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Green mucus from nose
Speaking with their nose
Headaches worsen in the morning
Face pain when I look down
Mucus drips into throat
Have a runny nose
Cough
Not seeing your symptoms? No worries!
Infection of the sinuses, which are cavities around the nose and face. The infection can be acute (lasting about a week) or chronic (lasting more than three months). Most often infections start as a viral upper respiratory infection (URI) and then bacterial infection sets in. The symptoms include fever, facial pain or pressure, and nasal obstruction or drainage. Imaging including CT scans may be necessary.
Your doctor may ask these questions to check for this disease:
Treatment depends on the duration and severity. Short courses of symptoms can be managed with nasal rinses, analgesics, and nasal steroid sprays. Symptoms lasting longer than a week may require oral antibiotics and/or even oral steroids. In chronic or recurrent cases, surgery may be necessary. Control of allergic rhinitis may be necessary as well. In children, surgery is often focused on removing adenoid tissues in lieu of doing surgery on the sinuses unless the infection extends outside the sinuses into the eye or brain.
Reviewed By:
Eric A. Gantwerker, MD, MMSC (Otolaryngology (ENT))
Pediatric Otolaryngologist at Northwell Health and Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell. He holds a Master of Medical Science (MMSc) in Medical Education with a special focus on educational technology, educational research, and game-based learning from Harvard Medical School and a Master of Science in Physiology and Biophysics from Georgetown University. He has a special interest in faculty development and has been a speaker or faculty at hundreds of local, national, and international courses and conferences. He is also an active blogger and podcaster for several organizations, including the Harvard Macy Institute (HMI), Harvard Medical School CME Online, and BackTable Innovations. He has been featured in the news and print for media outlets such as USA Today, Businesswire, The Washington Post, Nature Medicine, Fox News, and KevinMD. He was also the Vice President, Medical Director of a medical video game company, Level Ex from 2018 to 2023 that utilized game technology and psychology to create interactive experiences for healthcare professionals. | He is recognized as an expert on the implementation of educational technologies and gaming with a foundation in educational theory for health professions education. He was honored to be inducted as an Associate Member of the American College of Surgeons (ACS) Academy of Master Surgeon Educators and as an Associate Fellow of the Association for Medical Education in Europe (AMEE).
Rohini R, MD (Otolaryngology (ENT))
Dr. Rohini R is an ENT, Head and Neck Surgeon, with a Fellowship in Advanced Endoscopic Sinus and Skull Base Surgery and a Fellowship in Aesthetic Medicine and Lasers. Besides clinical practice and working with Ubie, she is actively training and mentoring medical students and residents. She has functioned in various work settings - teaching hospitals, private and free health centers, and worked with patients from all socioeconomic backgrounds due to her experience in free hospitals and volunteering in India and Singapore.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Can’t Breathe? Why Your Septum Is Deviated & Medical Next Steps
A.
Trouble breathing through one side of your nose is often caused by a deviated septum, an off-center wall of cartilage and bone that can lead to chronic congestion, sinus infections, nosebleeds, facial pressure, snoring, and poor sleep; there are several factors to consider, so see the details below. Next steps usually include an exam by a primary care clinician or ENT, trying saline rinses, steroid sprays, antihistamines or short-term decongestants, and considering septoplasty if symptoms persist, with urgent care needed for severe breathing problems, high fever, vision changes, severe headache, or facial swelling; more on diagnosis, risks, recovery, and how allergies and sleep apnea fit in is explained below.
References:
* Al-Azzawi MA. Etiology of nasal septum deviation: An overview. J Stomatol Oral Maxillofac Surg. 2020 Sep;121(4):448-450. doi: 10.1016/j.jormas.2020.04.012. Epub 2020 Apr 20. PMID: 32328005.
* Al-Sayed AA. Nasal Septum Deviation: Diagnosis and Management. Adv Otorhinolaryngol. 2018;80:61-68. doi: 10.1159/000481878. Epub 2017 Nov 2. PMID: 29094038.
* Kotecha D, Salna M, Kim J, Al-Sayed AA. Septoplasty Outcomes: A Systematic Review. Otolaryngol Head Neck Surg. 2021 Jul;165(1):20-27. doi: 10.1177/0194599820986506. Epub 2021 Mar 30. PMID: 33790539.
* Ghafouri M, Mohebbi N, Razavian P, Saedi B. Current Concepts in the Surgical Management of Deviated Nasal Septum. Front Surg. 2021 Dec 2;8:793834. doi: 10.3389/fsurg.2021.793834. PMID: 34914717; PMCID: PMC8675955.
* Hwang MJ, Hong J. Nasal Obstruction in Septal Deviation: A Review of Diagnosis and Management. J Clin Med. 2023 Jan 26;12(3):942. doi: 10.3390/jcm12030942. PMID: 36767355; PMCID: PMC9917395.
Q.
Nose Always Blocked? Why Your Nose Is Stuffy and Medical Next Steps
A.
A constantly stuffy nose most often comes from inflamed nasal tissue due to colds, allergies, sinusitis, non-allergic rhinitis, structural issues such as nasal polyps or a deviated septum, or rebound from overusing decongestant sprays. Next steps include tracking symptoms and triggers, trying saline rinses and humidification, using targeted medicines like antihistamines or nasal steroid sprays, and seeing a doctor if it lasts more than 10 to 14 days or if you develop severe facial pain, high fever, eye swelling, vision changes, confusion, or trouble breathing; testing and sometimes surgery are options for persistent cases. There are several factors to consider, so see the complete guidance below.
References:
* Shaker GM, Khan R, Shaker HM. Nasal Congestion: A Review of Pathophysiology and Treatment. Am J Rhinol Allergy. 2020 May;34(3):364-374. doi: 10.1177/1945892420919363. Epub 2020 May 13. PMID: 32415783.
* Van Crombruggen CJW, Hellings PW. Recent Advances in the Management of Allergic and Non-Allergic Rhinitis. Curr Allergy Asthma Rep. 2023 Aug;23(8):479-487. doi: 10.1007/s11882-023-01090-y. Epub 2023 Jul 11. PMID: 37434571.
* Bousquet J, Hellings PW, Agache I, et al. ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines: 2021 revision. J Allergy Clin Immunol. 2021 Aug;148(2):419-424. doi: 10.1016/j.jaci.2021.05.029. Epub 2021 Jun 1. PMID: 34212975.
* Scadding RRA, Durham CS, Holmes SB, Bousquet PS, Bachert LA. The obstructed nose: an overview of evaluation and management. Rhinology. 2020 Aug 1;58(4):328-336. doi: 10.4193/Rhin20.016. PMID: 32773177.
* van den Broek SHT, Fokkens WJ, Scadding RRA. Chronic rhinosinusitis: diagnosis and management. BMJ. 2022 Mar 28;376:e066373. doi: 10.1136/bmj-2021-066373. PMID: 35345719.
Q.
Persistent Sinus Pain? Why Your Body Is Failing: Otolaryngology Next Steps
A.
Persistent sinus pain usually means ongoing inflammation with blocked drainage, often due to allergies, structural problems, recurrent infection, or nasal polyps, and an otolaryngology evaluation with nasal endoscopy or sinus CT can identify the cause and guide next steps. There are several factors to consider, including when to seek urgent care and which treatments work best from saline and nasal steroids to biologics or surgery, so see below for specific timelines, red flags, and a step by step plan.
References:
* Fokkens, W. J., W. J. S. van Drunen, C. Bachert, et al. "European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020)." *Rhinology Journal*, vol. 58, no. Supplement S29, 2020, pp. 1-464. DOI: 10.4193/Rhin20.S29. PMID: 32205193.
* Lal, D., S. P. Ramakrishnan, and A. L. Palmer. "Microbial Pathogenesis in Chronic Rhinosinusitis." *Infectious Disease Clinics of North America*, vol. 35, no. 2, 2021, pp. 433-446. DOI: 10.1016/j.idc.2021.03.012. PMID: 34053676.
* Hopkins, C., and W. Fokkens. "Medical Management of Chronic Rhinosinusitis." *Otolaryngologic Clinics of North America*, vol. 54, no. 2, 2021, pp. 249-261. DOI: 10.1016/j.otc.2021.01.003. PMID: 33902928.
* Cho, Y., Y. Kim, and S. Kim. "Surgical outcomes of functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis." *Laryngoscope*, vol. 131, no. 8, 2021, pp. E2635-E2644. DOI: 10.1002/lary.29333. PMID: 33772879.
* Bachert, C., S. M. Han, P. G. G. Van Zele, et al. "Biologics for Chronic Rhinosinusitis with Nasal Polyps: An Update." *Journal of Allergy and Clinical Immunology: In Practice*, vol. 10, no. 5, 2022, pp. 1162-1172. DOI: 10.1016/j.jaip.2022.01.002. PMID: 35086036.
Q.
Sinus Headache? Why Your Sinuses Won’t Drain & Medically Approved Next Steps
A.
Sinus pressure that will not drain usually comes from inflamed, blocked sinus passages due to a cold, allergies, bacterial sinusitis, structural issues like polyps or a deviated septum, or irritants, and many so called sinus headaches are actually migraine. Medically approved first steps include saline nasal irrigation with sterile water, daily nasal steroid sprays, short term decongestants and antihistamines when appropriate, hydration and warm compresses, with antibiotics only in specific situations like symptoms beyond 10 days, worsening after initial improvement, high fever, or severe facial pain. There are several factors to consider. See below for how to tell sinusitis from migraine, exact red flags needing urgent care, and when to see an ENT for imaging or procedures, plus prevention tips that can change your next steps.
References:
* Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody N, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Feb;58(Suppl S29):1-464. doi: 10.4193/Rhin20.600. PMID: 32029103.
* Khan AH, Smedley N, Kalmar CL, Pyle GM, Lee JT, Lee S, et al. Chronic rhinosinusitis: an update for the allergist. Curr Opin Allergy Clin Immunol. 2019 Jun;19(3):234-242. doi: 10.1097/ACI.0000000000000523. PMID: 30985449.
* Kuan EC, Kuan EC, Klemens JM, Ng J. Headache associated with rhinosinusitis. Curr Pain Headache Rep. 2020 Feb 28;24(3):14. doi: 10.1007/s11916-020-0836-7. PMID: 32112108.
* Soler ZM, Soler ZM, Rosenfeld RM. Pharmacologic treatment of chronic rhinosinusitis. Laryngoscope Investig Otolaryngol. 2018 Apr 11;3(2):100-109. doi: 10.1002/lio2.158. PMID: 29770335; PMCID: PMC5946116.
* Maeso-Liacer E, Maeso-Liacer E, Cascales-Poy N, Marqués-Mateo M. Role of anatomy in chronic rhinosinusitis: a literature review. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):611-619. doi: 10.1007/s00405-017-4860-6. PMID: 29322253.
Q.
Allergy Agony? Why Your Sinuses Inflame & Medically Approved Next Steps
A.
Sinus inflammation from allergies happens when your immune system overreacts to triggers like pollen, mold, dust mites, or pet dander, releasing histamine that swells the nasal lining, boosts mucus, and causes congestion, sneezing, itchy watery eyes, and pressure, which differs from sinus infection symptoms. Medically approved next steps include reducing exposure, daily intranasal steroid sprays as the first line, non-drowsy antihistamines, saline rinses, cautious short-term decongestant use, and considering allergy immunotherapy. There are several factors to consider and red flag symptoms to act on, plus a symptom check link and technique tips, so see the complete guidance below.
References:
* Bachert C, van Zele T, Gevaert P. Inflammation of the paranasal sinuses caused by allergy and other factors. Am J Rhinol Allergy. 2011 Nov-Dec;25(6):e196-200. doi: 10.2500/ajra.2011.25.3670. Epub 2011 Nov 16. PMID: 22093557.
* Hwang PH, Chiou YH, Tai YL, Hsieh HH, Hsin CH. Chronic rhinosinusitis and allergy: a complex relationship. Allergy Rhinol (Providence). 2012 Fall;3(3):141-5. doi: 10.2500/ar.2012.3.0039. Epub 2012 Oct 23. PMID: 23350106.
* Small P, Keith PK. Mechanisms of Allergic Rhinitis. Allergy Asthma Immunol Res. 2018 Sep;10(5):451-460. doi: 10.4168/aair.2018.10.5.451. Epub 2018 Aug 3. PMID: 30129218.
* Bousquet J, Hellings PW, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2016 revision. Allergy. 2017 May;72(5):713-723. doi: 10.1111/all.13023. Epub 2016 Sep 30. PMID: 27500297.
* Han D, Zhang X, Zhang J, Wang C. The role of allergy in chronic rhinosinusitis: a review. Allergy Asthma Immunol Res. 2023 Jul;15(4):460-475. doi: 10.4168/aair.2023.15.4.460. Epub 2023 May 10. PMID: 37166164.
Q.
Still Congested? Why Your Nose Won’t Stop & Medically Approved Azelastine Next Steps
A.
Persistent congestion despite azelastine often reflects allergic or non-allergic rhinitis, sinusitis, or structural problems, and relief depends on consistent use and correct spray technique, sometimes with a combined steroid spray and saline rinses. Recommended next steps include optimizing technique and adherence, adding an intranasal steroid, checking for sinusitis or specific allergies, and seeking ENT evaluation for persistent or one-sided blockage while avoiding rebound from decongestant sprays. There are several factors to consider; see below for key symptoms, red flags, and detailed, medically approved steps that can guide your next move.
