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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.
Sinus Pain? Why Your Sinuses Are Inflamed & Medically Approved Next Steps
A.
Sinus pain happens when inflammation blocks normal drainage, most often from a viral cold, though allergies, bacterial infection, chronic inflammation, and structural issues can also be involved; there are several factors to consider, so see below to understand what best fits your symptoms. Medically approved next steps include saline rinses, daily intranasal steroid sprays, appropriate pain relief, brief use of decongestants, and allergy control, with antibiotics reserved for likely bacterial cases such as symptoms beyond 10 days or worsening after initial improvement. Seek urgent care for high fever, vision changes, swelling around the eyes, severe headache, confusion, stiff neck, or persistent or worsening symptoms; fuller guidance and prevention tips are below.
References:
* Ramakrishnan VR, Palmer JN. Acute Rhinosinusitis: Updates on Diagnosis and Management. Otolaryngol Clin North Am. 2022 Aug;55(4):743-757. doi: 10.1016/j.otc.2022.04.004. Epub 2022 May 11. PMID: 35840243.
* Hamilos DL. The Pathogenesis of Chronic Rhinosinusitis. J Allergy Clin Immunol Pract. 2019 Sep;7(7):2139-2147. doi: 10.1016/j.jaip.2019.02.049. PMID: 30939316.
* Kennedy DW, Palmer JN. Chronic Rhinosinusitis. Clin Chest Med. 2020 Dec;41(4):619-633. doi: 10.1016/j.ccm.2020.08.006. PMID: 33153676.
* Canonica GW, Mullol J, Bachert C. Allergic rhinitis and chronic rhinosinusitis with nasal polyps: united airways disease. Curr Opin Allergy Clin Immunol. 2019 Feb;19(1):1-7. doi: 10.1097/ACI.0000000000000507. PMID: 30489370.
* Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt J, Barham HP, Bassiouni A, Borish L, Bosso JV, Bradshaw J, Brown K, Cohen N, DelGaudio JM, Desrosiers M, Dhong HJ, Ebert CS Jr, Eloy JA, Farrell NF, Fever D, Field P, Fong K, Gose E, Griffith CC, Guss J, Han JK, Houser SM, Humphreys I, Kanjanaumporn J, Keschner DG, Kim J, Krouse JH, Lam K, Lanford J, Lee JT, Levy JM, Liu B, Luong AU, Marple B, Marzouk P, McMahon R, Mitchell K, Mukerji SS, Naik S, Nalawade W, Niyongabo E, Omachi T, Padhya TA, Palmer JN, Payne SC, Poe D, Riley C, Ritter J, Sacks W, Schlosser RJ, Sedaghat AR, Seiden AM, Setzen M, Shikani A, Shih L, Sikand A, Soler ZM, Steiling K, St. John N, Takashima G, Takata G, Tawfik A, Welch KC, White AA, Wormald PJ, Zanation AM, Zheng Z. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021 Dec;11(12):1597-1752. doi: 10.1002/alr.22741. PMID: 34927142.
Q.
Chronic Congestion? Why Your Nose Is Blocked & Medically Approved Next Steps
A.
Chronic nasal blockage lasting 12 weeks or more is most often due to chronic sinusitis, allergies, non-allergic rhinitis, nasal polyps, structural issues, or rebound from decongestant sprays. There are several factors to consider, and urgent red flags like high fever, severe facial pain, swelling around the eyes, or vision changes need prompt care; see below to understand more. Medically approved steps start with saline rinses and daily intranasal steroid sprays, then allergy control, reviewing decongestant use, and ENT evaluation or imaging if symptoms persist, with surgery only when necessary; key timing, lifestyle tips, and details that could change your next step are below.
References:
* Seccia, V., Lamberti, R., Ralli, M., Zampetti, P., & Cavaliere, C. (2020). Management of Chronic Rhinitis: A Practical Review. *Clinics and Practice, 10*(2), 1269. doi:10.3390/clinpract10020126
* Bousquet, J., Pfaar, O., Agache, I., Bedbrook, A., Akdis, C. A., Canonica, G. W., . . . Wöhrl, S. (2020). ARIA-EAACI guidelines on allergic rhinitis. *Allergy, 75*(1), 1-13. doi:10.1111/all.13962
* Lieberman, P. (2018). Nonallergic Rhinitis: Clinical Features, Pathophysiology, and Management. *Allergy and Asthma Proceedings, 39*(1), 2-8. doi:10.2500/aap.2018.39.4109
* Karkos, P. D., Karkos, C. D., Anagnostou, E., & Vassiliou, I. (2018). The management of nasal obstruction: a review of the literature. *European Archives of Oto-Rhino-Laryngology, 275*(1), 1-11. doi:10.1007/s00405-017-4740-4
* Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., . . . Scadding, G. K. (2020). European Position Paper on Rhinosinusitis and Nasal Polyps 2020. *Rhinology, 58*(Suppl 29), 1-464. doi:10.4193/Rhin20.600
Q.
