Your nose is stuffy and runny, and you have a crushing headache. You might think you have a cold, but it might instead be sinusitis, a condition that’s easy to confuse with a common cold. There are some telltale differences—most notably, sinusitis lasts longer—but early on, even doctors may have trouble distinguishing between the two.
Sinusitis symptoms and causes
The sinuses are air-filled spaces in the skull that are thought to have developed to keep the head lighter. There are four pairs of them—behind the eyes, between the eyes, in the forehead above the nose, and in the cheekbones.
Sinusitis is an inflammation or infection in one or more of these cavities, usually viral in origin. Because inflamed sinuses are almost always accompanied by inflamed nasal passages, it’s more accurately called rhinosinusitis (rhino, from the Greek for nose).
In addition to congestion and nasal discharge, you may also have—depending on which sinuses are affected—headache, pain in the upper jaw or teeth, pain in the upper cheek, pressure around or behind the eyes, or pain around the eyes. Fever, fatigue, sore throat, and cough are less common.
While colds usually go away on their own after a week or so, sinusitis usually lasts up to four weeks. But for many people, sinusitis is a chronic debilitating condition, lasting weeks, months, or even years.
What causes sinusitis? Because the nasal passages and sinuses are connected, anything that affects the nose can affect the sinuses. Acute sinusitis typically occurs after an upper-respiratory viral infection, such as a cold, or as a consequence of allergies, such as hay fever, both of which irritate the nasal mucous membranes. If mucus and air get trapped in the sinuses and can’t drain, the sinuses can become a breeding ground for bacteria that live in the nose, setting the stage for a bacterial infection (bacterial sinusitis).
Having a deviated septum, which may impair the flow of air through the nasal passage, also increases the risk of sinusitis. Nasal polyps (growths in the nose) may develop from repeated bouts of sinusitis or allergies and contribute to further bouts of sinusitis.
Soothing your sinuses
You may not know initially if you have a cold or sinusitis, but self-care at home for either condition includes drinking plenty of fluids to thin nasal secretions, using a saline spray or steam inhalation for congestion, and taking over-the-counter pain relievers. A decongestant may help, but should not be taken (especially the sprays) for more than a few days, since that can lead to more swelling and congestion. Keep your head elevated when sleeping. Acute viral sinusitis often resolves on its own.
If your symptoms are severe, don’t improve within a couple of weeks, or get worse after initially improving, see your doctor. You may have bacterial sinusitis and may need antibiotics. Though most cases of sinusitis are viral, an estimated 90 percent of people with symptoms are given antibiotics, which work only against bacterial infections. Thus, antibiotics won’t help in most cases of sinusitis—nor against colds.
If your sinusitis is allergy-related, antihistamines can help, if used early (otherwise they thicken secretions). An allergy specialist can determine the best treatment, which may include prescription nasal steroids. There’s some evidence that nasal steroids can directly help symptoms of sinusitis, too, such as nasal congestion and facial pain, even in people without allergies, with minimal risk of systemic side effects.
If you have recurring sinusitis or chronic sinusitis, your doctor may refer you to an ENT (ear, nose, and throat) specialist, who may take samples of nasal discharge to look for bacteria or even fungi (also implicated in sinus infections) and do a nasal endoscopy to confirm the diagnosis. You may also be referred for imaging studies, such as a CT scan. Regular X-rays of the sinus cavities are not useful.
In severe cases of chronic sinusitis not helped by medication, surgery may be recommended to enlarge the openings of the sinuses, remove nasal polyps, or correct a deviated septum. But you should get a second opinion before undergoing surgery.
Tips for preventing sinusitis
If you’re prone to sinusitis, you can use a saline nasal spray or do nasal irrigation to keep your nose moist, and a humidifier at home when the air is dry. Clean the humidifier properly because otherwise it can become a source of molds that may trigger allergic reactions and thus increaseyour risk of sinusitis. Staying well-hydrated may also help.
Take care of any allergies you may have and avoid pollutants, including smoke from cigarettes and wood-burning stoves. Swimming can force water into the sinuses, so if you’re prone to sinusitis you may want to spend less time in the water and avoid diving, in particular—or, at least, use a nose clip.