Sinusitis: Symptoms, Causes and Treatment

Introduction

Sinusitis is one of the most common reasons people seek medical attention for persistent nasal congestion, facial pain and headaches. While many cases develop following a common cold and resolve without complications, others may require medical treatment, particularly when symptoms become severe, prolonged or recurrent.

The sinuses are air-filled cavities located within the bones of the face and skull. Under normal circumstances, they produce mucus that drains freely into the nasal passages. When the lining of the sinuses becomes inflamed or swollen, this drainage can become blocked, allowing mucus to accumulate and increasing the risk of infection.

Patients often describe sinusitis as "a bad cold that never gets better." Common symptoms include nasal congestion, thick nasal discharge, facial pressure, headache, reduced sense of smell and fatigue. In some cases, sinusitis may also cause fever, tooth pain, ear pressure or a persistent cough.

Although most episodes of sinusitis are caused by viral infections and improve without antibiotics, bacterial sinusitis and chronic sinus disease require a different approach to diagnosis and treatment. Distinguishing between these conditions is important to ensure appropriate medical care while avoiding unnecessary antibiotic use.

Whether you are a resident or visiting Mallorca, understanding the symptoms of sinusitis and recognising when medical assessment is necessary can help prevent complications and support a faster recovery.

What Is Sinusitis?

Sinusitis, also known as rhinosinusitis, is inflammation of the lining of the paranasal sinuses and the nasal cavity.

The four pairs of sinuses are:

• Maxillary sinuses (located beneath the cheeks).
• Frontal sinuses (located behind the forehead).
• Ethmoid sinuses (located between the eyes).
• Sphenoid sinuses (located deeper behind the nose).

These cavities normally contain air and produce mucus that drains into the nasal passages through small openings.

When inflammation causes these drainage pathways to become blocked, mucus becomes trapped within the sinuses. This creates pressure, discomfort and, in some cases, an environment in which bacteria can multiply.

Sinusitis may affect one sinus, several sinuses or all of the sinuses simultaneously.

Types of Sinusitis

Doctors classify sinusitis according to the duration of symptoms.

Acute Sinusitis

Acute sinusitis lasts less than four weeks.

It is most commonly caused by viral respiratory infections such as the common cold.

Most patients recover completely without antibiotics.

Subacute Sinusitis

Subacute sinusitis lasts between four and twelve weeks.

Symptoms persist longer than expected but eventually resolve with appropriate treatment.

Chronic Sinusitis

Chronic sinusitis lasts more than twelve weeks despite treatment.

Patients often experience:

• Persistent nasal congestion.
• Facial pressure.
• Reduced sense of smell.
• Thick nasal discharge.

Chronic sinusitis frequently involves ongoing inflammation rather than an active bacterial infection.

Recurrent Acute Sinusitis

Some individuals experience several separate episodes of acute sinusitis each year, with complete recovery between episodes.

This pattern may suggest underlying allergies, anatomical abnormalities or chronic inflammation.

Common Causes of Sinusitis

Sinusitis has many possible causes, and more than one factor may contribute to its development.

Viral Infections

The vast majority of acute sinus infections begin as viral upper respiratory tract infections.

Viruses cause swelling of the nasal lining, narrowing the sinus drainage pathways and trapping mucus inside the sinuses.

Most viral sinusitis improves within 7 to 10 days without antibiotics.

Bacterial Infections

A bacterial infection may develop when mucus remains trapped within the sinuses for an extended period.

Common bacteria include:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

Bacterial sinusitis is more likely when:

• Symptoms last longer than ten days without improvement.
• Symptoms initially improve before suddenly becoming worse.
• High fever develops together with facial pain and thick nasal discharge.

Unlike viral sinusitis, bacterial infections may require antibiotic treatment in selected patients.

Allergies

Allergic rhinitis is one of the leading causes of recurrent sinus inflammation.

Exposure to allergens such as:

• Pollen.
• Dust mites.
• Animal dander.
• Mould.

can cause persistent swelling of the nasal passages, making normal sinus drainage more difficult.

Poorly controlled allergies significantly increase the risk of recurrent sinusitis.

Nasal Polyps

Nasal polyps are soft, non-cancerous growths that develop inside the nasal passages.

Large polyps may partially block sinus drainage, contributing to chronic inflammation and recurrent infections.

Anatomical Abnormalities

Structural problems that narrow the nasal passages may impair mucus drainage.

Examples include:

• Deviated nasal septum.
• Enlarged turbinates.
• Congenital anatomical variations.

