acute sinusitis usually goes away again within one or two weeks. In rare cases, it leads to complications or lasts several months. Chronic sinusitis can lead to nasal polyps (growths in the tissue lining the nose and sinuses). These make it more difficult to breathe through your nose and can reduce your sense of smell.

In very rare cases, the inflammation may spread to nearby parts of the body, like the eyes or brain. Signs of this include a high fever, swelling around the eyes, inflamed and reddened skin, severe facial pain, sensitivity to light and a stiff neck. If you have these symptoms, it’s important to seek medical advice immediately – either at a doctor's practice or hospital.

Diagnosis

The doctor will first ask about your symptoms and then gently tap and press certain parts of your face with their hands to see if it hurts. A thin tube-like device with a small lamp on it (endoscope) can be used to take a closer look at the inside of your nose and see whether the membranes are swollen, for instance. In rare cases, a sample of the secretions is taken and tested for germs in a lab. This is done by inserting a probe into the nose. If the sample isn't enough to provide a clear diagnosis or if there are signs of complications, a computed tomography (CT) scan or ultrasound scan can be done.

Finding out whether sinusitis is caused by bacteria or viruses involves quite a lot of effort and usually isn't necessary. In acute sinusitis, it hardly makes a difference to the treatment that’s recommended anyway.

It can be helpful to do an allergy test in chronic sinusitis. This is because chronic sinusitis often occurs together with an allergy.

Treatment

Steroid nasal sprays can relieve the symptoms of both acute and chronic sinusitis. Decongestant (anti-swelling) nasal sprays only help over the short term, if at all. They shouldn't be used for longer than a few days. A nasal rinse or inhalation also helps in some people. It only rarely makes sense to use antibiotics.

In chronic sinusitis with nasal polyps, treatment with medications known as biologics may be considered. So far, the biologics called dupilumab, omalizumab and mepolizumab have been approved for the treatment of sinusitis in Germany. Dupilumab can reduce the inflammation in the membranes lining the nose. Research on omalizumab and mepolizumab suggests that they can help, too.

Some people who have chronic sinusitis choose to have surgery to widen narrow passageways in their sinuses and also to remove nasal polyps. This is an option if other treatments haven’t helped enough.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Sources

• Chitsuthipakorn W, Kanjanawasee D, Hoang MP et al. Benefits of nasal saline treatment in acute rhinosinusitis: Systematic review and meta-analysis. Int Forum Allergy Rhinol 2022; 12(8): 1006-1017. [PubMed: 34971301]
• Chong LY, Head K, Hopkins C et al. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database Syst Rev 2016; (4): CD011996. [PMC free article: PMC9393647] [PubMed: 27115217]
• Chong LY, Piromchai P, Sharp S et al. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev 2021; (3): CD013513. [PMC free article: PMC8094915] [PubMed: 33710614]
• Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Rhinosinusitis (S2k-Leitlinie, in Überarbeitung). AWMF-Registernr.: 053-012. 2017.
• Lemiengre MB, van Driel ML, Merenstein D et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev 2018; (9): CD006089. [PMC free article: PMC6513448] [PubMed: 30198548]
• Liu L, Pan M, Li Y et al. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol 2020; 86(5): 639-646. [PMC free article: PMC9422444] [PubMed: 32534983]
• Rimmer J, Fokkens W, Chong LY, Hopkins C. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev 2014; (12): CD006991. [PMC free article: PMC11193160] [PubMed: 25437000]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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