Can’t Breathe? Why Your Septum is Blocked + Medically Approved Next Steps
A.
Nasal blockage from a deviated septum is common and treatable; doctors confirm it with an exam or endoscopy, start with nasal steroid sprays, saline rinses, and allergy control, and consider septoplasty if breathing stays limited. There are several factors to consider, including other causes that can mimic septal blockage, what recovery and risks look like, and warning signs that need urgent care. See the complete, medically approved next steps below to choose the right path for your symptoms.
References:
* Konerding, M., Leick, S., & Hüttenbrink, K. B. (2022). Deviated nasal septum: from aetiology to diagnosis and treatment. *European Archives of Oto-Rhino-Laryngology*, *279*(10), 4697-4705.
* Kim, C. K., Park, S. W., Kim, J., Kim, K. S., & Park, Y. H. (2022). Outcomes of Septoplasty With or Without Concomitant Turbinate Surgery in Patients With Nasal Obstruction: A Systematic Review. *JAMA Otolaryngology–Head & Neck Surgery*, *148*(10), 914-922.
* Lorusso, F., Pistorio, A., De Corso, E., Scarpa, A., Bressi, F., Corvo, R., ... & De Vincentiis, M. (2019). Current aspects of diagnosis and treatment of nasal obstruction. *Journal of Otolaryngology-Head & Neck Surgery*, *48*(1), 1-13.
* Al-Dhahli, S., Al-Rawahi, Y., Al-Fahdi, Y., & Al-Maniri, A. (2022). Pathophysiology and Surgical Treatment of Nasal Obstruction Due to Deviated Nasal Septum: A Review of the Literature. *Ear, Nose & Throat Journal*, *101*(8), 534-541.
* Shah, A. R., & Selesnick, S. H. (2019). Nasal Obstruction. *Seminars in Plastic Surgery*, *33*(03), 154-159.
Q.
Constant Sinus Pain? Why Your Sinuses Stay Blocked & Medical Next Steps
A.
Constant sinus pain is usually due to ongoing inflammation rather than a lingering cold, commonly from chronic sinusitis, allergies, nasal polyps, a deviated septum, recurrent infections, or overuse of decongestant sprays; seek urgent care for eye swelling or redness, vision changes, a severe new headache, high fever, confusion, or a stiff neck. For next steps, track patterns, try saline rinses and humidified air, and see a clinician if symptoms last beyond 10 to 14 days or over 12 weeks for possible allergy testing, imaging, nasal steroid therapy, targeted antibiotics, and ENT referral or surgery if needed. There are several factors to consider. See below for important details that can guide the right choice for you.
References:
* Hamilos DL. Chronic Rhinosinusitis: Pathophysiology and Medical Management. J Allergy Clin Immunol Pract. 2018 Sep-Oct;6(5):1481-1490. doi: 10.1016/j.jaip.2018.04.032. Epub 2018 Jun 8. PMID: 29891005.
* Kennedy DW. Current concepts in the medical management of chronic rhinosinusitis. Curr Opin Allergy Clin Immunol. 2019 Feb;19(1):15-21. doi: 10.1097/ACI.0000000000000492. PMID: 30745233.
* Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Baciu L, Baroody F, Benninger M, Calus L, Cervin A, Chazal J, Chen J, Chiarella E, Ciprandi G, Custovic A, De Gabory A, Desrosiers M, Diamant Z, Douglas R, Eloy P, Georgalas C, Gosepath J, Harvey R, Herrmann P, Hirschberg A, Horváth G, Joos G, Juto JE, Kanjanaumporn J, Khunkaewla P, Kjeldsen A, Kostamo K, Kross K, Leskinen K, Leunisse N, Llewellyn C, Mariën G, Mesko M, Mösges R, Netzer A, Neuenschwander B, Nishino T, O'Connor M, Onerci M, Pfaar O, Pugin B, Rimmer J, Salib R, Schünemann HJ, Segboer S, Sklamberg S, Sprangers B, Stjärne P, Takeno S, Tantilipikorn P, Teeling T, Tomazic J, Trecca V, Van der Beek N, Van Zele T, Verbanck S, Verhaeghe B, Wagner R, Wang Y, Weschta D, Wihl JÅ, Wilkie C, Wong B, Wormald PJ, Zuberbier T. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 May 11;58(Suppl S29):1-464. doi: 10.4193/Rhin20.600. PMID: 32420968.
