Sinusitis describes an inflammation of the mucous membranes of the paranasal sinuses.


  • Incidence: 2500.00 cases per 100,000 person-years
  • Peak incidence: 40-50 years
  • Sex ratio: 1:1
Condition Relative
Viral upper respiratory tract infections12.00
Acute sinusitis1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+


The sinuses are usually sterile - the most common infectious agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.

Predisposing factors include:
  • nasal obstruction e.g. Septal deviation or nasal polyps
  • recent local infection e.g. Rhinitis or dental extraction
  • swimming/diving
  • smoking

Clinical features

  • facial pain: typically frontal pressure pain which is worse on bending forward
  • nasal discharge: usually thick and purulent
  • nasal obstruction


Management of acute sinusitis
  • analgesia
  • intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
  • NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
  • oral antibiotics are not normally required but may be given for severe presentations. The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if 'systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications'