Sinusitis
Also called: sinus infection, rhinosinusitis, acute sinusitis, chronic sinusitis, chronic rhinosinusitis
Sinusitis is swelling of the lining of the sinuses, the air spaces around the nose, usually after a cold. It causes a blocked nose, thick mucus and pain in the face. Most cases are caused by viruses and get better by themselves in 2 to 3 weeks without antibiotics.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
The sinuses are small air-filled spaces in the bones of the face, behind the cheeks, forehead and around the eyes. They are lined with a thin wet layer (mucous membrane) that drains into the nose. In sinusitis this lining becomes swollen. The swelling blocks the drainage, so mucus builds up and causes pressure and pain. Doctors often call it rhinosinusitis, because the inside of the nose is swollen too.
Acute sinusitis is the common short-term type. It usually starts after a cold or flu and is nearly always caused by a virus. It normally lasts about 2 to 3 weeks and gets better on its own. Only a small number of cases, about 2 in 100, are complicated by a bacterial infection. It is hard to tell a viral and a bacterial infection apart, and antibiotics make little difference for most people, so they are usually not needed.
Chronic sinusitis means the symptoms have lasted 12 weeks or longer, and a doctor can see swelling inside the nose or on a scan. Some people with chronic sinusitis also have nasal polyps (soft, painless swellings inside the nose). Chronic sinusitis is linked with allergies, asthma, smoking and some other long-term conditions. It is treated with salt water rinses and steroid nose sprays, and sometimes with an operation.
In Pakistan: what studies show
Pakistan has no national data on how common sinusitis is. Hospital studies of people with nasal polyps found a fungal cause in 23.7% to 40.7% of patients, and in one Quetta hospital 69.80% of prescriptions for nose and throat infections included an antibiotic.
- In one hospital study in Karachi of 221 people operated on for nasal polyps, 40.7% had a fungal infection in the removed tissue.[1] (cross-sectional, data October 2010 - January 2015)
- In another Karachi hospital study of 114 people having surgery for nasal polyps, 23.7% had allergic fungal sinusitis.[2] (cross-sectional, data December 2016 - November 2018)
- In that same Karachi study, the polyps came back in 9.6% of patients.[2] (cross-sectional, data December 2016 - November 2018)
- In one hospital study in Quetta of 163 adults with nasal polyps on both sides, 30.7% had allergic fungal sinusitis.[3] (cross-sectional, data January - December 2024)
- In one hospital study in Lahore of 216 people with long-term (chronic) sinusitis, 20.8% had allergic fungal sinusitis.[4] (cross-sectional, data April 2014 - September 2017)
- In a small Pakistani study of 86 people with long-term sinusitis of the cheek sinuses, bacteria grew from the sinus fluid of 90.7% of patients.[5] (cross-sectional, data not stated)
- In that study, Staphylococcus aureus was the most common germ, found in 10.4% of patients.[5] (cross-sectional, data not stated)
- In a review of 4,126 prescriptions for nose and throat infections (including sinusitis) at one Quetta hospital clinic, 69.80% included an antibiotic.[6] (cross-sectional, data 1 March - 31 May 2021)
What we do not know yet: There is no national survey of how common sinusitis is in Pakistan, and no published Pakistan guideline was found. Studies are small single-hospital series, mostly of patients having surgery; we found no Pakistan study of antibiotic resistance in sinus bacteria, and the Quetta prescription study reports sinusitis antibiotic choices inconsistently between its text and tables.
