Sinusitis
Swollen, blocked sinuses, usually after a cold, causing face pain, a blocked nose and thick mucus. It’s almost always viral and usually settles in 2–3 weeks without antibiotics.
Symptoms
- Pain, pressure or tenderness around the cheeks, eyes or forehead, often worse when bending forward.
- A blocked or runny nose, thick yellow or green mucus, and a reduced sense of smell.
- Sometimes fever, headache, toothache, bad breath, cough or ear pressure.
- Chronic sinusitis: blockage, reduced smell and face pressure lasting more than 12 weeks.
Causes and risk factors
- Usually a cold or other virus, occasionally followed by a bacterial infection.
- Untreated hay fever, nasal polyps or a bent nasal septum.
- Smoking, and overusing decongestant nose sprays.
How it’s diagnosed
- Usually from your symptoms and a look in the nose. Scans aren’t needed for ordinary sinusitis.
- A bacterial infection is more likely with several of: fever, severe pain on one side (especially teeth and jaw), pus-like mucus, symptoms over 10 days, or getting worse after first improving.
- CT scans and specialist checks are for chronic or recurring sinusitis, or suspected complications.
The sinusitis ladder
Most sinusitis clears on its own. The early steps make you more comfortable while it does. Antibiotics are kept for the few with severe or lingering bacterial-type symptoms.
- Step 1 · Self-carePain relief, fluids and salineParacetamol or ibuprofen, rest, fluids, and saline spray or rinses.
- Works
- Pain relief eases symptoms. Saline has little evidence in short-term sinusitis but is safe and many find it soothing; rinses help a little in chronic sinusitis
- Cost
- About $5–20
- How long
- Until it settles, usually 2–3 weeks
- Watch for
- Use boiled-then-cooled or sterile water for rinses, never straight from the tap.
Flushing your nose is weird the first time and oddly satisfying by the third.
- Step 2 · PharmacyDecongestant nasal sprayFor a very blocked nose in adults, for a few days.
- Works
- Little evidence in sinusitis, but may ease blockage for a few hours
- Cost
- About $8–15
- How long
- 3–5 days at most
- Watch for
- Longer use causes rebound blockage, which can itself lead to more sinus trouble.
A short-term loan with very high interest.
- Step 3 · Pharmacy or prescriptionSteroid nasal spray (mometasone, fluticasone, budesonide)Calms swelling in the lining of the nose and sinuses. Some are available from pharmacies.
- Works
- Modest help: 73% improved vs 66% on a dummy spray, with higher doses doing better. Also first-line for chronic sinusitis
- Cost
- About $10–25
- How long
- Daily for a week or two; longer for chronic sinusitis
- Watch for
- Nosebleeds, dryness. Aim the spray away from the middle of the nose.
Slow and steady: it takes a few days to kick in.
- Step 4 · PrescriptionAntibioticsOnly for severe illness, symptoms lasting over 10 days with signs of bacterial infection, or complications. Sometimes given as a ‘use if not better’ script.
- Works
- Speeds recovery for about 5–11 extra people in 100, but 13 more in 100 get side effects. Without them, about half are better in a week and two-thirds in 2 weeks
- Cost
- Usually under the $25 PBS co-payment
- How long
- Usually 5–7 days
- Watch for
- Diarrhoea, thrush, rash. Seek help if you get worse while taking them.
A coin toss at best, with a side of diarrhoea.
- Step 5 · SpecialistENT specialist and sinus surgeryFor sinusitis that keeps coming back, lasts more than 3 months despite treatment, or affects only one side.
- Works
- Endoscopic sinus surgery helps selected people with chronic sinusitis or polyps when sprays and rinses aren’t enough
- Cost
- Free in the public system (waits apply); private out-of-pocket costs vary
- How long
- One procedure, then ongoing sprays
- Watch for
- Bring a list of every spray and course of antibiotics you’ve tried.
The plumber’s option, for blockages the sprays can’t shift.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Decongestant tabletsNo good evidence they help sinusitis, and ones containing phenylephrine don’t even unblock a normal cold.
- Antihistamines (unless you have allergies)No evidence they help ordinary sinusitis. Worth it only if hay fever is driving your symptoms.
- Steam inhalation and warm face packsNo evidence they speed recovery, and bowls of hot water scald children. A warm shower is safer.
- Antibiotics in the first 10 daysEarly sinusitis is nearly always viral. Antibiotics add side effects without helping.
What you can do
- Give it time: most sinusitis improves within 2–3 weeks.
- Use saline rinses and, if blocked, a steroid nasal spray; ask a pharmacist to show you how.
- Treat hay fever properly if allergies keep setting off your sinuses.
- Limit decongestant sprays to 3–5 days.
- If you smoke, quitting helps your sinuses clear and stay clear.
See your GP if
- Symptoms aren’t improving after 10 days, or after 3 weeks of self-care
- You get worse after starting to improve
- Sinusitis keeps coming back, or lasts more than 12 weeks
- Symptoms are only on one side, or there’s blood from one nostril
- You have a weakened immune system
Get urgent help (call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries) for swelling or redness around the eye, double or reduced vision, an eye that’s pushed forward or hard to move, a severe headache, a stiff neck, confusion, drowsiness or feeling very unwell. These can mean the infection is spreading to the eye or brain.
Common questions
Does green mucus mean I need antibiotics?
No. Coloured mucus is common in viral sinusitis and colds. It’s the overall picture, including how long it lasts and how unwell you are, that matters.
How do I use a saline rinse?
Use a rinse bottle with a sachet of salt mix in sterile or boiled-then-cooled water. Lean over a sink, squeeze gently into one nostril and let it drain out the other. Wash the bottle after each use.
Is it sinusitis or a migraine?
Headache without a blocked nose or coloured mucus is less likely to be sinusitis, and migraine is a common mimic. See our migraine fact sheet.
Can children get sinusitis?
Yes, though their sinuses are still developing. Children aged 11 and under with suspected sinusitis should see a doctor rather than relying on pharmacy treatment.
Helpful resources
- National Asthma Council: Nasal spray and rinse videosShort videos on using nasal sprays and saline irrigation correctly. Australia.
- NHS: SinusitisClear guide to self-care, pharmacy options and when to see a GP. UK.
Evidence and more information
- Healthdirect: Sinusitis
- NHS: Sinusitis
- NICE: Sinusitis (acute) antimicrobial prescribing (NG79)
- Cochrane: Antibiotics for acute sinusitis in adults (2018)
- Cochrane: Intranasal steroids for acute sinusitis
- Cochrane: Saline irrigation for chronic rhinosinusitis
maladywise.com/sinusitis/