At first it's just a runny nose: a week of tissues and the hope that it will soon pass. But the second week comes, the nose is still blocked, the face hurts, and the head throbs as if something inside is wrong. What follows is about what happens in the sinuses, how acute sinusitis differs from chronic, and when it's time to see an ENT specialist.
What happens inside: the sinuses and the mucosa
The sinuses (sinus paranasales) are small cavities behind the cheekbones and forehead, connected to the nasal cavity. There are four pairs: maxillary, frontal, ethmoid and sphenoid. Sinusitis is inflammation of the mucous membrane that lines them. It swells, the openings to the nose narrow, and mucus stops draining normally into the nose and throat — hence the congestion and the feeling of pressure.
Acute and chronic: the difference is in time
Sinusitis is classified by duration: acute — less than four weeks, subacute — from four to twelve, chronic — twelve weeks or longer. By location, the inflammation has separate names: maxillary sinusitis — the maxillary sinus, frontal sinusitis — the frontal, ethmoiditis — the ethmoid, sphenoiditis — the sphenoid. This determines where it hurts: the maxillary sinuses refer pain to the cheek and teeth, the frontal sinuses to the forehead above the eyes, the ethmoid sinuses between the eyes and along the sides of the upper nose, the sphenoid sinuses behind the eyes or in the crown of the head. In the chronic course, fever and pain are less pronounced, but congestion, night cough, general malaise and gradual loss of smell persist.
Symptoms and how this differs from a cold
Sinusitis usually begins after a cold or flu. The main signs are pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked nose, thick yellow or green mucus, a reduced sense of smell and fever. Headache, toothache, bad breath, cough, a feeling of pressure in the ears, and sometimes a nasal voice and snoring are added. In young children — irritability, difficulty feeding, mouth breathing.
What to watch for when a runny nose drags on:
- symptoms do not ease or get worse;
- facial pain intensifies when you bend your head forward;
- symptoms last longer than four weeks.
A runny nose that clears up in the usual time is a cold (ARI). If a runny nose drags on and facial pain is added, that's a reason to see a doctor. What is called sinus pain often turns out to be migraine (types of headache): with migraine there is usually no thick nasal mucus.
Causes: viruses, bacteria, allergy, nasal structure
Most cases are caused by viruses. A bacterial cause occurs much less often. Other factors are allergy and environmental irritants, features of the structure of the nasal cavity and sinuses (deviated septum, vasomotor or hypertrophic rhinitis, in children — enlarged adenoids, congenital structural abnormalities of the nose), and reduced immunity. Recurrent episodes are more common in people with asthma, cystic fibrosis and immunodeficiency.
How it is diagnosed
The diagnosis is based on symptoms and their duration. An ENT specialist can examine the nasal cavity with an endoscope and confirm inflammation. In the acute course, imaging is usually not needed unless complications are suspected; in chronic cases, computed tomography is recommended. Maxillary sinusitis is confirmed by the clinical picture together with X-ray or tomography of the sinuses.
When to see an ENT specialist and what reduces the risk
Referral to an ENT specialist is made if symptoms last more than three months, if sinusitis recurs, or if pain and congestion are only on one side of the face. The risk of inflammation is influenced by ordinary things: hand washing, up-to-date vaccinations, not smoking.
Call 103 or 112 immediately if, against the background of sinusitis, swelling or bulging of the eye appears, the eye moves poorly, vision worsens, or a severe headache occurs together with confusion or seizures.
Complications are rare, about one case in ten thousand, but that is exactly why these signs are worth knowing by heart.
This text is for reference, so the decision about examination and treatment is still made by a doctor at an appointment.
Sources
Update history
This content is for reference and does not replace a doctor's consultation. Medical disclaimer