Pakistan studies cited
- Sajjad SMQ, Suhail Z, Ahmed R. Prevalence of fungal infection in nasal polyposis - A cross-sectional study, conducted at a tertiary care hospital in Karachi. Journal of the Pakistan Medical Association (JPMA) 2020;70(1):48. doi:10.5455/JPMA.300509. Open source
- Dhanani R, Ghaloo SK, Salam B, et al. Prevalence of allergic fungal sinusitis among patients with nasal polyposis. Journal of the Pakistan Medical Association (JPMA) 2021;71(6):1605-1608. doi:10.47391/JPMA.050. Open source
- Malik TR, Malik KZ, Ali M, et al. Prevalence of Allergic Fungal Rhinosinusitis Among Patients Having Nasal Polyposis. Journal of Rawalpindi Medical College 2025;29(4). doi:10.37939/jrmc.v29i4.2869. Open source
- Awan NU, Cheema KM, Naumeri F, et al. Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis. Pakistan Journal of Medical Sciences 2020;36(3). doi:10.12669/pjms.36.3.1661. Open source
- Latif Malik T, Ullah Awan N, Basir Pal M. Microbiology of Chronic Maxillary Sinusitis. Esculapio - Journal of Services Institute of Medical Sciences 2024;12(1):35-38. doi:10.51273/esc16.712110. Open source
- Hashmi H, Sasoli NA, Sadiq A, et al. Prescribing Patterns for Upper Respiratory Tract Infections: A Prescription-Review of Primary Care Practice in Quetta, Pakistan and the Implications. Frontiers in Public Health 2021;9:787933. doi:10.3389/fpubh.2021.787933. Open source
Symptoms
- Blocked or stuffy nose
- Thick yellow or green mucus from the nose, or mucus running down the back of the throat
- Pain, swelling or tenderness around the cheeks, eyes or forehead
- Reduced or lost sense of smell
- Headache or toothache
- High temperature (fever), mainly in acute sinusitis
- Bad breath, cough, a feeling of pressure in the ears or a nasal-sounding voice
- In young children: irritability, trouble feeding and breathing through the mouth
Causes and risk factors
Causes
- A virus, usually after a cold or flu; this is the most common cause of acute sinusitis
- A bacterial infection on top of a viral one, which happens only in a small number of cases
- Allergies, such as hay fever or allergy to dust mites and moulds, which make the nose lining swell
- Dental disease; a tooth infection can also cause similar face pain
- Things that block the sinus openings, such as nasal polyps or the shape of the inside of the nose
- In chronic sinusitis, a fungal infection in some people, especially those with nasal polyps
What makes it more likely
- A recent cold or flu
- Allergic rhinitis (hay fever or year-round nose allergy)
- Asthma
- Smoking or breathing in other people's smoke and air pollution
- Nasal polyps or differences in the shape of the inside of the nose
- A weak immune system, for example during chemotherapy or with HIV
- Cystic fibrosis or a reaction to aspirin that affects the airways
- Dental disease
Complications
Most people get better without problems. Rarely, infection spreads from the sinuses to nearby areas. It can reach the tissues around the eye (orbital cellulitis), causing swelling of the eyelids, a bulging eye, double vision or poor eyesight. Very rarely it reaches the brain and its coverings, causing meningitis or a brain abscess (a pocket of pus). These are emergencies. Long-term sinusitis can disturb sleep, make asthma worse and leave a person with a poor sense of smell. Using antibiotics that are not needed has its own risks, such as diarrhoea and nausea, and it helps germs become resistant to antibiotics.
When to see a doctor
- Swelling or redness around the eye, a bulging or displaced eye, double vision or any new change in eyesight: get emergency care
- Severe headache at the front of the head, swelling over the forehead bone, signs of meningitis, or new weakness or other nerve problems: get emergency care
- Feeling very unwell all over, or getting worse despite treatment
- Symptoms that get worse quickly or a lot, or that get better and then come back worse
- No improvement after 3 weeks, or painkillers do not help
- Symptoms on one side of the face only that do not go away: see a doctor, who may refer you to an ENT specialist
- A weak immune system, for example during chemotherapy, with any sinus symptoms
Diagnosis
Acute sinusitis is diagnosed from the symptoms and a simple check of the nose and face. Most people do not need X-rays or scans. A doctor looks for signs that make a bacterial infection more likely: symptoms for more than 10 days, thick coloured mucus, strong pain on one side over the teeth or jaw, fever, or getting better and then much worse. The doctor also checks for a tooth infection and for signs that the infection has spread.
Chronic sinusitis is suspected when a blocked nose, mucus, face pain or loss of smell has lasted 12 weeks or more. To confirm it, an ear, nose and throat (ENT) specialist may look inside the nose with a thin camera (nasal endoscopy) or arrange a CT scan of the sinuses. Allergy tests or tests of the immune system may help find a cause. People are usually referred to an ENT specialist if sinusitis keeps coming back, lasts more than 3 months, or affects one side only.
Treatment
- For acute sinusitis that has lasted about 10 days or less, look after yourself at home. Antibiotics are not needed, because most cases are caused by a virus and clear in 2 to 3 weeks.
- Ease pain and fever with paracetamol or ibuprofen. Your doctor or pharmacist decides the dose, especially for children. Do not give aspirin to children under 16.
- Salt water (saline) nose rinses may help. A decongestant nose spray can be used for a short time only, no more than 7 days, because longer use can make the blockage come back worse.
- If symptoms have lasted about 10 days or more without getting better, a doctor may suggest a steroid nose spray for people aged 12 and over. The doctor may also give a back-up antibiotic prescription to use only if you do not improve or get worse.
- An antibiotic is given straight away only if you are very unwell, show signs of a more serious illness, or are at high risk of complications. Your doctor chooses the medicine and the dose.
- For chronic sinusitis, the main treatment is regular salt water rinses and a steroid nose spray, plus treating allergies, asthma or other triggers. A short course of steroid tablets may be used for nasal polyps.
