Picture of the Sinuses

Yellow or green mucus can mean a bacterial infection. Even then, it usually clears up in 7 to 14 days without antibiotics. But if you keep feeling worse, your symptoms last and are severe, or if you get a fever, it’s time to see a doctor.

Sinusitis: Symptoms, Diagnosis, Treatment

Pain in the forehead or between the eyes? Upper teeth ache? Face feeling full, nose stuffy and congested? You may have a common complaint that sends many people to a doctor’s office: sinus trouble.

What Are Sinuses?

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What Are Sinuses?

Americans see their primary care doctors less often than they did a decade ago. Adults under 65 made nearly 25% fewer visits to primary care providers in 2016 than they did in 2018, according to National Public Radio. In the same time period, the number of adults who went at least a year without visiting a primary care provider increased from 38% to 46%.

They’re air spaces in your skull lined with mucous membranes. Most people have four sets of nasal sinuses:

• Two in the forehead above the eyes
• One inside each cheekbone (dark triangles seen in this image)
• A group of them, called the ethmoid sinuses, behind the bridge of the nose
• Another group behind the nose and underneath the brain called the sphenoid sinuses

Sinuses are like fingerprints: Everybody’s are different. Some people have no frontal sinuses or just one.

What Is Sinusitis?

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It’s inflammation in your sinuses. Tiny, hair-like structures called cilia (magnified here) move mucus across sinus membranes and toward an exit. All of your sinus cavities connect to your nose to allow a free exchange of air and mucus. Infections or allergies make sinus tissues inflamed, red, and swollen.

Just a Cold … at First

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Sinusitis usually starts with inflammation triggered by a cold, allergy attack, or irritant. But it may not end there. Colds, allergies, and irritants make sinus tissues swell.

How It Feels

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Most people have a stuffy nose and pain or pressure in several areas around the face or teeth. There’s usually a nasal discharge that may be yellow, green, or clear. You may also have fatigue, trouble with sense of smell or taste, cough, sore throat, bad breath, headache, pain when you bend forward, and fever.

When It Won’t Go Away

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Inflammation of the sinuses that lasts for more than 3 months is chronic sinusitis. Bacteria can make their home in blocked sinuses, but they aren’t the only cause. Anatomy, allergies, polyps, immune system problems, and dental diseases may also be to blame.

Nasal Polyps

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If your sinuses remain inflamed, sinus membranes can thicken and swell. The swelling may be enough to cause grape-like masses called polyps (shown here). They can jut out from the sinus into the nasal passage and block your nasal airway.

Nasal Decongestants

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These sprays open swollen nasal passages and allow your sinuses to drain. But you should use these drugs only for a few days. After that, there’s a kickback effect, making your nasal passages swell shut again. Nasal steroid sprays, saline sprays or washes, or a bioelectric microcurrent device may be other options. If symptoms don’t stop, see your doctor.

Do You Need Antibiotics?

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The common cold is a viral infection. Colds can lead to sinusitis symptoms, but these usually clear by themselves. Antibiotics don’t treat viruses, so they won’t help the sinus symptoms of a cold. Your cold should be over in a week or two. Usually, cold-related sinusitis goes away then, too.

Treating Allergy-Related Sinusitis

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Have you tried irrigation with saline solution, either with a neti pot or squeeze bottle? Nasal steroid sprays might help, too, if your sinus symptoms are due to allergies. Antihistamines could also come in handy, especially if you’re sneezing and have a runny nose.

When to See the Doctor

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Yellow or green mucus can mean a bacterial infection. Even then, it usually clears up in 7 to 14 days without antibiotics. But if you keep feeling worse, your symptoms last and are severe, or if you get a fever, it’s time to see a doctor.

Will You Need Sinus Surgery?

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An operation called FESS (functional endoscopic sinus surgery) can bring some relief, if nothing else works. But start with the simplest solution: Avoid things that irritate your sinuses, and then work with your doctor to see if medicines help. Surgery is the last resort.