These abnormalities increase the likelihood of recurrent or chronic sinusitis.

Dental Infections

The roots of the upper back teeth lie close to the maxillary sinuses.

In some cases, untreated dental infections or dental procedures may spread into the adjacent sinus, resulting in odontogenic sinusitis.

This type of sinusitis often requires both dental and medical treatment.

Environmental Irritants

Repeated exposure to airborne irritants may contribute to chronic sinus inflammation.

Examples include:

• Cigarette smoke.
• Air pollution.
• Dust.
• Chemical fumes.
• Dry air.

Avoiding these irritants may help reduce the frequency of symptoms.

Risk Factors

Several factors increase the likelihood of developing sinusitis.

These include:

• Recent viral respiratory infection.
• Seasonal allergies.
• Asthma.
• Nasal polyps.
• Deviated nasal septum.
• Smoking.
• Exposure to second-hand smoke.
• Chronic allergic rhinitis.
• Frequent air travel.
• Swimming and diving.
• Dental infections.
• Weakened immune system.

Understanding these risk factors can help patients reduce the likelihood of recurrent sinus infections.

Common Symptoms of Sinusitis

The symptoms of sinusitis vary depending on the underlying cause, severity and duration of inflammation.

Common symptoms include:

• Nasal congestion.
• Thick yellow or green nasal discharge.
• Facial pain or pressure.
• Pain around the cheeks, forehead or eyes.
• Headache.
• Reduced or complete loss of smell.
• Reduced sense of taste.
• Toothache, particularly affecting the upper teeth.
• Ear pressure or fullness.
• Postnasal drip.
• Persistent cough, especially at night.
• Bad breath (halitosis).
• Fatigue.
• Fever in some cases.

Symptoms often become worse when bending forward because of increased pressure within the affected sinuses.

When Should You Seek Emergency Medical Care?

Although most cases of sinusitis are mild and improve without complications, certain symptoms may indicate a serious infection or the spread of infection beyond the sinuses.

Seek immediate emergency medical attention if you experience:

• Severe swelling around one or both eyes.
• Redness or swelling of the eyelids.
• Double vision or blurred vision.
• Difficulty moving the eyes.
• Sudden loss of vision.
• Severe or persistent headache unlike previous headaches.
• High fever associated with severe facial swelling.
• Confusion, drowsiness or altered mental status.
• Neck stiffness.
• Persistent vomiting.
• Difficulty breathing due to severe facial or throat swelling.

These symptoms are uncommon but may indicate serious complications such as orbital cellulitis, meningitis or an intracranial infection, all of which require urgent hospital treatment.

When Should You Arrange a Medical Assessment?

Medical assessment is recommended if:

• Symptoms persist for more than 10 days without improvement.
• Symptoms initially improve but then become significantly worse.
• You develop a high fever.
• Facial pain becomes severe.
• Symptoms repeatedly return.
• Nasal congestion persists for several weeks.
• You experience recurrent sinus infections throughout the year.
• You have chronic sinus symptoms lasting more than 12 weeks.
• You have underlying asthma or significant allergies.
• Over-the-counter treatments have failed to provide relief.

Early assessment helps distinguish between viral sinusitis, bacterial infection, allergic rhinitis and other conditions that may produce similar symptoms.

How Is Sinusitis Evaluated?

Diagnosis begins with a detailed medical history and physical examination.

Your doctor may ask questions such as:

• When did your symptoms begin?
• Did they start after a cold?
• Are your symptoms improving or worsening?
• What colour is your nasal discharge?
• Do you have facial pain or pressure?
• Which areas of the face are painful?
• Have you experienced fever?
• Do you suffer from seasonal allergies?
• Have you had previous sinus infections?
• Have you recently travelled by air or been diving?
• Have you recently undergone dental treatment?

Understanding the pattern and duration of symptoms often provides valuable clues regarding the underlying cause.

Physical Examination

A comprehensive examination may include:

• Measurement of temperature.
• Assessment of vital signs.
• Examination of the nasal passages.
• Inspection of the throat.
• Examination of the ears.
• Palpation of the facial sinuses for tenderness.
• Assessment for facial swelling.
• Examination of the eyes for redness, swelling or reduced movement.
• Examination of the neck for enlarged lymph nodes.

The examination helps determine whether the infection remains localised or whether complications may be developing.

Additional Investigations

Most cases of acute sinusitis do not require extensive testing.

