Sinusitis, also known as rhinosinusitis or a sinus infection, is an inflammation of the mucous membranes in the sinuses. Typical symptoms include facial pressure, stuffy nose, difficulty breathing through the nose, headaches and impaired sense of smell. Sinusitis can be acute (acute sinusitis), typically following a cold, or chronic (chronic sinusitis) if symptoms persist for more than three months. Rhinosinusitis mainly affects the maxillary sinuses and ethmoidal cells, but much less frequently affects the frontal and sphenoid sinuses.

Mann in Behandlung für eine Sinusitis

The sinuses at a glance

The sinuses are air-filled cavities in the skull that are connected to the nasal cavity via small openings (ostia). They extend from the forehead to the upper jaw and are divided into the frontal cavity, maxillary sinus cavity, sphenoid sinus cavity and ethmoidal cells (approx. 10 chambers). The inner surfaces of the nasal cavity and the sinuses are lined with mucous membranes (mucosa), which are covered with tiny cilia.

The cilia move rhythmically within the liquid secretion layer and transport the mucus lying on it with trapped dust particles and germs towards the throat and mouth. There, it is either swallowed and rendered harmless by the stomach acid or expelled by coughing and sneezing. This natural self-cleaning mechanism is also referred to as mucociliary clearance.

Course of the illness and causes

Viral infection as part of a cold or flu

If a cold or flu leads to irritation or inflammation of the nasal mucosa, this often produces thick mucus. This causes the fine cilia to become stuck and the mucociliary clearance no longer proceeds as usual. The secretion accumulates instead of being transported away; the nose feels “stuffy” and the airways are congested.

From a common cold to acute sinusitis

If acute rhinosinusitis does not completely heal or continues recurring, it can become chronic. If the mucous membranes remain permanently swollen and constantly produce viscous secretions, the narrow drainage channels between the nasal cavity and sinuses are often permanently blocked. This disrupts sinus ventilation, which can lead to pathogens and inflammatory processes.

Other risk factors for sinusitis

Other risk factors that can trigger or promote sinusitis include:

  • Bacterial infection
    Bacteria are possible triggers of sinus inflammation. However, they often appear as secondary infections only during the course of a viral infection and can thus prolong the course of sinusitis.
  • Allergies
    Inflammation of the nasal mucosa can also be due to an allergic reaction, such as hay fever.
  • Anatomical factors
    If the nasal septum is curved (deviated septum) or the openings to the sinuses are narrowed, secretions accumulate more easily. This can lead to or exacerbate sinus inflammation.
  • Pathological nasal mucosa changes
    Another possible trigger for sinusitis is pathological changes in the nasal mucosa, such as benign nasal polyps. These can block the sinuses and cause secretions to build-up.

Symptoms of sinusitis

Sinusitis usually manifests as typical complaints that differ from a simple cold. The most common signs of rhinosinusitis include

  • Feeling of pressure or pain in the face (forehead, cheeks, eyes)
  • Stuffy or runny nose
  • Green and yellow or thick nasal discharge
  • Impaired sense of smell and taste
  • Headaches, especially when bending over
  • General feeling of sickness, sometimes with fever

Diagnosis

Rhinosinusitis is usually diagnosed by a doctor specialising in otorhinolaryngology (ORL), also known as an ear, nose, and throat (ENT) doctor. When making a diagnosis, it is crucial to differentiate between acute and chronic forms, as this leads to different treatment approaches. The following diagnostic procedures can be used:

  • Case history: review of the patient’s medical history, with a focus on symptoms, duration of complaints and nature of their headaches.
  • Physical examination: examination of the nose and sinuses, e.g. by feeling for pain due to pressure.
  • Nose examination (rhinoscopy): endoscopic assessment of the nasal mucous membranes and possible changes.
  • Imaging techniques: if chronic or complicated cases are suspected, CT, MRI or ultrasound (sonography) can be used.
  • Allergy tests: carrying out tests if allergies are a possible trigger.

Treatment

The treatment of sinusitis always depends on the cause and course of the illness. The aim is to alleviate the symptoms, support the healing process and prevent potential complications. A distinction is made between measures for acute and chronic forms.

Treatment of acute sinusitis

  • Decongestant nasal sprays (maximum of seven days)
  • Painkillers and fever reducers such as ibuprofen or paracetamol
  • Inhalations with saline or essential oils
  • Antibiotics, only for bacterial infections and severe cases

Treatment of chronic sinusitis

  • Nasal sprays containing cortisone for anti-inflammation
  • Treatment of allergies (e.g. antihistamines)
  • Surgical interventions (e.g. endoscopic sinus surgery), when conservative measures are not sufficient

Prevention

A strong immune system plays a key role in fending off infections such as sinusitis. A functioning immune system and proper mucociliary clearance make it difficult for pathogens to take hold. This can be supported by the following measures:

  • A diet rich in vitamins and nutrients
  • Regular exercise
  • Adequate sleep, relaxation and conscious recovery

In addition, allergies should be treated early to prevent the mucous membranes from swelling.

If you already have a cold and want to prevent it from developing into sinusitis, the following measures also help:

  • Drink enough fluids to keep the mucous membranes moist and prevent the mucus in the sinuses from thickening.
  • Ventilate regularly and ensure that there is enough humidity to prevent dry air indoors.
  • Gently blow your nose, only clearing one nostril at a time.
  • Nasal rinses, seawater sprays and inhalations can have a soothing effect and help loosen stuck mucus.

FAQ

Is sinusitis contagious?

Sinusitis itself is not directly transmissible. However, as it often occurs as a result of a cold, the underlying viruses can be passed on.

Is sinusitis viral or bacterial?

In most cases, sinusitis is triggered by viruses. However, bacteria can “attack” an existing viral infection and prolong the course of the disease; this is referred to as a secondary bacterial infection.

Can sinusitis also occur in small children?

In small children, the sinuses are not yet fully developed. The frontal sinuses in particular often only develop fully after school age. This is why sinusitis is rare in the first few years of life.

How long does sinusitis last?

Acute sinusitis usually heals within one to two weeks. A chronic form is when the symptoms persist for more than 12 weeks.

When should you see a doctor if you have sinusitis?

If the symptoms persist for more than 10 days, worsen significantly or are accompanied by severe fever, severe headache or impaired vision, medical clarification is required.