Rare Complications

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Only a layer of bone separates your sinuses from your brain. It’s not likely, but if a sinus infection passes through the bone, it can infect the lining of the brain or the brain itself. It’s also uncommon, but a sinus infection could spread into the eye socket, causing an infection that could cause blindness. Less severe complications include asthma attacks and loss of smell or taste, which are usually temporary.

Can You Prevent Sinusitis?

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Unfortunately, no. But you can do these three things that help:

• Keep your sinuses moist. Use saline sprays, nasal lubricant sprays, or nasal irrigation often.
• Avoid very dry indoor environments.
• Avoid exposure to irritants, such as cigarette smoke or strong chemical odors.

Show Sources

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Picture of the Sinuses

The sinuses are a connected system of hollow cavities in the skull. The largest sinus cavities are about an inch across. Others are much smaller.

• Your cheekbones hold your maxillary sinuses (the largest).
• The low-center of your forehead is where your frontal sinuses are located.
• Between your eyes are your ethmoid sinuses.
• In bones behind your nose are your sphenoid sinuses.

They’re lined with soft, pink tissue called mucosa. Normally, the sinuses are empty except for a thin layer of mucus.

The inside of the nose has ridges called turbinates. Normally these structures help humidify and filter air. A thin wall, called the septum, divides the nose. Most of the sinuses drain into the nose through a small channel or drainage pathway that doctors call the “middle meatus.”

Why do we have sinuses? Experts don’t know. One theory is that they help humidify the air we breathe in. Another is that they enhance our voices.

Sinus Conditions

Acute sinusitis (sinus infection): Viruses, bacteria, or fungi infect the sinus cavity, causing inflammation. More mucus; nasal congestion; discomfort in the cheeks, forehead, or around the eyes; and headaches are common symptoms.

Chronic sinusitis (or chronic rhinosinusitis): More than just a series of infections, chronic sinusitis is a persistent process of inflammation of the sinuses.

Deviated septum: If the septum that divides the nose is too far too one side, it can obstruct airflow in a nostril.

Hay fever (allergic rhinitis): Allergens like pollen, dust mites, and pet dander cause the defenses in the nose and sinuses to overreact. Mucus, nasal stuffiness, sneezing, and itching result.

Nasal polyps aresmall growths in the nasal cavity. They can happen due to inflammation from asthma, chronic sinus infections, and nasal allergies (such as hay fever).

Turbinate hypertophy: The ridges on the nasal septum are enlarged, which can block airflow.

Sinus Tests

Physical examination: A doctor can look into the nose with a lighted viewer to see the turbinates, which may be swollen. They may press or tap on the face over the sinuses to check for pain.

Computed tomography (CT scan): A CT scanner uses X-rays and a computer to create detailed images of the sinuses. CT scanning can help diagnose chronic sinusitis.

Magnetic resonance imaging (MRI): Magnetic waves create highly detailed images of the sinuses. You may get CT and MRI scans.

Rhinoscopy: Doctors use a flexible tube with a camera on its end to see inside your nose and sinuses.

Sinus cultures: Your doctor uses a needle to take a mucus sample from inside your sinuses.

Skin test for allergies: These help to see if allergies are involved in your sinusitis.

Sinus X-ray: A plain X-ray may show problems with the bones around the sinuses. A CT scan is better.

Sinus Treatments

Antibiotics may be needed to treat bacterial sinusitis.

Antihistamines: Medicines that can reduce the nasal and sinus symptoms from allergic rhinitis.

Decongestants: Drugs that cause blood vessels in the inner nasal tissue to constrict. As a result, there is less sinus congestion, mucus, and postnasal drip.

Nasal saline spray: Salt water (saline) nasal spray breaks up dried mucus and helps to keep the nose moist.

Nasal steroid spray: These medications ease tissue swelling and help prevent the regrowth of nasal polyps after sinus surgery.

Nasal washes: They rinse mucus from the nasal cavities and sinuses.

Sinus surgery can improve or correct some sinus conditions. Doctors use it to remove growths or to open a blockage.

Show Sources

Porter, G. Paranasal Sinus Anatomy and Function, January 2002.

Johns Hopkins Medicine: “Sinusitis.”

American Academy of Allergy, Asthma, and Immunology: “Nasal Polyps.”