However, additional investigations may be recommended when symptoms are severe, recurrent or prolonged.

These may include:

• Blood tests.
• Nasal endoscopy performed by an ENT specialist.
• CT scan of the sinuses.
• MRI in selected cases involving suspected complications.
• Allergy testing.
• Dental assessment if an upper tooth infection is suspected.

Imaging is generally reserved for chronic sinusitis, suspected complications or patients who do not respond to appropriate treatment.

Treatment for Sinusitis

Treatment depends on the underlying cause, the duration of symptoms and their severity.

Viral Sinusitis

Most cases of acute sinusitis are viral and improve without antibiotics.

Supportive treatment may include:

• Adequate hydration.
• Rest.
• Saline nasal irrigation.
• Pain relief when appropriate.
• Intranasal corticosteroid sprays in selected patients.
• Humidified air.

Symptoms usually improve within one to two weeks.

Bacterial Sinusitis

Antibiotics may be considered when:

• Symptoms persist for more than 10 days without improvement.
• Symptoms become significantly worse after initial improvement.
• High fever and severe facial pain are present.
• Clinical assessment strongly suggests a bacterial infection.

Not every patient with sinusitis requires antibiotics, and unnecessary use contributes to antibiotic resistance.

Allergic Sinusitis

When allergies contribute to sinus inflammation, treatment may include:

• Identification and avoidance of allergens.
• Antihistamines.
• Intranasal corticosteroid sprays.
• Saline nasal irrigation.
• Allergy management when appropriate.

Controlling allergies often reduces the frequency of recurrent sinus infections.

Chronic Sinusitis

Management of chronic sinusitis may involve:

• Long-term intranasal corticosteroids.
• Regular saline irrigation.
• Treatment of underlying allergies.
• Management of nasal polyps when present.
• Referral to an Ear, Nose and Throat (ENT) specialist.
• Endoscopic sinus surgery in selected cases when conservative treatment has failed.

Most patients improve with appropriate medical management and do not require surgery.

Can Flying Make Sinusitis Worse?

Yes.

Changes in cabin pressure during air travel can increase pressure within blocked sinuses, leading to:

• Increased facial pain.
• Ear discomfort.
• Headache.
• Temporary worsening of congestion.

People with active sinus infections may experience greater discomfort during take-off and landing.

Remaining well hydrated and following medical advice before flying may help reduce symptoms.

Common Myths About Sinusitis

Myth 1: Green mucus always means you need antibiotics.

False.

The colour of nasal discharge alone cannot distinguish between viral and bacterial infections. Many viral infections produce yellow or green mucus without requiring antibiotics.

Myth 2: Every sinus infection is caused by bacteria.

False.

The majority of acute sinus infections are caused by viruses and resolve without antibiotic treatment.

Myth 3: Sinusitis is contagious.

False.

The inflammation itself is not contagious. However, the viral infection that triggered the sinusitis may spread to other people.

Myth 4: Surgery is the only treatment for chronic sinusitis.

False.

Most patients with chronic sinusitis improve with medical treatment, including nasal corticosteroids, saline irrigation and management of underlying allergies. Surgery is reserved for carefully selected cases.

Myth 5: Sinus headaches are always caused by sinus infections.

False.

Many headaches that patients believe are caused by sinusitis are actually migraines or tension-type headaches. A medical assessment is often needed to determine the correct diagnosis.

Medical Assessment for Sinusitis at Dr. Indhira Ghyssaert's Practice in Mallorca

At Dr. Indhira Ghyssaert's practice in Mallorca, patients presenting with symptoms of sinusitis receive a comprehensive medical assessment to determine the underlying cause and develop an individualised treatment plan.

Because nasal congestion, facial pain and headaches may result from viral infections, bacterial sinusitis, allergic rhinitis, chronic inflammation, dental disease or other medical conditions, an accurate diagnosis is essential before treatment is recommended.

The assessment is designed to distinguish between conditions that can be managed conservatively and those requiring medication, further investigations or specialist referral.

Depending on the patient's symptoms and clinical findings, the assessment may include:

• A detailed medical history.
• Measurement of vital signs, including temperature.
• Examination of the nasal passages.
• Assessment of the ears, throat and neck.
• Evaluation of facial tenderness and sinus pressure.
• Examination for signs of orbital or neurological complications.
• Blood tests when clinically indicated.
• Referral for imaging or specialist ENT assessment when appropriate.
• Assessment for contributing factors such as allergies or dental infections.

