All about sinusitis

It is the inflammation of the mucosa that covers the paranasal sinuses, small cavities dug into the bones of the face at the cheekbones, forehead, jaw and sides of the nose.

It is the inflammation of the mucosa that covers the paranasal sinuses, ie small cavities full of air dug into the bones of the face at the cheekbones, forehead, jaw and sides of the nose.

What is it

Sinusitis is inflammation of the mucosa that lines the nasal or paranasal sinuses, i.e. small cavities filled with air dug into the bones of the face at the cheekbones, forehead, jaw and sides of the nose.

Inflammation is caused by the abundant production of mucus, which stagnates causing a nasal obstruction; It is a fairly frequent condition that usually occurs after a cold, an allergic attack or due to irritation due to environmental factors.

There are three forms of sinusitis, which are distinguished according to their duration:

Type of sinusitis Duration
Acute sinusitis < 3 weeks
Chronic sinusitis > 3 months
Recurrent sinusitis > 3-4 acute episodes/year

Depending on the location, maxillary, frontal, ethmoid and sphenoidal sinusitis are distinguished.


In general, the causes of sinusitis are to be linked to complications of a common rhinitis, also called cold, and can be viral bacterial, allergic or, although more rarely, due to the presence of fungi in the upper respiratory tract.

The bacterial form is probably the most common and is generally identified with symptoms that worsen after the first week and persist for more than ten days, if the severity of its manifestation is greater than any viral cause and if the use of decongestants does not involve any benefit.

On the other hand, the viral form is usually of lower intensity and duration.

The mucous membrane of the paranasal sinuses in the face of infection, becomes inflamed, swells and produces large amounts of mucus that remains trapped in the cavities. This creates an ideal environment for the proliferation of microorganisms.

The onset of sinusitis is also favored by the presence of predisposing conditions of the individual himself such as nasal polyps or anatomical defects (deviation of the nasal septum, hypertrophy of the turbinates) such as to hinder the drainage and the escape of mucus from the nasal cavities.

Among the factors that increase the risk of sinusitis we also find:

  • impairment of the immune system (HIV, chemotherapy)
  • particular types of allergy (allergic rhinitis or hay fever) or other medical conditions that mainly affect the airways (cystic fibrosis or gastroesophageal reflux disease) or that prevent the proper functioning of the eyelashes at the nasal level.

In more rare cases, it may be due to an infection in the teeth (granulomas, abscesses) that is not properly treated.

Smoking, air and water pollution, scuba diving and high-altitude travel are all risk factors.

Common symptoms

Its characteristic manifestation in the acute phase is the feeling of pressure on the face that follows the movements of the head accompanied by an accentuated pain and localized in the area where mucus stagnates.

A pain in the forehead, for example, indicates that the frontal sinuses are affected, if instead it affects the jaw, upper dental arch and cheeks it may indicate that the maxillary sinuses are affected.

Other symptoms are:

  • stuffy nose
  • abundant secretion of greenish-yellow mucus
  • fatigue
  • swelling and facial pain especially at the level of the forehead and around cheeks and eyes
  • cough with phlegm
  • sore throat
  • Earache
  • toothache
  • alteration of taste and smell (hyposmia)
  • halitosis
  • dizziness.

Age also plays an important role in determining the clinical picture. In fact, younger children often complain of symptoms very similar to a common cold (stuffy or runny nose, light fever) while during the adolescent period it is more common dry cough, fever, congestion that intensifies, toothache, ear pain and pain in the face. Sometimes they may also have stomach pain, nausea, headache and pain in the eye area.

Sometimes fever is also present among adults combined with a general state of malaise.

Chronic sinusitis, on the other hand, gives disorders of variable degree even if usually more nuanced but constant, such as heaviness in the head that often translates into real headache and difficulty breathing through the nose.


The most serious complications mainly concern chronic and purulent forms. Among the main ones we find:

Sometimes, in rarer but more serious situations, sinusitis can lead to the onset of optic neuritis, meningitis, cavernous and longitudinal sinus thrombosis as well as ocular complications especially in early childhood. In addition, in asthmatic people, sinusitis can cause an aggravation of respiratory symptoms while, especially in acute forms, it can overlap with ear infections.


