Sinusitis: symptoms, what helps and when antibiotics are needed

Sinusitis often follows a cold and usually improves without antibiotics. For mild symptoms, you can manage pain and try a saline nasal solution. Contact a doctor if symptoms have not started improving within ten days or get worse after an initial improvement. Swelling around an eye or a change in vision needs immediate assessment.

A blocked nose, pressure in your cheeks and a headache can make you feel that you need something stronger. But the right treatment depends on more than how troublesome your runny nose is or the colour of the mucus. How long symptoms last, how they change and what comes with them all matter.

What is sinusitis and why does it happen?

The sinuses are spaces in the bones around your nose, connected to it through narrow openings. When their lining becomes inflamed and swollen, mucus cannot drain as easily. This can cause pressure or a feeling of fullness in your face.

Doctors also use the term rhinosinusitis because the lining of the nose is often inflamed too. Acute symptoms are most often associated with a viral infection. A bacterial cause is less common.

What are the symptoms of sinusitis?

Typical symptoms include:

• a blocked or runny nose;
• pressure, pain or tenderness around the cheeks, forehead or eyes;
• a reduced sense of smell;
• mucus dripping down the throat, sometimes with a cough;
• sometimes a fever, headache or pain in the upper teeth.

Pain in the forehead or cheek alone does not establish the diagnosis. Migraine or a dental problem can cause similar pain. Yellow or green mucus does not, by itself, mean that you need antibiotics.

How long can sinusitis last?

Acute symptoms can take two to three weeks to settle. That does not mean you should wait throughout this period regardless of how you feel.

If symptoms have not started improving within ten days, arrange a consultation. Tell the doctor if you were getting better but then developed worsening pain, nasal symptoms or a fever again. Seek help sooner for severe symptoms.

Symptoms lasting more than twelve weeks may fit a pattern of chronic rhinosinusitis. This needs a different assessment from a single episode after a cold; it should not automatically be treated as a prolonged bacterial infection.

What may help and how do nasal treatments differ?

Rest as needed, drink enough fluids and avoid smoke. Paracetamol or ibuprofen may help pain or fever if suitable for you. Follow the leaflet and check the ingredients of combined cold remedies so you do not take the same active ingredient twice.

Nasal sprays and rinses serve different purposes:

For a neti pot or another nasal rinsing device, use only sterile or distilled water suitable for this purpose, or water that has been boiled and allowed to cool. Tap water being safe to drink does not make it safe for nasal rinsing. Prepare the saline solution as instructed, then wash the device after use and let it dry.

If you are pregnant, have high blood pressure or glaucoma, or take other medicines, discuss your choice of treatment with a pharmacist or doctor first. If your immune system is weakened, ask about nasal rinsing too. Antihistamines may help an accompanying nasal allergy; they are not a routine treatment for every episode of sinusitis.

When are antibiotics needed?

Antibiotics do not work against viruses. A doctor may consider them if a bacterial infection is suspected, particularly with severe illness, deterioration after initial improvement or persistent symptoms that are not improving. Your risk of complications and overall health also matter.

Reaching day ten does not automatically mean starting antibiotics. For an uncomplicated illness, further observation with an agreed follow-up may be appropriate. If you need an antibiotic, the doctor will choose the medicine and treatment duration. Do not start taking leftovers from a previous prescription yourself.

Can sinusitis be related to a tooth?

Yes. Some infections of the maxillary sinus, in the cheek area, start in the upper teeth. Tell the doctor about symptoms on one side, foul-smelling discharge, toothache or recent dental treatment. You may also need a dental examination and treatment of the source; antibiotics alone cannot replace that treatment.

Should you see a GP or an ENT specialist?

For acute symptoms that are not settling, you can contact a GP. Recurrent, prolonged or persistently one-sided symptoms may need assessment by an ENT specialist.

The doctor will ask about the course of the illness and examine you. An X-ray or CT scan is not routinely needed for uncomplicated acute sinusitis. Further investigations depend on suspected complications, an alternative cause or the pattern of longer-term symptoms.

Prepare the starting date, any pattern of fever and the names of nasal sprays you have used, including for how long. Note whether the pain affects one side and whether you had dental treatment before it started.

When do you need help today or immediately?

Contact a doctor today if you have severe pain that usual painkillers do not relieve, a high or persistent fever, rapidly worsening symptoms or feel very unwell. Seek prompt advice if you have a weakened immune system.

Go to a hospital emergency department immediately if sinus symptoms are accompanied by:

• swelling or redness around an eye;
• double vision, newly reduced vision or difficulty moving an eye;
• swelling of the forehead or a new, unusually severe headache, especially with a stiff neck;
• confusion, reduced consciousness, a seizure or new limb weakness.

For reduced consciousness, a seizure, new weakness or another serious sudden deterioration in Czechia, call 155. If you are unsure how serious the situation is, describe the symptoms to the emergency operator. Do not wait for a routine appointment or a reply to a contact form.

Frequently asked questions

Can you have sinusitis without a runny nose?

Mucus can drain down the throat, so you may not have much discharge from the front of your nose. But if there is no nasal blockage either and headache or facial pain is the main problem, do not automatically assume sinusitis. A doctor can also consider migraine or a dental cause.

Can you have sinusitis without a fever?

Yes, a fever is not always present. Its absence does not rule out sinusitis and does not, on its own, determine whether you need antibiotics. The combination of symptoms, their duration and how they change are important.

Help arranging a planned appointment

Would you like to arrange a consultation for persistent or recurring sinus symptoms? Contact OpenMedical and briefly describe the problem and how long it has been going on. We can help check options for a planned appointment. Examinations and treatment are provided by healthcare facilities and doctors.

This article provides general information for adults and does not replace an individual medical assessment.