Treatment recommendations are tailored to the underlying diagnosis and follow current evidence-based clinical guidelines.

Management may include supportive care, prescription medication, treatment of allergies, referral to an Ear, Nose and Throat specialist or further investigations when clinically indicated.

The primary objective is to relieve symptoms, treat the underlying cause and reduce the risk of recurrent or chronic sinus disease.

Sinusitis While Visiting Mallorca

Sinus symptoms can become particularly troublesome while travelling.

Changes in air pressure during flights, exposure to seasonal allergens, swimming, air conditioning, dehydration and viral respiratory infections may all contribute to the development or worsening of sinusitis during a holiday.

Most cases are mild and improve with supportive care. However, travellers should seek medical attention if symptoms become severe, last longer than ten days without improvement, or are accompanied by high fever, significant facial swelling or visual disturbances.

Early medical assessment helps distinguish uncomplicated viral sinusitis from bacterial infection or more serious conditions requiring prompt treatment.

Frequently Asked Questions

What is the difference between a cold and sinusitis?

A common cold is a viral infection affecting the upper respiratory tract and usually improves within seven to ten days.

Sinusitis occurs when inflammation blocks the normal drainage of the sinuses, leading to facial pressure, nasal congestion and persistent symptoms. In some cases, a cold can develop into acute sinusitis.

Do I always need antibiotics for sinusitis?

No.

Most cases of acute sinusitis are caused by viruses and improve without antibiotics.

Antibiotics are generally considered only when symptoms strongly suggest a bacterial infection or fail to improve after an appropriate period.

How long does sinusitis usually last?

Viral sinusitis usually improves within one to two weeks.

Bacterial sinusitis may last longer and sometimes requires antibiotic treatment.

Chronic sinusitis is defined as symptoms lasting longer than twelve weeks.

Can allergies cause sinusitis?

Yes.

Allergies can cause ongoing inflammation and swelling of the nasal passages, making it more difficult for mucus to drain normally and increasing the risk of recurrent sinus infections.

Can I fly if I have sinusitis?

Many people are able to fly safely with mild sinusitis.

However, changes in cabin pressure may increase facial pain, ear discomfort and sinus pressure.

If symptoms are severe or you have significant pain, it is advisable to seek medical advice before travelling.

Can sinusitis cause tooth pain?

Yes.

The roots of the upper back teeth lie close to the maxillary sinuses.

Inflammation within these sinuses can produce pain that feels like a dental problem, even when the teeth themselves are healthy.

Key Takeaways

• Sinusitis is inflammation of the nasal passages and paranasal sinuses that may be caused by viral infections, bacteria, allergies or structural abnormalities.
• Most cases of acute sinusitis improve without antibiotics.
• Symptoms lasting longer than ten days, worsening after initial improvement or associated with high fever may suggest a bacterial infection.
• Severe eye swelling, visual changes, confusion or neurological symptoms require immediate emergency medical attention.
• Persistent or recurrent sinus symptoms should be medically assessed to identify underlying causes and reduce the risk of chronic disease.

Conclusion

Sinusitis is a common condition that can significantly affect quality of life, causing nasal congestion, facial pain, headaches and fatigue.

Although most cases resolve with supportive care, persistent, recurrent or severe symptoms may indicate bacterial infection, chronic inflammation or another underlying condition requiring medical evaluation.

A comprehensive assessment allows healthcare professionals to establish an accurate diagnosis, recommend appropriate treatment and identify patients who may benefit from further investigations or specialist referral.

At Dr. Indhira Ghyssaert's practice in Mallorca, patients receive personalised, evidence-based medical care focused on identifying the underlying cause of sinus symptoms and providing an individualised management plan that supports both recovery and long-term sinus health.

About Dr. Indhira Ghyssaert

Dr. Indhira Ghyssaert is a physician based in Mallorca with a special interest in acute medical care, preventive healthcare and personalised medicine.

She provides comprehensive medical assessments for residents and international visitors experiencing sinusitis, respiratory infections, allergic conditions and other acute medical concerns, combining evidence-based medicine with an individualised approach to patient care.

Medical Disclaimer

The information provided in this article is intended for educational purposes only and should not replace professional medical advice, diagnosis or treatment.

Although most cases of sinusitis are mild, severe facial swelling, visual disturbances, confusion, neck stiffness or persistent high fever may indicate a serious complication requiring immediate medical attention. If you experience these symptoms, contact your local emergency services or attend the nearest emergency department without delay.