References:
* Corren, J., & Krouse, J. H. (2020). Rhinitis and Nasal Congestion: An Updated Review. *Allergy & Asthma Proceedings*, *41*(5), 350-357. https://pubmed.ncbi.nlm.nih.gov/32958046/
* Vurimindi, V., & Corren, J. (2020). Azelastine hydrochloride nasal spray: a review of its use in allergic and nonallergic rhinitis. *Therapeutic Advances in Respiratory Disease*, *14*, 1753466620947704. https://pubmed.ncbi.nlm.nih.gov/32820549/
* Stewart, M., et al. (2023). International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis 2023. *International Forum of Allergy & Rhinology*, *13*(9), 1199-1582. https://pubmed.ncbi.nlm.nih.gov/37675718/
* Platt, C. D., & Naclerio, R. M. (2018). Pharmacologic Management of Nonallergic Rhinitis. *Otolaryngologic Clinics of North America*, *51*(5), 943-958. https://pubmed.ncbi.nlm.nih.gov/30343759/
* Li, R., et al. (2018). Intranasal corticosteroids plus azelastine versus intranasal corticosteroids alone for the treatment of allergic rhinitis: a systematic review and meta-analysis. *Rhinology*, *56*(3), 226-234. https://pubmed.ncbi.nlm.nih.gov/29961608/
Q.
Face Feeling Crushed? Why Sinusitis Persists & Medically-Approved Steps
A.
Sinus pressure that feels like your face is being crushed is usually sinusitis that lingers when drainage is blocked, most often from a virus that improves in 7 to 10 days, but sometimes from allergies, a bacterial infection that lasts over 10 days or worsens after initial improvement, or chronic issues like polyps or a deviated septum. Evidence based relief includes saline nasal irrigation, daily intranasal steroid sprays, short term decongestants, pain relievers, allergy control, and antibiotics only when bacterial criteria are met, with urgent care for red flags such as eye swelling, vision changes, or severe headache, and surgery only if medical therapy fails. There are several factors to consider and key details that can change your next steps, so see the complete guidance below.
References:
* pubmed.ncbi.nlm.nih.gov/37628318/
* pubmed.ncbi.nlm.nih.gov/34407987/
* pubmed.ncbi.nlm.nih.gov/35926521/
* pubmed.ncbi.nlm.nih.gov/33948795/
* pubmed.ncbi.nlm.nih.gov/37160759/
Q.
Face Thumping? Why Your Sinuses Are Inflamed & Medically-Proven Relief
A.
There are several factors to consider with face thumping facial pain. It is most often due to inflamed, blocked sinuses causing pressure around the cheeks, eyes, and forehead with congestion, thick yellow or green discharge, reduced smell, and fatigue; most cases are viral and improve in about 7 to 10 days. Evidence-based relief includes sterile saline nasal irrigation, daily nasal steroid sprays, pain relievers, hydration, and steam; see below for how to tell viral from bacterial, when antibiotics are truly needed, red flags that require urgent care, and prevention and next-step options if symptoms persist or recur.
References:
* Fukumitsu, R., & Takeno, S. (2020). Pathophysiology of chronic rhinosinusitis with nasal polyps: an update. *Auris Nasus Larynx*, *47*(2), 161–168. PMID: 31753765.
* Stevens, W. W., Lee, J. J., & Tan, B. K. (2023). Current concepts in the medical management of chronic rhinosinusitis. *Annals of Allergy, Asthma & Immunology*, *131*(2), 180–186. PMID: 37372332.
* Fokkens, W. J., Lund, V. J., Mullol, J., Bachert, C., Acar, B., Al-Hammadi, A. S., ... & Gane, S. (2020). European Position Paper on Rhinosinusitis and Nasal Polyps 2020. *Rhinology*, *58*(Supplement S29), 1–464. PMID: 32089146.
* Soler, Z. M., & Schlosser, R. J. (2019). The Role of Endotypes and Phenotypes in Chronic Rhinosinusitis. *Current Allergy and Asthma Reports*, *19*(11), 54. PMID: 31563914.
* Orlandi, R. R., Kingdom, T. T., Hwang, P. H., Smith, T. L., Alt, J. A., Stankiewicz, J. A., ... & Rosenfeld, R. M. (2021). International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. *International Forum of Allergy & Rhinology*, *11*(S1), S1–S318. PMID: 34019197.
Q.
Head Like Lead? Why Your Sinus Infection Throbs + Medically Approved Relief
A.
That heavy, throbbing sinus pain happens when blocked drainage leads to pressure buildup, tissue inflammation, and trigeminal nerve irritation, often worse when you bend forward or wake up. Most cases are viral and improve in 7 to 10 days, while bacterial sinusitis is more likely if symptoms last beyond 10 days, worsen after initial improvement, or include high fever with facial pain. Medically approved relief includes saline rinses, nasal steroid sprays, short term decongestants, OTC pain relievers, warm compresses, steam, and good hydration, with antibiotics only when a clinician confirms a bacterial infection and urgent care needed for red flags like eye swelling, vision changes, severe headache, high fever, confusion, stiff neck, or persistent vomiting. There are several factors to consider when choosing next steps, so see the complete guidance below.
References:
* Lam, J. J., & Jan, G. M. (2021). Understanding and Managing Pain in Chronic Rhinosinusitis. *Current Pain and Headache Reports*, *25*(11), 74.
* Palmer, J. N. (2020). Pain mechanisms in chronic rhinosinusitis. *The Laryngoscope*, *130*(11), 2533–2534.
* Venkatraman, A., Ramachandran, K., & Ramachandran, K. K. (2020). Acute Rhinosinusitis: A Systematic Review of Current Management. *Frontiers in Pharmacology*, *11*, 584981.
* Choi, J. Y., & Ramakrishnan, V. R. (2022). Medical management of chronic rhinosinusitis. *Allergy and Asthma Proceedings*, *43*(3), 209–216.
* Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, T. S., Brook, I., Evans, P. L., Ganiats, T. G., ... & Corrigan, M. (2015). Clinical practice guideline: Adult Sinusitis. Executive Summary. *Otolaryngology--Head and Neck Surgery*, *152*(4), 598–611.
Q.
Sinus Concrete? Why Your Face Is Heavy—Medically Approved Sudafed Steps
A.
Facial heaviness that feels like concrete is most often sinus congestion from sinusitis or a cold; short-term, properly dosed Sudafed (pseudoephedrine) can shrink swollen nasal tissues to open drainage and ease pressure, and works best when combined with saline rinses, fluids, warm compresses, nasal steroids for allergies, and head elevation. There are several factors to consider. See below for who should avoid Sudafed, which product and dose to choose, how long to use it, and the red flags that may signal bacterial infection or urgent issues, which can affect your next healthcare steps.
References:
* Yu J, Hu Y, Jin J, Deng Y, Zheng C, Li Z, Mao Z, Cao Y. Prevalence of Facial Pain in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2023 Sep;169(3):421-432. doi: 10.1177/01945998221146609. Epub 2022 Dec 27. PMID: 36573172.
* De Sutter A, Lammens C, Mingoes S, Linder L, Van Driel M, De Backer H, Bosteels C, Maes L, De Backer W, Van Canselaer L, Van Ganse E. Efficacy of pseudoephedrine in relieving symptoms of the common cold: a systematic review and meta-analysis. J Allergy Clin Immunol Pract. 2017 Mar-Apr;5(2):498-500.e1. doi: 10.1016/j.jaip.2016.12.016. Epub 2017 Feb 1. PMID: 28162817.
* Coggins WB, Ramakrishnan VR. Pharmacotherapy for Acute Rhinosinusitis. Otolaryngol Clin North Am. 2019 Feb;52(1):15-28. doi: 10.1016/j.otc.2018.08.006. Epub 2018 Oct 31. PMID: 30391039.
* Adappa ND, Kennedy DW. The Pathophysiology of Rhinosinusitis. Immunol Allergy Clin North Am. 2016 Feb;36(1):1-14. doi: 10.1016/j.iac.2015.08.001. Epub 2015 Oct 13. PMID: 26617066.
* Pynnonen MA. Adult Sinusitis: A Review. JAMA. 2023 Oct 17;330(15):1478-1488. doi: 10.1001/jama.2023.18731. PMID: 37847039.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Weinberger M. Whither Sinusitis? Clin Pediatr (Phila). 2018 Aug;57(9):1013-1019. doi: 10.1177/0009922818764927. Epub 2018 Mar 22. PMID: 29562756.
https://journals.sagepub.com/doi/10.1177/0009922818764927Melén I. Chronic sinusitis: clinical and pathophysiological aspects. Acta Otolaryngol Suppl. 1994;515:45-8. doi: 10.3109/00016489409124323. PMID: 8067243.
https://www.tandfonline.com/doi/abs/10.3109/00016489409124323Tan R, Spector S. Pediatric sinusitis. Curr Allergy Asthma Rep. 2007 Nov;7(6):421-6. doi: 10.1007/s11882-007-0064-5. PMID: 17986371.
https://link.springer.com/article/10.1007/s11882-007-0064-5