Sinusitis

Sinusitis — also called rhinosinusitis — is inflammation of the lining of the paranasal sinuses (the air-filled spaces in the bones around your nose, cheeks and eyes). Healthy sinuses are lined with a thin, moist membrane that makes mucus and drains it into the nose through small natural openings. When that lining swells, the openings narrow, mucus builds up behind them, and you get the familiar pressure, blockage and thick discharge. Because your nose and your sinuses are really one connected system, the nose lining is nearly always inflamed at the same time — which is why you may hear it called rhinosinusitis. It is one of the most common conditions affecting the nose and sinuses.

Sinusitis is grouped by how long it lasts, and that matters more than how severe it feels on any given day. Acute sinusitis lasts under four weeks and is by far the most common form — it usually follows a cold and settles by itself. Subacute sinusitis lingers between four and twelve weeks. Chronic sinusitis means symptoms have been present for twelve weeks or longer, often with less dramatic pain but constant blockage, postnasal drip (mucus trickling down the back of your throat) and a dulled sense of smell. Recurrent acute sinusitis describes several separate episodes in a year with genuinely clear periods in between. Each pattern points towards a different cause and a different plan.

Most acute sinusitis begins with an ordinary viral cold. The virus inflames the nasal lining, drainage slows, and the sinuses become congested. At this stage the illness is viral, not bacterial — which is precisely why most cases need no antibiotic at all. Only a minority go on to develop a bacterial infection on top of it. Longer-lasting or repeated sinusitis usually has something else keeping the drainage pathways blocked: untreated allergic rhinitis (allergy-driven nasal inflammation), a deviated septum (the partition that divides the two sides of the nose sitting off-centre — often further back than you can see), nasal polyps (soft, painless swellings of the lining), enlarged adenoids in children (a patch of soft tissue at the very back of the nose, above the throat, which can swell and block drainage), an infected upper tooth, or ongoing irritation from smoking, dust or fumes. Finding that underlying reason is the key to lasting relief.

A common question is how to tell sinusitis from a cold that is simply dragging on. A cold usually peaks around the third day and then eases steadily. Sinusitis is more likely when symptoms persist beyond about ten days without improving, when they are severe from the outset — a high fever (around 39°C) together with thick discoloured discharge, both persisting for three to four days in a row rather than a fever on a single day — or when you seem to recover and then clearly worsen again, sometimes called double worsening. Discoloured mucus on its own is not proof of a bacterial infection; green or yellow discharge is a normal stage of many viral colds. The timing and pattern of your symptoms, rather than the colour of the mucus, are what guide the treatment you actually need.

It is also worth knowing that facial pain or headache on its own — with no blocked nose and no discharge — is usually not sinusitis. Migraine in particular is often mistaken for 'sinus headache', and it needs quite different treatment, so repeated courses of sinus medicine rarely help. Sinusitis itself is rarely dangerous. A small number of signs, though — swelling around an eye, changed or double vision, a severe or rapidly worsening headache, neck stiffness or confusion — mean urgent care rather than a routine appointment; they are listed in full at the end of this page. They are uncommon, but they are the ones worth recognising early.

Diagnosis starts with your story — how long the symptoms have lasted, whether they followed a cold, whether they improved and then suddenly worsened, and what makes them flare. Dr. G Abhinav Kumar Reddy then examines your nose and throat in the outpatient clinic (OPD). Where a closer look would help, diagnostic nasal endoscopy is available at Abhinav's ENT Care Center: a slim telescope is passed gently into the nose after a numbing spray, letting us see the sinus drainage openings, and any pus, polyps or a deviated septum, directly. It is done while you are awake and usually takes only a few minutes. For chronic or complicated sinusitis, a CT scan may be advised to map the sinuses. Not everyone needs a scan or an endoscopy — Dr. Reddy will decide with you after examining you.

For most acute sinusitis, treatment is about supporting your body while the inflammation settles, rather than attacking an infection. Saline nasal irrigation (rinsing the nose with a salt-water solution) helps thin the mucus and clear the drainage pathways — always make the rinse up with previously boiled and cooled, distilled or sterile water, never straight from the tap, and rinse the device out and let it air-dry after each use. Some people find steam inhalation soothing, though it does not appear to shorten the illness — and it should be kept well away from children because of the risk of scalds. Simple pain relief eases facial pressure. Decongestant nasal sprays can give useful short-term relief, but using them for more than a few days in a row can cause the nose to block up again worse each time the spray wears off (rebound congestion) — so they should only be used briefly, and on advice. Decongestants are generally not suitable for young children, or for people with high blood pressure or heart problems, without medical advice. An intranasal corticosteroid spray (a steroid spray that reduces swelling in the nasal lining) is often the mainstay where inflammation is the main problem, particularly when allergy is involved. Treating that underlying allergy properly frequently does more for recurrent sinusitis than repeated courses of medicine for each individual episode.

Antibiotics deserve a clear word. They do nothing against viruses, and since most acute sinusitis is viral, most people do not need them. They are considered only when the pattern above genuinely points to a bacterial infection — and that pattern is about timing, not about the colour of your mucus. Taking an antibiotic when it is not needed does not speed your recovery, and it makes these medicines less effective for the times you truly do need them. Dr. Reddy will tell you after examining you whether one is right for you. The same applies to long-standing sinusitis: chronic sinusitis is driven mainly by ongoing inflammation rather than infection, so repeated antibiotic courses are usually not the answer — treating the inflammation and the underlying cause is.

When sinusitis is chronic or keeps returning despite proper medical treatment, and especially when examination or a scan shows a structural reason — persistent polyps, a markedly deviated septum, or blocked drainage pathways — functional endoscopic sinus surgery (FESS) may be discussed. It is performed through the nostrils with a telescope, without any external cuts, and aims to reopen the natural drainage openings so the sinuses can clear and your sprays can reach the lining. It is not a first step and it is not a guaranteed cure — results vary from person to person, and continued care for allergy or inflammation is usually still needed afterwards. If it turns out to be the right step for you, FESS is carried out here at Abhinav's ENT Care Center.