Sinusitis is inflammation of the air cavities around the nose and of the nasal lining; there is an acute form, lasting less than four weeks, and a chronic form, lasting at least 12 weeks. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, examines the sinus openings with an endoscope and, if needed, assesses them with a CT scan. Most acute sinusitis is viral and improves with supportive treatment. In chronic sinusitis, nasal rinses and nasal steroid sprays are the core treatment; if there is no response, endoscopic sinus surgery is considered.
What is sinusitis?
Sinusitis is inflammation of the air-filled cavities inside the bones around the nose (the paranasal sinuses) and of the nasal lining; in medicine it is therefore also called rhinosinusitis. The maxillary (cheeks), frontal (forehead), ethmoid (between the eyes) and sphenoid (near the base of the skull) sinuses drain their secretions into the nose through narrow channels. When these channels are blocked by swelling, polyps or a structural narrowing, secretions build up in the sinus and inflammation develops.
What is the difference between acute and chronic sinusitis?
- Acute sinusitis: lasts less than four weeks. Most cases are viral inflammation that follows a cold and clears up on its own.
- Recurrent acute sinusitis: several episodes a year, with full recovery in between
- Chronic sinusitis: symptoms for at least 12 weeks and signs of inflammation on examination or CT scan; it can occur with or without nasal polyps.
Bacterial sinusitis is suspected when symptoms last more than 10 days or when, after an initial improvement, they get worse again.
What are the symptoms?
Common symptoms are a blocked nose, thick nasal discharge or postnasal drip, pressure or pain in the face and forehead, and a reduced sense of smell. They may come with a cough that is worse at night, bad breath and tiredness. Not every headache is sinusitis; if there is only a headache without nasal symptoms, other causes are also investigated.
What causes sinusitis?
The most common cause is upper respiratory tract infections. In recurrent and chronic sinusitis, underlying factors are investigated: a deviated septum, enlarged turbinates, allergic rhinitis, nasal polyps, tobacco smoke and, rarely, infections of dental origin. Other causes of a blocked nose are in the article common causes of a blocked nose.
How is it diagnosed?
The diagnosis is made by examination. Op. Dr. Süleyman Kumbasar examines the inside of the nose and the sinus openings with an endoscope; this shows the source of the discharge, polyps and structural narrowing. A CT scan is not usually needed in acute sinusitis. In chronic sinusitis, a sinus CT scan is requested when surgery is being planned or if spread towards the eye or brain is suspected.
How is sinusitis treated?
In acute viral sinusitis, treatment is supportive: saline nasal rinses, painkillers and nasal sprays prescribed by the doctor. If bacterial sinusitis is suspected, antibiotics may be started or, under certain conditions, a short period of watchful waiting may be chosen; the decision depends on how long the symptoms have lasted and how severe they are. In chronic sinusitis, long-term saline rinses and nasal steroid sprays are the core treatment; if there is allergy, its treatment is added.
Endoscopic sinus surgery
In chronic sinusitis and nasal polyps that persist despite medical treatment, endoscopic sinus surgery is considered. The operation is done through the nostrils with fine camera instruments; there are no incisions on the face. Blocked sinus openings are widened and polyps and inflamed tissue are removed. In selected cases, balloon sinuplasty, in which the sinus opening is widened with a balloon, is another option. If there is a deviated septum, it can be corrected in the same session.
Which symptoms are urgent?
If sinusitis comes with swelling and redness around the eye, changes in vision or double vision, a severe headache, a stiff neck or changes in consciousness, seek emergency care without delay. These signs can indicate that the inflammation has spread around the eye or inside the skull.
The surgical process
Endoscopic sinus surgery; done through the nostrils, with no incisions on the face.
General anaesthesia. A CT scan and an anaesthetic assessment are carried out before the operation.
Depending on the scope, usually 1–2 hours; adding septum surgery makes it longer.
Discharge on the same day or the next day.
Whether packing or dissolvable dressings are used depends on the surgical plan.
Recovery timeline
Blocked nose, bloodstained discharge and crusting. Saline rinses are started; do not blow your nose.
The inside of the nose is cleaned at check-ups. Most people return to office work at the end of the first week.
The lining heals and the sense of smell and nasal breathing start to improve.
Especially with nasal polyps, regular check-ups and nasal spray treatment continue.
Frequently asked questions
Does sinusitis cause headaches?
Sinusitis can cause pressure or pain in the face, forehead and around the eyes. But if there is only a headache without a blocked or runny nose, the cause is not usually sinusitis; other types of headache, such as migraine, are also investigated.
Are antibiotics always needed for sinusitis?
No. Most acute sinusitis is viral and does not need antibiotics. Symptoms lasting more than 10 days, getting worse after an improvement or being severe suggest bacterial sinusitis; the decision on antibiotics is made at the consultation.
Is a sinus CT scan always done?
It is not usually needed in acute sinusitis. It is requested in chronic sinusitis, when surgery is being planned or if spread around the eye or inside the skull is suspected.
What are nasal polyps?
Nasal polyps are benign growths that develop in the lining of the nose and sinuses because of chronic inflammation. They cause blockage and loss of smell. If a polyp is seen on one side only, or a mass that bleeds, it is investigated separately.
Do polyps come back after endoscopic sinus surgery?
Chronic sinusitis with polyps is a long-term inflammatory disease and can come back after surgery too. To reduce the risk, nasal steroid sprays and regular check-ups continue.
Who is balloon sinuplasty suitable for?
Balloon sinuplasty can be used in selected cases with a narrowed sinus opening and no significant polyps. Sinusitis with polyps or extensive disease needs endoscopic sinus surgery; suitability is determined from the CT scan and endoscopy.
Related treatments
Articles on this topic
Sources
- Rosenfeld RM et al. Clinical Practice Guideline (Update): Adult Sinusitis. Otolaryngology–Head and Neck Surgery, 2015.
- Seidman MD et al. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology–Head and Neck Surgery, 2015.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.