Published on
May 5, 2024
Sinusitis
Introduction
Sinusitis is an inflammation of the membrane lining the facial sinuses. It can be acute (lasting < 4 weeks), subacute (4 to 12 weeks) or chronic (> 12 weeks). Very common, it often complicates viral rhinitis or pharyngitis. The sinuses most often affected are the maxillary sinuses, followed by the frontal, ethmoid and sphenoid sinuses. Although the majority of sinusitis cases heal spontaneously within a few days, certain bacterial or complicated forms require specific treatment.
If you experience facial pain accompanied by a fever or a persistent purulent nasal discharge, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play.
Who is at risk?
There are numerous contributing factors: repeated viral respiratory infections (colds, flu), allergies (allergic rhinitis, asthma), deviated nasal septum, nasal polyposis, smoking, exposure to pollution, scuba diving, swimming, dental infections (particularly for maxillary sinusitis), immunosuppression, and cystic fibrosis. Both children and adults can be affected.
Symptoms of Sinusitis
Main Symptoms
Facial pain: throbbing, increased by pressure on the affected sinus, or when bending the head forward.
A feeling of heaviness or pressure in the face or forehead.
Nasal discharge: clear at first, then purulent (yellowish or greenish).
Post-nasal drip causing throat irritation.
Nasal congestion and obstruction.
Decreased sense of smell (hyposmia) and taste.
Mild to high fever depending on the cause.
Headache and fatigue.
Nighttime cough (throat irritation).
Depending on the location: pain under the eye (maxillary), above the eye (frontal), at the root of the nose (ethmoid), or behind the eye (sphenoid).
When to consult urgently?
An emergency consultation is necessary in the following situations:
Frontal or sphenoid sinusitis: intense pain, risk of orbital or intracranial complications.
Periorbital edema or redness of the eyelid (suspected complicated ethmoiditis in children or orbital cellulitis).
Visual changes: decreased visual acuity, pain when moving the eyeball, double vision.
Persistent high fever, deterioration of general health.
Neurological signs: intense headaches, stiff neck, altered consciousness — call 144.
Sinusitis in an immunosuppressed or diabetic patient.
Recurrent or persistent sinusitis lasting beyond 10-12 weeks.
What to do before calling Docadom? Rinse your nose with saline solution, take paracetamol, stay hydrated, and contact your primary care physician first. If they cannot be reached or if you need a doctor at home outside of regular hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of severe signs (eyelid swelling, visual changes, neurological signs), call 144 immediately.
Causes of Sinusitis
Acute Viral Sinusitis
The most common type, a commonplace complication of a cold. The viruses responsible are rhinoviruses, adenoviruses, influenza viruses, and coroniviruses. Symptoms generally improve within 5 to 10 days.
Acute Bacterial Sinusitis
Suspected in case of worsening after 7-10 days, intense symptoms (high fever, abundant purulent discharge, intense pain), or a double-sickening pattern. The main pathogens are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Maxillary sinusitis of dental origin is caused by anaerobic bacteria.
Chronic Sinusitis
Inflammation persisting > 12 weeks, often multifactorial: allergies, nasal polyps, septal deviation, immune disorders, cystic fibrosis, or recurrent infections. Symptoms are prolonged but often less intense.
Specific Types of Sinusitis
Fungal sinusitis: in immunocompromised patients (mucormycosis, aspergillosis).
Sinusitis in children: a specific form (ethmoiditis) to monitor closely.
Tooth-related sinusitis.
Diagnosis of Sinusitis
Diagnostic Methods
Medical history and clinical examination: palpation of the sinuses, ENT exam.
Anterior rhinoscopy: shows purulent discharge and swelling of the nasal lining.
Nasal endoscopy by an ENT specialist if there is doubt.
Sinus CT scan: reference examination for chronic, recurrent, atypical, or complicated sinusitis. Not necessary for typical acute sinusitis.
Lab tests: CBC, CRP in case of systemic signs.
Bacterial swab if antibiotics fail or in complicated cases.
Alternative Diagnoses
Allergic or vasomotor rhinitis.
Migraine or tension headache.
Cluster headache.
Trigeminal neuralgia.
Dental issues.
Tumor of the sinuses or nasopharynx.
Treatment of Sinusitis
Viral Sinusitis (the majority of cases)
Nasal washes with saline solution, several times a day.
Pain relievers and fever reducers (paracetamol).
Topical nasal decongestants (short term, < 5 days).
Inhaled nasal corticosteroids in the presence of an allergic component.
Rest, hydration, humid atmosphere.
Antibiotics are not indicated.
Bacterial Sinusitis
Amoxicillin: first-line treatment for 7 days.
Amoxicillin-clavulanic acid in case of tooth-related sinusitis or initial treatment failure.
Macrolides or pristinamycin in case of penicillin allergy.
Oral corticosteroids: exceptionally as a short course in highly inflammatory sinusitis.
Associated measures: nasal rinses, pain relievers, short-term decongestants.
Chronic Sinusitis
Specialized care from an ENT specialist:
Daily nasal rinses.
Long-term inhaled nasal corticosteroids.
Treatment of triggering factors: allergy, GERD, polyposis, smoking.
Endoscopic sinus surgery in case of medical failure or extensive polyps.
Biologics (anti-IL-4/IL-13, anti-IL-5) in severe polyps.
Prevention of Sinusitis
Regular nasal washes with saline during colds or allergy seasons.
Early treatment of rhinitis and ENT infections.
Management of respiratory allergies (immunotherapy, antihistamines).
Quitting smoking.
Avoiding exposure to pollution.
Rigorous oral hygiene, regular dental check-ups.
Flu, COVID-19, and pneumococcal vaccinations for at-risk individuals.
Adequate hydration and humid atmosphere in winter.
Correction of anatomical anomalies (septal deviation, polyps) in case of recurrences.
Possible Complications
Complications are rare but can be serious: orbital cellulitis or orbital abscess (ophthalmic emergency), cavernous sinus thrombosis, meningitis, brain abscess, or osteomyelitis of the frontal bone (“Pott’s puffy tumor”). Ethmoiditis in infants is an emergency. Chronic sinusitis can permanently alter quality of life: loss of smell, fatigue, sleep disturbances, depression.
When to contact a physician for sinusitis
Any severe or prolonged sinusitis deserves medical advice:
First resort: contact your primary care physician, who can determine whether it is a viral or bacterial sinusitis and prescribe appropriate treatment.
If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation with a doctor at home. Call 021 845 45 45 or make your request via our mobile app, available for free on the App Store and Google Play.
In case of severe signs (periorbital swelling, visual changes, neurological signs, very high fever), call 144 without delay.
Conclusion: nasal washes and patience for the majority of cases
Sinusitis is a common condition, usually benign. It is characterized by facial pain, purulent nasal discharge, and congestion, which can lead to rare but serious complications like orbital cellulitis, meningitis, or brain abscess. The vast majority of viral sinusitis cases heal spontaneously with simple measures (nasal washes, paracetamol). Antibiotic therapy is reserved for confirmed bacterial forms. Chronic sinusitis requires specialized ENT management.
If in doubt, consult your primary care physician first. If they are unavailable, Docadom provides an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile app (App Store, Google Play) to request an emergency consultation.