- If medicines do not help, an ENT specialist may suggest endoscopic sinus surgery to open the blocked sinuses. Newer injected medicines (biologics) are used for some people with severe chronic sinusitis and polyps.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Pain relievers and fever reducers | ease face pain, headache and fever in acute sinusitis; they do not shorten the illness; doctor or pharmacist decides the dose | Paracetamol (350 brands), Ibuprofen (378 brands) |
| Nasal corticosteroid sprays | reduce swelling inside the nose; considered in acute sinusitis that has lasted about 10 days or more (age 12 and over), and a main long-term treatment for chronic sinusitis and nasal polyps; they may ease symptoms but are unlikely to shorten acute sinusitis | MOMETASONE FUROATE (3 brands), Fluticasone propionate (1 brand) |
| Nasal decongestants | may ease a blocked nose for a short time; use for no more than 7 days, because longer use causes rebound blockage | Xylometazoline (6 brands) |
| Antibiotics | not needed for most people; used only when a bacterial infection is likely and symptoms are not improving, or straight away if the person is very unwell or at high risk; amoxicillin or amoxicillin with clavulanic acid are common choices, and doxycycline or a macrolide may be used for penicillin allergy depending on local guidance; doctor chooses the medicine and dose | Amoxicillin (248 brands), Amoxicillin + clavulanic acid (176 brands), Doxycycline (80 brands), Clarithromycin (489 brands), Erythromycin (11 brands) |
| Antihistamines | may help only when allergy is the cause of the sinus swelling; they are not useful for ordinary acute sinusitis | Cetirizine (42 brands), Loratadine (175 brands), Fexofenadine (46 brands) |
Also used (not yet in our price list): Phenoxymethylpenicillin (penicillin V): the first-choice antibiotic in UK guidance when an antibiotic is needed, Biologic injections such as dupilumab: used by specialists for some adults with severe chronic sinusitis and nasal polyps
Self-care and prevention
Self-care
- Rest and drink plenty of fluids
- Take paracetamol or ibuprofen for pain or fever, following the label or your pharmacist's advice
- Rinse your nose with a salt water (saline) solution
- Use a decongestant nose spray for no more than 7 days, if at all
- Avoid things you are allergic to, such as dust and smoke
- Do not smoke, and avoid other people's smoke
- If you have a fever or feel too unwell for normal activities, stay at home and avoid close contact with others
- Do not ask for antibiotics for a short sinus illness; they rarely help and can cause side effects
Prevention
- Avoid things you are allergic to, such as dust and smoke, and keep allergies under control
- Do not smoke, and keep away from second-hand smoke and polluted air
- Keep long-term conditions such as asthma and allergies well controlled
- If sinusitis keeps coming back, see a doctor to look for a cause such as allergy or nasal polyps
Common questions
Do I need antibiotics for a sinus infection?
Usually not. Most sinus infections are caused by viruses and get better on their own in 2 to 3 weeks. Antibiotics make little difference to how long it lasts for most people, and they can cause diarrhoea and nausea. A doctor may advise one if symptoms last more than about 10 days and are not improving, or if you are very unwell.
My mucus is green. Is that a bacterial infection?
Not always. Coloured mucus on its own does not prove a bacterial infection. A doctor looks at several signs together, such as illness lasting more than 10 days, fever, strong pain on one side over the teeth or jaw, and getting much worse after first getting better, before deciding if bacteria are likely.
How long does sinusitis last?
Acute sinusitis usually lasts about 2 to 3 weeks, and most people are better within about 4 weeks. If symptoms last 12 weeks or more, it is called chronic sinusitis and needs a doctor's review.
What is the difference between acute and chronic sinusitis?
Acute sinusitis is a short illness, usually after a cold, that clears within a few weeks. Chronic sinusitis lasts 12 weeks or longer, often with a blocked nose and poor sense of smell rather than fever. It is often linked with allergies, asthma or nasal polyps and is treated with salt water rinses and steroid nose sprays.
When should I see a doctor urgently?
Get urgent help if you have swelling around the eye, double vision or changes in eyesight, a severe headache at the front of the head, signs of meningitis, or you feel very unwell. These can be signs that the infection has spread beyond the sinuses, which is rare but serious.
Sources
- NICE. Sinusitis (acute): antimicrobial prescribing (NG79) (2017 (updated 2022)).
- American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Bulletin. New CPG: Adult Sinusitis Update (2025).
- NHS Grampian, NHS Scotland. Acute Sinusitis | Right Decisions (NHS Grampian primary care antimicrobial guidance) (2026).
- NHS. Sinusitis (sinus infection) (2024).
- American Family Physician (AAFP). Acute Rhinosinusitis: Rapid Evidence Review (2025).
- StatPearls (NCBI Bookshelf). Chronic Sinusitis (2026).
- Journal of Pakistan Medical Association (JPMA). Prevalence of fungal infection in nasal polyposis - A cross-sectional study, conducted at a tertiary care hospital in Karachi (2020).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Common coldAllergic rhinitis (hay fever)AsthmaInfluenza (flu)Middle ear infection (otitis media)Sore throat (pharyngitis and tonsillitis)