AI Summary Overview
Quick Glance: Common Sinusitis Symptoms
Sinusitis can cause a combination of nasal, facial and respiratory symptoms.
Common sinusitis symptoms include:
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Blocked or congested nose
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Runny nose
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Thick yellow or green nasal mucus
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Mucus draining down the back of the throat
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Facial pain, pressure or tenderness
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Reduced or lost sense of smell
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Headache
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Toothache, particularly involving the upper teeth
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Cough
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Bad breath
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Pressure or fullness in the ears
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Fever in some cases
Sinusitis Symptoms That Should Not Be Ignored
Symptoms that persist beyond 10 days, recur, or significantly worsen after initial improvement require medical assessment.
The following are symptoms of sinusitis which should not be ignored:
| Symptom | What It May Indicate |
| Symptoms lasting for several weeks without improvement | May indicate persistent sinus inflammation or another underlying nasal condition |
| Symptoms lasting 12 weeks or longer | May be consistent with chronic rhinosinusitis and require further assessment |
| Symptoms that improve and then become worse again | Can occur when an acute respiratory illness progresses to bacterial rhinosinusitis |
| Severe or worsening facial pain | May indicate significant sinus inflammation or another cause of facial pain |
| Persistent loss or marked reduction of smell | Can occur with chronic sinus inflammation, particularly when nasal polyps are present |
| Persistent symptoms affecting only one side of the nose or face | May warrant assessment for a localised dental, structural or other underlying cause |
| Blood-stained nasal discharge with persistent one-sided symptoms | Requires assessment for causes other than uncomplicated sinusitis |
| Unilateral foul-smelling nasal discharge or unpleasant smell | May occur with sinusitis arising from a dental source |
Why Do Sinusitis Symptoms Occur?
Sinusitis symptoms occur when inflammation causes the lining of the nose and paranasal sinuses to swell, narrowing the small drainage pathways through which mucus normally leaves the sinuses. When drainage becomes impaired, mucus can accumulate and contribute to nasal congestion, discharge, facial pressure and discomfort.
Inflammation around the nasal passages can also interfere with airflow to the smell receptors, reducing or eliminating the sense of smell. Pressure and inflammation within the sinuses may cause facial discomfort, headache, or pain around the cheeks, forehead, or upper teeth.
Sinusitis Symptoms That Require Immediate Medical Attention
Most sinusitis is uncomplicated, but infection can rarely spread beyond the sinuses to tissues around the eyes or structures inside the skull.
Seek immediate medical attention for the symptoms of sinusitis given below:
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Severe swelling or redness around one or both eyes
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Painful or restricted eye movement
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Double vision
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Reduced or rapidly changing vision
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A severe or rapidly worsening headache
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Severe facial swelling
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Confusion or unusual drowsiness
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Seizures
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Stiff neck with severe illness
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New weakness, difficulty speaking or another neurological change
Eye swelling accompanied by painful eye movements, restricted movement or altered vision can indicate orbital involvement. Severe headache, seizures, confusion or focal neurological symptoms can occur with rare intracranial complications and require emergency assessment.
Symptoms of Sinusitis Based on Type
Sinusitis can be classified according to how long symptoms last and whether separate episodes repeatedly occur.
The table below compares the main sinusitis symptom patterns:
| Type of Sinusitis | Typical Symptom Pattern |
| Acute sinusitis | Nasal blockage or discharge, facial pain or pressure, reduced smell, headache, cough or tooth pain developing over a relatively short period, often after a viral respiratory infection |
| Chronic rhinosinusitis | Nasal obstruction, nasal discharge, reduced sense of smell and/or facial pressure persisting for at least 12 weeks |
| Recurrent acute sinusitis | Four or more separate episodes of acute sinusitis within a single year, with complete resolution of symptoms between episodes. |
Symptoms of Sinusitis-Specific Conditions
Some sinusitis-related conditions have symptom patterns that provide additional clues about the underlying cause or form of inflammation.
The table below summarises important sinusitis-related conditions:
| Sinusitis-Related Condition | Common Symptoms or Pattern |
| Acute bacterial rhinosinusitis | Nasal discharge with obstruction or facial pain that persists for at least 10 days without improvement, or symptoms that worsen again after initially improving |
| Chronic rhinosinusitis with nasal polyps | Persistent nasal blockage, nasal discharge and a reduced or lost sense of smell; facial pressure may also occur |
| Chronic rhinosinusitis without nasal polyps | Persistent nasal blockage or discharge with facial pressure and reduced smell; facial discomfort may be more noticeable in some people |
| Odontogenic sinusitis | Often one-sided nasal discharge or blockage, facial pressure, postnasal drainage and an unpleasant or foul smell or taste; dental pain may be absent |
| Allergic fungal rhinosinusitis | Persistent nasal blockage, thick mucus, reduced smell and nasal polyps, sometimes with markedly one-sided or asymmetric disease |
| Acute invasive fungal rhinosinusitis | A rare but serious condition that may cause facial pain or swelling, fever, facial numbness, eye swelling, vision changes or dark necrotic tissue inside the nose, particularly in people with significantly weakened immunity |
Symptoms of Sinusitis in Children
Sinusitis symptoms in children can overlap with those of a prolonged cold, making the condition more difficult to recognise. Persistent nasal symptoms and cough are often particularly noticeable.
Parents may notice the following symptoms of sinusitis in children:
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Persistent blocked or congested nose
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Nasal discharge
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Daytime cough that may become worse at night
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Fever
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Bad breath
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Irritability
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Mouth breathing
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Reduced appetite or feeding difficulty
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Facial pain or pressure, particularly in older children
Younger children may be unable to describe facial pressure, headache or changes in smell clearly. Changes in breathing, behaviour, sleep or feeding may therefore be more noticeable.
Can You Have Sinusitis Without Symptoms?
Sinusitis generally appears with noticeable symptoms. Acute sinusitis typically presents with nasal obstruction or discharge, facial pressure, pain, or other respiratory symptoms, whereas chronic rhinosinusitis requires a persistent symptom pattern for diagnosis.
Sinus changes may occasionally be noticed incidentally on an imaging test performed for another reason. However, an abnormal scan without a compatible symptom history does not by itself establish chronic rhinosinusitis.
Symptoms may also be mild, particularly with chronic disease, so some people may not immediately recognise that ongoing nasal congestion or reduced smell is related to sinus inflammation.
When Can Sinusitis Symptoms Become Life-Threatening?
Serious sinusitis complications are uncommon, but infection can occasionally spread into tissues around the eye or into structures surrounding the brain. These complications require urgent treatment.
The table below highlights symptoms of sinusitis that may indicate a serious complication:
| Symptom | Why It Is Serious |
| Marked swelling or redness around an eye | May indicate that infection has spread from the sinuses into the tissues surrounding the eye |
| Painful or restricted eye movement | Can indicate deeper orbital infection |
| Double vision or reduced vision | May occur when infection affects structures involved in eye movement or vision |
| Severe headache with confusion or unusual drowsiness | May indicate the spread of infection towards intracranial structures |
| Seizures or new neurological changes | Can occur with serious intracranial complications and require emergency assessment |
| Stiff neck with severe headache, fever or altered consciousness | May indicate inflammation or infection involving tissues surrounding the brain |
| Rapidly worsening facial swelling with severe illness | May indicate spreading infection requiring urgent treatment |
How are Sinusitis Symptoms Diagnosed?
Sinusitis is assessed using the pattern, duration and severity of symptoms together with an examination of the nose and face. Additional investigations depend on whether the illness appears acute, chronic, recurrent or complicated.
The following tests and assessments may be used to diagnose sinusitis symptoms:
| Diagnostic Test or Assessment | Purpose |
| Medical and symptom history | Reviews nasal blockage, discharge, facial symptoms, smell changes, duration and whether symptoms improved and then worsened |
| Nasal examination | Looks for swelling, discharge, polyps or other abnormalities within the nasal passages |
| Nasal endoscopy | Allows a closer examination for inflammation, pus, polyps or another structural problem when required |
| CT scan of the sinuses | Provides detailed images of sinus anatomy, inflammation, and blockage, primarily indicated for chronic, recurrent, or complicated disease, or when surgical intervention is considered |
| MRI | May be used when complications involving the eye, brain or surrounding soft tissues are suspected |
| Allergy assessment | May be considered when an allergy appears to contribute to persistent nasal and sinus inflammation |
| Dental assessment | May be needed when one-sided maxillary sinusitis, foul smell or another feature suggests a dental source |
FAQs
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Q1. What is usually the first symptom of sinusitis?
Ans: Sinusitis usually starts with nasal congestion or a runny nose. As the inflammation develops, facial pressure, thick nasal discharge and a reduced sense of smell may also appear. -
Q2. Can sinusitis occur without fever?
Ans: Yes. Sinusitis can occur without fever, especially in chronic cases. Symptoms such as nasal blockage, thick discharge, facial pressure and a reduced sense of smell may still be present. -
Q3. Which sinusitis symptoms should never be ignored?
Ans: Sinusitis symptoms should not be ignored if they become severe, persist for a long time or mainly affect one side. Blood-stained discharge, worsening facial pain or prolonged loss of smell need medical assessment, while eye swelling, vision changes, confusion or other neurological symptoms should be evaluated by a doctor at the earliest.
