Sinusitis is one of the most common diagnoses in America. If you have experienced a cold that persisted for longer than 10 days, chances are you have had sinusitis.

What is sinusitis?

Each person has four pairs of sinus cavities. The maxillary sinuses are in your cheekbones, the frontal sinuses are in your forehead, the ethmoid sinuses are between your eyes, and the sphenoid sinuses are behind your eyes. When any of these cavities become inflamed or infected, we call this sinusitis.

Sinusitis is typically triggered by a viral cold or allergic swelling in the nose. The resulting inflammation of the mucous membrane prevents nasal and sinus mucus from draining properly. If this mucous becomes infected with bacteria, the swelling and blockage worsen, creating facial pressure, pain, and nasal blockage. The mucous may become thick, discolored, and even develop an odor. We call this acute bacterial sinusitis. If sinusitis lasts longer than 3 months, we call it chronic sinusitis.

The most common symptoms of sinusitis are:

  • Nasal congestion
  • Loss of smell or taste
  • Discolored nasal drainage
  • Thick drainage in the throat
  • Facial pain or pressure
  • Upper tooth pain
  • Cough

Fever is rare, except in children. Children have small sinuses at birth, and more frequently develop respiratory infections in the tonsils, adenoids, and middle ears.

How is acute sinusitis diagnosed?

Most experts agree that uncomplicated upper respiratory tract infections should be treated as a common cold for the first week. If nasal and sinus symptoms worsen after the first week, or if there is no improvement within 10 days, then it is more likely that a bacterial infection has developed. Guidelines recommend against X-ray studies for the diagnosis of acute, uncomplicated sinusitis. Antibiotics may be prescribed to cover the most likely bacteria.

When do I see the specialist?

Your primary physician can manage most episodes of acute, uncomplicated sinusitis. A consultation with an ENT specialist (otolaryngologist-head and neck surgeon) may be helpful if you are having recurrent episodes of acute sinusitis, chronic sinusitis, or uncontrolled allergies.

Consult an ENT specialist if you have sinus or allergy symptoms…

  • 3 times per year, or
  • 3 months at a time, or
  • 3 seasons in a row.

What should I expect during my ENT appointment?

  • A complete medical history
  • Ear nose and throat examination
  • Nasal endoscopy
  • Thorough explanation

What should I expect during my ENT appointment?

Meet Dr. Armstrong:

What comes next?

We typically recommend antibiotics, nasal steroid sprays, and saltwater (saline) rinses as the initial treatment for patients with recurrent or persistent sinusitis. We may prescribe oral steroids if you have severe symptoms or nasal polyps. If you have already completed adequate medical management, then we may offer you a CT scan or allergy test to better understand the cause of your symptoms.

We may recommend endoscopic sinus surgery if you have recurrent or persistent sinus disease despite appropriate medical treatment. In many cases, we can open the sinus drainage pathway under local anesthesia in the office using a balloon or dilating tool. This minimally invasive procedure is called sinuplasty. Most patients can return to work or school the day after sinuplasty.

If you have nasal polyps, you likely have severe nasal obstruction and a very poor sense of smell. You may have tried and failed surgery in the past. Do not give up! We have seen tremendous improvements in surgical techniques over the past several years and there are several new methods for delivering steroids into the sinuses. Richmond ENT continues to be a research center for several randomized clinical trials involving new biological medications that may be useful for nasal polyps.

Tips for preventing sinusitis

Rinse your nose daily with salt water (saline) to remove thick mucus and bacteria

  • Use a daily nasal steroid such as Rhinocort, Flonase or Nasacort for allergies
  • Wear a mask if you may be exposed to dust, pollen or COVID-19
  • Avoid touching your face with dirty hands
  • Follow instructions from your allergy doctor
  • Use decongestants sparingly when sick

Consult your ENT provider with any questions or concerns you may have.


Richmond ENT © 2020, by Michael Armstrong MD and Michaela Bailey.