Sinusitis (sinus infection)
Sinusitis is inflammation of the lining of the sinuses, the air-filled spaces inside the bones of the face.
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Medicines commonly prescribed for Sinusitis (sinus infection)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 1000 mgActive substance: amoxicillinManufacturer: Laboratorio Reig Jofre, S.A.Prescription requiredDosage form: TABLET, 1000 mgActive substance: amoxicillinManufacturer: Almus Farmaceutica S.A.U.Prescription requiredDosage form: CAPSULE, 500 mgActive substance: amoxicillinManufacturer: Ldp Laboratorios Torlan S.A.Prescription required
Sinusitis is inflammation of the lining of the sinuses, the air-filled spaces inside the bones of the face. It almost always begins as an ordinary cold that has settled into the sinuses: the nose blocks up, a heaviness appears over the cheeks and the bridge of the nose, and the head fills when you bend forward. One thing is worth knowing from the start: the great majority of sinusitis is caused by viruses, it clears on its own, and antibiotics do not speed that up. There is, however, a short list of signs that cannot wait even a day, and they have a section of their own further down.
What the sinuses are and why they block
The sinuses are air-filled cavities in the bones of the skull that open into the nose. The maxillary sinuses sit under the cheekbones, the frontal ones above the eyebrows, the ethmoids between the eye sockets, and the sphenoid deep inside, almost in the middle of the head. Each is lined with the same membrane as the nose and constantly makes a little mucus, which tiny hairs sweep towards the exit.
That exit is very narrow — an opening a few millimetres across. During a cold or a flare of allergy the lining swells, the opening closes over and the mucus stops draining. The rest follows on its own: pressure builds in a sealed cavity, the stagnant mucus thickens, and the lining becomes more inflamed still. That is why the pain gets worse when you lean forward or lie down, and why the nose blocks first on one side and then on the other through the day.
From that comes the guiding principle of treatment: what helps is not what kills microbes but what brings the swelling down and gets the drainage going again.
In children it looks different. The frontal sinuses do not finish developing until the teenage years, so there is next to nothing above a small child's eyebrows to ache, and sinusitis in that age group shows itself instead as a wet cough that drags on and as breathing through the mouth.
What it feels like
The usual picture brings several things together at once:
- a stubbornly blocked nose that blowing does not clear;
- thick mucus — clear, white, yellow or green — sometimes running down the back of the throat;
- pressure, heaviness or pain across the cheeks, the bridge of the nose or the forehead, occasionally deep in the head; worse on bending forward and first thing in the morning;
- a reduced sense of smell and, with it, of taste, so that food tastes of nothing much;
- a cough that is worse at night and in the early hours, from mucus trickling down;
- aching upper teeth on one side: their roots run right up against the maxillary sinus;
- blocked or clicking ears and a changed, nasal-sounding voice;
- bad breath, a raised temperature and a general sense of being wrung out.
In small children it is the behaviour that stands out: fractious, sleeping badly, eating less, breathing through the mouth, with a cough that goes on for weeks. One detail is worth holding on to: pain and blockage strictly on one side only is not the ordinary pattern, and it is worth telling a doctor about.
Why antibiotics are almost always beside the point
Sinusitis is, in the overwhelming majority of cases, caused by the same viruses as the common cold. Antibiotics have no effect on viruses at all, so they do not shorten the illness, do not ease the pain and do not prevent complications. Even where bacteria have joined in, a large share of cases settles without them: the body deals with it, just rather more slowly than anyone would like.
The price of taking them "just in case" is real enough — diarrhoea, nausea, rashes, thrush — and, at the level of a household or a city, bacteria that stop responding to treatment at the moment it is genuinely needed.
A separate word about the colour of the mucus, because this is the hardiest misconception of the lot. Green or yellow mucus does not mean antibiotics are needed. The colour comes from an enzyme carried by the white blood cells that have arrived to deal with the inflammation, and it turns up in an ordinary viral cold too, usually around the third or fourth day. Pus-like discharge on its own does not separate a virus from a bacterium. A doctor decides on how the illness moves over time, not on the colour of the handkerchief.
When it stops looking like an ordinary cold
The marker is not colour or thickness but duration and the shape of the curve. Bacterial sinusitis is considered when one of three things fits:
- no improvement beyond ten days — the symptoms sit flat or creep downhill without a single let-up;
- it got better and then sharply worse — someone was already on the mend and suddenly the temperature climbs again, the facial pain returns and the discharge increases; of the three, this is the most telling;
- severe from the outset — a high temperature together with purulent discharge and marked facial pain for three or four days running.
Without waiting for any of those timings, see a doctor sooner if you have diabetes, take medication that suppresses the immune system, are having chemotherapy, get sinusitis several times a year, or have symptoms on one side only. If an antibiotic is prescribed after all, the full course is taken: a half-finished bacterial infection in the sinuses comes back more readily than it goes away.
What genuinely helps at home
Saline rinsing. This is the single most useful thing to do at home: it washes out thick mucus, moistens the lining and frees up the breathing. Ready-made pharmacy solutions and sprays work, and so does a home-made solution — but the water for it must be boiled and cooled, or distilled, and never straight from the tap. The bottle, bulb or neti pot is washed and dried after every use. Rinsing can be done several times a day and nothing gets used to it.
