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Acute sinusitis

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Brief description of the condition

Sinusitis, also known as rhinosinusitis, refers to inflamed sinuses, almost always accompanied by inflamed adjacent mucosa. The most common trigger is a viral upper respiratory tract infection. Acute sinusitis is generally a self-limiting condition with symptoms usually lasting 2-3 weeks. Only around 2% of sinusitis cases are complicated by bacterial infections.39 Sinusitis can cause pain in the area of the upper posterior teeth that can be difficult to distinguish from toothache.

Key signs and symptoms

  • Pain (facial, headache, toothache [especially upper teeth], when bending down)
  • Nasal congestion/obstruction
  • Decreased sense of smell
  • Fever
  • Fatigue
  • Purulent nasal discharge

Initial management

Recommend optimal analgesia (see Analgesia).

Advise the patient that acute sinusitis is usually caused by a virus, typically lasts 2-3 weeks, and most people get better without antibiotics.39,40

Advise the patient that information about self-management of symptoms is available on the NHS Inform website (e.g. rest, hydrate, nasal decongestants, warm face packs, salt water nasal rinse).

  • Although there is no evidence that self-management interventions such as nasal rinse, nasal decongestants or steam inhalation are effective in treating sinusitis, they may provide symptomatic relief for some people by loosening mucus and aiding clearance of the nasal passages.40 Nasal decongestants should not be used for more than a week due to the risk of rebound congestion.41

Advise the patient to seek medical advice if their symptoms worsen rapidly or significantly, do not improve after 3 weeks, or they become systemically very unwell.39

If the patient is systemically unwell, or has symptoms and signs of a more serious illness or condition, or for patients with a high risk of complications (e.g. immunocompromised status) refer to a medical professional for urgent assessment.40

Subsequent care

If symptoms worsen, persist or change advise the patient to seek medical advice, or dental assessment to rule out endodontic infection or trauma from recent extraction.