Many of the acute infections of the paranasal sinuses resolve with self-medication treatments and lead to complete healing.

Especially at the first manifestation, to free the cavities from mucus, natural remedies are recommended, especially through single-dose vials or non-medicated saline nasal sprays based on physiological solution (useful only for washing) or hypertonic (with decongestant effect).

To these, depending on the needs, are added:

  • inhalation of hot steam (aerosol)
  • thermal treatments based on annual cycles of crenotherapy
  • Fumigations with eucalyptus essential oils
  • warm compresses on the forehead.

Anche l’assunzione di abbondanti liquidi sembrerebbe avere un effetto positivo nell’alleviare la sintomatologia e il grado di infiammazione andando a fluidificare le secrezioni nasali e contribuendo all’eliminazione degli agenti infettivi per azione meccanica.

Nelle forme più gravi, croniche o ricorrenti è invece opportuno intervenire farmacologicamente tenendo presente la causa scatenante in modo da ottimizzare l’efficacia delle cure.

Viral cases of sinusitis usually do not require any precise therapy although drops or nasal sprays medicated with vasoconstrictors with decongestant action are widely used, sometimes even through the combination of several active ingredients. It is important to remember that their use should however be discontinued after 6-7 days of consecutive use to avoid relapse.

Strictly on the advice of the doctor and when the sinusitis is of bacterial origin, antibiotics to be taken for eight or ten days could be indicated, perhaps associated with corticosteroids and mucolytics also for aerosols.

Amoxicillin, doxycycline and sulfamethoxazole-trimetroprim are those most recommended and prescribed especially for patients with chronic sinusitis, with pain and discomfort in the face that does not improve after the first week of therapy with simple decongestants or in case of severe symptoms of rhinosinusitis. Limited-spectrum antibiotics are generally preferred, i.e. active only against a small number of bacteria, as they are less subject to resistance.

If antibiotic therapy does not prove effective even with broad-spectrum active ingredients, allergy testing or desensitization methods is usually necessary.

Appropriate precautions of active ingredient, dose and duration of treatment are to be kept in mind in cases of pediatric sinusitis.

In the case of allergic sinusitis, it may be appropriate to take antihistamine drugs, both topical (spray) and systemic, always on the advice of the doctor.

Over-the-counter formulations can be helpful in reducing itching, sneezing, or nasal congestion. Combinations of antihistamines with low doses of a decongestant with good action on the nasal mucosa are also available.

Antihistamines, due to their mechanism of action, can have sedative effects and cause drowsiness. However, new non-sedative formulations are on the market and sometimes also available in combination with decongestants to relieve symptoms as well as overall side effects, including sedation.

In addition, to prevent and relieve the symptoms of allergic rhinitis in predisposed subjects, among the over-the-counter products we also find medicated nasal sprays based on corticosteroids (prescription) to be started a couple of weeks before the allergic season without time restrictions of use.

In general, to keep pain at bay it is possible to resort to anti-inflammatories or analgesics such as paracetamol, acetylsalicylic acid or ibuprofen.

Finally, surgery is considered when symptom control through the natural and/or pharmacological approach has had no effect. The most common technique is endoscopic and involves the use of a small tube inserted into the nasal cavity with the aim of widening the mucus drainage channels between the sinuses and the nose allowing air recycling and mucus escape. In the simplest cases this type of intervention is performed in day-hospital and with local anesthesia.

When to consult your doctor

It is important not to neglect sinusitis as it can become chronic and, to prevent the infection from spreading to surrounding tissues, the doctor should always be consulted.

It is necessary to turn in particular to the specialist figure of the otolaryngologist in severe forms of sinusitis and when disorders such as high fever, difficulty in breathing and perceiving odors (anosmia), feeling of constant heaviness when keeping the head down, throbbing pain in the forehead and at the height of the cheekbones that increases with pressure, presence of blood in the mucus, Swelling of the face, blurred vision, coughing and voice of nasal timbre last for more than two weeks.

For those who want to cure themselves naturally, there are also valid herbal remedies: Sinusitis: natural remedies to cure it

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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