Sinusitis: Causes, Symptoms, Treatments


Sinusitis is referred to as an inflammatory condition involving the nasal sinuses which are hallow spaces present behind the forehead, cheeks, nose, and eyes. Sinusitis can involve either one or more than one sinus.
Maxillary sinus(space in the bones around the nose) is the most commonly involved, followed by ethmoid(hallow space in the bones in the upper part of the nose between the eyes), frontal (hallow space in the bones in the lower part of the forehead, and reaches over the eyesockets and eyebrows)and sphenoid sinuses(hallow space in the bones in the middle and towards the front of the skull). Generally, the mucus does not accumulate in the nasal cavity, but in a few individuals when the sinus ostia are obstructed or ciliary clearance is improper or absent the secretions or mucus remains in the sinus which causes typical signs and symptoms of sinusitis. As these secretions accumulate in the sinus, they become more susceptible to a variety of pathogens like viruses, bacteria, and fungi.
Based on the duration of the illness, it can be classified into either acute or chronic sinusitis and, based upon the cause of the sinusitis, like viral, bacterial, and fungal, it can be called either infectious or non-infectious sinusitis.
Viral sinusitis is more common in comparison to bacterial sinusitis.
Viruses that cause sinusitis include Rhinovirus, Influenza virus and Parainfluenza virus, Respiratory syncytial virus, Adenovirus, and Enterovirus.
Bacteria that cause sinusitis include Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes,  and Staphylococcus aureus.
Rhinocerebral mucormycosis is a condition that is caused by fungi, which include Rhizopus, Rhizomucor, Mucor, Lictheimia, and Cunninghamella. Fungal sinusitis mostly occurs only in diabetic patients with ketoacidosis and transplant recipients, hematologic malignancies, and patients receiving glucocorticoid therapy (e.g: beclomethasone, betamethasone, budesonide, cortisone, dexamethasone, hydrocortisone, methyprednisolone, prednisolone, triamcinolone) and also in individuals who receive deferoxamine therapy.

If you suspect you may have Sinusitis or have risk factors for one, it is crucial to consult with an ENT.


  • Allergic rhinitis
  • Barotrauma (from deep-sea trauma or air travel)
  • Exposure to chemical irritants
  • Sinus tumors (squamous cell carcinoma)
  • Granulomatous diseases like granulomatosis with polyangiitis, rhinocerical
  • A few conditions lead to altered mucus content e.g. Cystic fibrosis

Risk Factors

  • Structural concerns like septal deviation
  • Nasal polyposis obstructs sinus drainage by polyps
  • Immunocompromised individuals, like patients with recurrent allergies, HIV, AIDS, asthma, diabetes, immunosuppressive individuals receiving chemotherapy and or steroids, transplant recipients, and hematologic malignancies.
  • In ICU nasotracheal intubation and nasogastric tubes are major risk factors for nosocomial sinusitis. The bacteria that generally cause sinusitis in the hospital environment include multi-drug resistant pathogens like Pseudomonas aeruginosa, Klebsiella pneumonia, Serratia marcescens, and Enterobacter species.


General symptoms of sinusitis include:

  • Nasal drainage and congestion
  • Facial pain or pressure in the affected sinuses
  • Headache
  • Thick, purulent nasal discharge
  • Cough, sneezing
  • Fever
  • Fatigue
  • Tooth pain mostly in the upper molars 
  • Bad breath

Maxillary sinusitis causes symptoms like nasal congestion, purulent nasal discharge, facial pain, loss of smell/odour (anosmia)

Symptoms of ethmoid sinusitis include pain between the the corners of the eyes, pain at the top of the head, near the forehead, pain at the bridge of the nose, blurred vision or decreased vision. 

Symptoms of frontal sinusitis include, osteomyelitis is a complication of frontal sinusitis.
Sphenoid sinusitis causes symptoms like earaches, pain in the neck, aches behind the eyes, pain at the top of the head.

