A blocked nose, pressure across the face, pain that sharpens when you lean forward: most sinus infections are viral and settle on their own. Here is how to relieve them, and how to recognize the cases that really do need a doctor.
What is sinusitis?
The sinuses are air-filled cavities in the bones of the face that open into the nasal passages. When the lining of the nose swells — usually in the days following a cold — drainage is blocked and secretions stagnate. That is sinusitis, which doctors now call rhinosinusitis, because the nose and the sinuses are always affected together.
In the great majority of cases it is viral and clears up on its own. Fewer than one sinus infection in fifty goes on to become a genuine bacterial infection.
The symptoms
- a feeling of pressure or pain in the face: forehead, cheekbones, around the eyes, sometimes the upper teeth;
- a blocked nose on one or both sides, with thick discharge;
- pain that increases when you bend forward;
- a loss of smell and a nasal-sounding voice;
- sometimes a mild fever, headaches, and a cough that gets worse at night.
Viral or bacterial: how can you tell?
Contrary to a stubborn myth, it is neither the colour of the discharge nor the severity of the pain that settles the question. Three patterns over time are what raise the suspicion of a bacterial cause:
- symptoms lasting more than ten days with no improvement at all;
- severe symptoms right from the start: a high fever together with marked facial pain or purulent discharge, for three to four days in a row;
- a clear worsening after a phase of improvement — the cold was getting better, then the fever and the pain came back.
Outside these three situations an antibiotic adds nothing, and needlessly exposes you to side effects and to antibiotic resistance.
How to ease the symptoms
Rinsing the nose with saline or sea water, several times a day, is the single most effective measure: it flushes out the secretions and reopens the drainage openings. A painkiller such as paracetamol relieves the facial pain. Humid air, drinking plenty of fluids and sleeping with your head raised also help.
Decongestant nasal sprays should not be used for more than a few days — beyond that they keep the blockage going. They must not be used in children, in pregnancy, or in people with high blood pressure.
When to seek urgent care
Some signs suggest that the infection has spread beyond the sinuses and call for immediate medical advice:
- swelling or redness around the eye, or an eyelid that puffs up;
- double vision, reduced vision, an eye that moves poorly or becomes painful;
- a violent headache, a stiff neck, confusion;
- swelling of the forehead.
These situations are rare but serious: they are not something to wait out.
When should you see a doctor?
- if the symptoms go beyond ten days without improving;
- if things get worse after an initial improvement;
- if the facial pain or the fever are severe from the very start;
- if you get repeated sinus infections, or if you have asthma, diabetes or a weakened immune system.
Seeing Dr Nathalie Gozlan
Dr Nathalie Gozlan, a family doctor, can see you for sinusitis — on a home visit in the Sharon region (Netanya, Kfar Saba, Raanana, Kadima-Tzoran and the moshavim and kibbutzim of the area), or by video consultation anywhere in Israel, in French, Hebrew and English.
The consultation serves above all to place the episode on a timeline: it is the chronology, more than the examination, that says whether an antibiotic is justified — and it makes sure no sign of a complication is missed.
Frequently asked questions
Does green discharge mean a bacterial sinus infection?
No. The colour of the discharge comes from white blood cells and is seen just as often in ordinary colds and in viral sinusitis. On its own it does not indicate that an antibiotic is needed.
How long does sinusitis last?
Viral sinusitis improves within seven to ten days, even if a stuffy nose can linger a little longer. Beyond ten days with no improvement, medical advice is warranted.
Is rinsing the nose really useful?
Yes, it is the most effective thing you can do and it has almost no drawbacks. It should be done several times a day, with enough volume, blowing your nose gently afterwards.
Can sinusitis be managed by video consultation?
Yes: the diagnosis rests mainly on the history and on the timing of the symptoms, which works very well on video. An antibiotic can be prescribed if the criteria are met. If there is any eye or neurological sign, you need to be seen in person straight away.
This article is for information only and does not replace a medical consultation. If in doubt or in an emergency, see a doctor.