A steroid nasal spray. This works on exactly the thing that is causing the blockage, the swelling of the lining. It does not act at once; the effect builds over several days, so it needs using regularly rather than at moments of distress. Aim the jet slightly outwards, towards the side wall of the nose rather than the septum: there is then less dryness and less blood on the tissue.
Pain relief. Paracetamol or ibuprofen take the edge off the facial pain and bring a temperature down. Aspirin is not given to children and adolescents.
Warmth and moisture. A hot shower, breathing steam, a humidifier in the bedroom, plenty to drink, sleeping with the head of the bed raised a little. None of this cures anything, but it makes the evenings and the nights noticeably easier. While the illness lasts, it is worth staying well away from cigarettes and smoky rooms.
What easily makes it worse
Decongestant drops and sprays (xylometazoline, oxymetazoline and the like) really do open the nose within minutes, but they must not be used for more than a few days in a row. The lining adapts, and when they are stopped the blockage returns worse than it was; the person sprays more and more often and breathes worse and worse. Getting out of that loop then takes weeks and usually needs a doctor's help. If you have noticed that without the spray the nose will not pass air at all, that is a reason to seek advice, not to increase the dose.
Antihistamines are worth taking only by those whose sinusitis is tied to an allergy. In an ordinary viral episode all they do is thicken the mucus and hold it back.
Trying to "heat" the sinuses with a bag of salt or a lamp at the height of the inflammation gives no relief and is unwise where there is pus. Warm moist steam is a different matter and carries no such risk.
Signs that need attention the same day
The sinuses are separated from the eye socket and from the inside of the skull by thin plates of bone, in places no thicker than paper. Very occasionally the infection crosses that boundary, and then the clock runs in hours. Go to hospital immediately, the same day, if any of these appear:
- swelling, redness or tenderness around the eye, the eyelids or the bridge of the nose;
- the eye pushed forward, or eye movements limited or painful;
- double vision or loss of vision, colours looking washed out;
- a very severe headache that painkillers do not touch, especially alongside a high temperature;
- confusion, unusual drowsiness or seizures;
- a stiff neck, an inability to put the chin to the chest, discomfort in bright light, persistent vomiting;
- a soft swelling on the forehead above the eyebrows.
Behind these signs lie infection of the tissue in the eye socket, clotting in the veins inside the skull, meningitis, a brain abscess and destruction of the frontal bone. Treated in time they usually end well; missed, they do not. They are rare, but they are precisely what must not be overlooked, and precisely what most often goes missing from pages about sinusitis.
With confusion, seizures or a stiff neck, call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single number is 112). With the other signs on the list, the thing to do is not to ring and wait but to get to a hospital emergency department that same day.
There is one further, uncommon situation that stands apart. In someone with poorly controlled diabetes or a badly weakened immune system, fast-growing one-sided facial pain with numbness of the cheek — and still more so black crusts inside the nose or a dark patch on the palate — calls for emergency admission. That is how an aggressive fungal infection of the sinuses declares itself.
When the congestion runs into months
Once symptoms have lasted beyond twelve weeks the sinusitis counts as chronic, and the logic changes completely: what is being looked for is not a microbe but an obstruction to drainage. Most often that means nasal polyps, allergic rhinitis, a deviated septum or asthma; less often the inflamed root of an upper tooth, which gives a one-sided picture with a foul smell.
This is territory for an ear, nose and throat specialist. They examine the inside of the nose with an endoscope, a slim camera on a flexible lead, and order a CT scan if it is needed. A plain sinus X-ray adds almost nothing in a chronic problem, and it is best not to lose time over one.
Treatment here is a long business built on a steroid spray, regular rinsing and control of any allergy or asthma. Where that is not enough, endoscopic surgery is discussed: working through the nose, with no cuts on the face, the natural openings of the sinuses are widened and polyps and obstructing tissue are removed. Surgery improves the drainage but does not cancel the aftercare — the rinsing and the spray usually continue, or everything comes back.
Worth remembering separately are persistently one-sided symptoms: blockage and pain only on the left or only on the right, especially with blood-stained discharge, numbness of the cheek, teeth working loose or a change in vision. That picture must be looked at by an ENT specialist without fail — rarely, but a tumour or a fungal growth in the sinus can sit behind it.
Online consultation
In sinusitis the decision rests on how the illness is moving rather than on a test result, so a conversation with a doctor does almost all the work here.
Online it is straightforward to work out which day you are on and whether your curve fits an ordinary viral episode; to judge whether an antibiotic is needed or whether waiting is the calmer course; to choose a spray and go through the rinsing technique, which accounts for much of the result; to look into why the sinusitis keeps coming back and map out what to check next; and to help you come off decongestant sprays if you have been on them too long.
It helps to come with the day it all started, whether there was an improvement followed by a downturn, how high the temperature went, whether the symptoms are one-sided or on both sides, and what you have already taken and for how long.
Endoscopic examination of the nose, imaging and swabs are done in person, and an online appointment does not replace them. And with swelling around the eye, double vision, loss of vision, a severe headache with fever or confusion, do not spend time booking anything: what is needed is a hospital, and it is needed today.
This material is for information only and does not replace medical advice.
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