Complications of sinusitis include -Pott’s puffy tumour, meningitis (inflammation/swelling of the protective membranes covering the brain and spinal cord) , epidural abscess(infection in the space between the skull bones and the brain lining)  and cerebral abscess(pus filled pockets in the brain).

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Based upon the duration of the illness, it can be classified into acute or chronic sinusitis and, based upon the cause of the sinusitis, like viral, bacterial and fungal, it can be called either infectious or non-infectious sinusitis.


  • Rhinosinusitis - it is an inflammatory condition involving the nasal sinuses.
  • Generally, if the symptoms of the sinusitis do not resolve in about 7 days then antibiotics would be recommended
  • In case of acute conditions, oral penicillins would be advised for 10 days.
  • In case of allergy to penicillins, then clindamycin or fluoroquinolones.
  • In case of severe abscess or osteomyelitis then systemic antibiotics would be recommended which may require hospitalization in the initial few days.
  • Endoscopic drainage of the abscess would be the recommended choice.
  • Prophylactic antibiotics are not recommended in case of recurrent episodes of sinusitis.

Preventive Measures

Receiving vaccines like flu vaccine annually. It can prevent flu or reduce the risk of having severe flu symptoms which in few cases require admission to the hospital. 

Do's & Don’t's

Do's Don't
Drink plenty of fluids Avoid exposure to cigarette smoke
Use a humidifier or steam inhalation Don't use decongestant nasal sprays for more than a few days without consulting a doctor
Use saline nasal sprays or rinses Avoid allergens and irritants such as pollen, dust, and strong odors
Practice good hygiene, such as washing hands frequently Don't engage in activities that worsen sinus congestion, such as diving or swimming underwater
Use over-the-counter pain relievers as directed Avoid overuse of antibiotics without proper medical supervision
Apply warm compresses to your face Don't ignore symptoms that worsen or persist for more than a week
Rest and get plenty of sleep Avoid consuming excessive amounts of alcohol
Maintain a healthy diet Don't ignore underlying conditions such as allergies or nasal polyps
Follow any treatment plan prescribed by your doctor Avoid self-diagnosis and self-treatment without medical advice
Keep your nasal passages moist and clear Don't ignore symptoms such as severe headache, high fever, or vision changes, which may indicate a more serious condition

If you suspect you may have Sinusitis or have risk factors for one, it is crucial to consult with an ENT.

Frequently Asked Questions
Sinusitis is the inflammation or swelling of the tissue lining the sinuses. The sinuses are air-filled cavities located behind the bones of the face. When they become blocked and filled with fluid, bacteria, viruses, and fungi can grow and cause an infection.
Common symptoms include facial pain or pressure, nasal congestion, nasal discharge (yellow or green), difficulty breathing through the nose, reduced sense of smell, cough, headache, fatigue, and fever.
Sinusitis can be acute (lasting less than four weeks), subacute (lasting four to 12 weeks), chronic (lasting more than 12 weeks), or recurrent (several acute episodes within a year).
Sinusitis can be caused by viral infections (most common), bacterial infections, fungal infections, allergies, nasal polyps, deviated septum, or other structural problems in the nose and sinuses.
Diagnosis is usually based on the patient's symptoms, physical examination, and sometimes imaging studies such as CT scans or MRIs. In some cases, nasal endoscopy or allergy testing may be recommended.
Treatment depends on the cause and severity of the sinusitis. It may include over-the-counter or prescription decongestants, nasal corticosteroid sprays, saline nasal irrigation, pain relievers, antibiotics (if bacterial infection is present), allergy medications, or in severe cases, surgery to improve drainage.
You should see a doctor if you have symptoms of sinusitis that persist for more than 10 days, if symptoms worsen despite home treatment, if you have a fever higher than 102°F (38.9°C), or if you experience severe headache, facial swelling, vision changes, or confusion.
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