This article is on Acute sinusitis, a condition commonly experienced by patients and seen by General Practitioners/Otolaryngologists. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What are the sinuses?

To best understand acute sinusitis you may want to read our page on nose and sinus anatomy which provides some background [hyperlink]

 

What is Acute Sinusitis?

Acute sinusitis or acute rhinosinusitis (ARS) is an infection of the nose and sinuses. It is more than a simple cold which is an infection of the nose only. Commonly acute sinusitis will occur in the days after infection with a cold virus.

Most cases of acute sinusitis get better on their own within approximately 7 days but sometimes it can last for several weeks.

Acute Sinusitis

Who gets Acute Sinusitis?

Acute sinusitis is extremely common and can affect people of all age groups.

 

What are the causes?

Acute sinusitis most commonly occurs after infection with a cold virus. The effects of the cold virus extend from the nose into the sinuses. While mostly this is due to direct spread of the virus it is thought that in a small number of people acute sinusitis occurs due to a bacterial infection. This is important as antibiotics do not affect viruses in any way and so mostly antibiotics do not help with acute sinusitis.

Commonly involved bacteria:
– Streptococcus pneumonia
– Haemophilus influenza
– Staphylococcus aureus
– Morraxella catarrhalis

 

What are the symptoms?

Common symptoms include:

  1. a snotty nose which can be clear and watery or more commonly thick and green / yellow
  2. blocked nose with reduced sense of smell
  3. pain in the face
  4. fevers / sweats and tiredness

 

How is it diagnosed?

Acute sinusitis is diagnosed based on symptoms and no scans or x-rays of the sinuses are required unless a complication is suspected. Nasal swabs are not taken routinely but can be taken in complicated cases.

Bacterial sinusitis should be considered if symptoms do not improve after 7-10 days or symptoms worsen after initially improving.

 

What are the potential complications?

Most cases of acute sinusitis settle spontaneously and complications are very rare. When complications occur this involves infection spreading out of the sinuses into the eye socket, brain or the face. Usually this makes patients very unwell with associated fever.

Symptoms of potential complications include:

  • double vision, blurry vision, swelling/redness around the eye or pain with eye movement
  • swelling of forehead
  • neck stiffness, severe headache, sensitivity to bright lights

 

What are the treatment options?

As with common colds, rest, pain relief and drinking plenty of water are the most important things. Simple pain relief (Paracetamol, Ibuprofen) can be taken for fevers or facial pain. Using a bottle designed for washing salt water through the nose and nasal sprays containing decongestant medicines can help.

Mostly antibiotics are not needed. Antibiotics should be considered in prolonged cases or in patients with reduced immunity.

If episodes of acute sinusitis are severe and occur more than 4 times in a year, or if symptoms persist for greater than 12 weeks, there may be value in seeing an ENT Surgeon to discuss whether endoscopic sinus surgery [hyperlink] might assist.

 

Can you prevent acute sinusitis?

There are no specific ways to prevent acute sinusitis. However, the things that we have learned with Covid such as good hand hygiene, staying home when sick and flu vaccination can reduce the risk of colds which lead to acute sinusitis.

 

What is the prognosis?

For most people, acute sinusitis will get better within approximately 7 days with no long term effects.

 

Further reading:

1. Acute Sinusitis – Mayoclinic.org
2. What is Sinusitis – WebMD

 

References:
1. Image: Paranasal Sinus and Nasal Cavity Cancer Treatment: https://www.ncbi.nlm.nih.gov/books/NBK66003/figure/CDR0000258028__276/
2. Aring A, Chan M. Acute Rhinosinusitis in Adults. 2011. Am Fam Physician. 83(9):1057-1063.
3. Arnstead N, Chan Y, Kilty S et al. Choosing wisely Canada rhinology recommendations. 2020. J Otolaryngol Head Neck Surg. 49:10.
4. Morcom S, Phillips N, Pastuszek A, Timperley D. Sinusitis. 2016. AFP. 45(6):374-377.

 

Author + Affiliation:
Dr Johnny Wu, Department of Otolaryngology, Waikato Hospital.
Reviewed by Dr Andrew Wood, Otolaryngologist, Waikato Hospital

 

Date of Publication +/- Review:
Date of Publication: 16/04/2020
Date of Review: 14/04/2021

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Acute Sinusitis

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