* Hwang B, Hwang PH, Hwang SK, Kim DI, Kwon YM, Choi KY, Jang M, Lee JS. Bacterial biofilms in chronic rhinosinusitis. Int J Mol Med. 2020 Oct;46(4):1233-1244. doi: 10.3892/ijmm.2020.4682. Epub 2020 Jul 31. PMID: 32747190.
* Cohen NA, Tawfik K, Kimple AJ. Inflammation in chronic rhinosinusitis. Ann N Y Acad Sci. 2019 May;1442(1):164-171. doi: 10.1111/nyas.13968. Epub 2019 Jan 23. PMID: 30677102.
Q.
Pain Behind the Eyes? Why Your Ethmoid Bone Aches & Expert Medical Steps
A.
Pain behind the eyes is most often from inflammation of the ethmoid bone’s sinuses, typically triggered by viral sinusitis, allergies, or drainage blockage, and it brings deep pressure between the eyes, congestion, thick mucus, and pain that worsens when you lean forward. Expert steps range from saline rinses, steam, hydration, and nasal steroids or antihistamines, to antibiotics only for likely bacterial cases, with imaging or an ENT referral for chronic or severe symptoms; seek urgent care for eye swelling, vision changes, severe headache, high fever, or confusion. There are several factors that could change your next steps, so see the complete answer below for important details.
References:
* Shah R, Marzouk H. Frontal and Ethmoid Sinusitis: Current Management. Otolaryngol Clin North Am. 2021 Apr;54(2):227-240. doi: 10.1016/j.otc.2020.12.001. Epub 2021 Jan 12. PMID: 33451737.
* Benveniste R, Benveniste JS, Miller ME. Headaches and Facial Pain Related to Rhinosinusitis: A Diagnostic Dilemma. Headache. 2020 Nov;60(10):2618-2624. doi: 10.1111/head.13963. Epub 2020 Oct 14. PMID: 33052067.
* Kern RC, Schleimer RP, Tan BK, Stevens WW, Lee RJ, Peters AT, Randall RL, Poposki JA, Kennedy DW, Hamilos DL. Recurrent Acute Rhinosinusitis and Chronic Rhinosinusitis: A Current Review. Allergy Asthma Immunol Res. 2017 May;9(3):180-8. doi: 10.4168/aair.2017.9.3.180. Epub 2017 Mar 29. PMID: 28416790; PMCID: PMC5389476.
* Stevens WW, Lee RJ, Schleimer RP, Kern RC, Tan BK, Randall RL, Poposki JA, Peters AT. Chronic Rhinosinusitis: A Focused Review on Pathophysiology, Diagnosis, and Treatment. Allergy Asthma Immunol Res. 2016 May;8(3):186-98. doi: 10.4168/aair.2016.8.3.186. Epub 2016 Mar 29. PMID: 27019771; PMCID: PMC4819777.
* Mainardi F, Zanchin G. Headache attributed to rhinosinusitis. Curr Pain Headache Rep. 2011 Feb;15(1):75-9. doi: 10.1007/s11916-010-0158-9. PMID: 20978873.
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.
Constant Congestion? Why Nasal Polyps Block Air & Medically Approved Next Steps
A.
Nasal polyps can cause constant congestion by blocking airflow and sinus drainage, leading to persistent stuffiness, reduced smell, postnasal drip, facial pressure, and repeat infections. Evidence based next steps include daily steroid nasal sprays first, short courses of oral steroids when severe, and for refractory cases biologic injections or endoscopic sinus surgery; there are several factors to consider that could change your plan, including coexisting asthma or allergies and warning signs that need urgent care, so see the complete details below.
References:
* Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody A, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). *Rhinology*. 2020 Feb 20;58(Suppl S29):1-464. doi: 10.4193/Rhin20.600. PMID: 32073712.
* Hamilos DL. Mechanisms of airway obstruction in chronic rhinosinusitis with nasal polyps. *Curr Opin Allergy Clin Immunol*. 2018 Feb;18(1):15-20. doi: 10.1097/ACI.0000000000000418. PMID: 29135763.
* Zhang Y, Meng Y, Sun X, Zhang J, Li J, Liu X. Biologic Treatment for Chronic Rhinosinusitis with Nasal Polyps: A Review. *Clin Rev Allergy Immunol*. 2023 Aug;65(1):153-174. doi: 10.1007/s12016-022-08940-5. Epub 2023 Feb 24. PMID: 36829775.
* Triantafillidou ME, Tsetsos N, Vlastos I, Nikolaidis P, Triantafillidis M, Konstantinidis I. Management of chronic rhinosinusitis with nasal polyps: an update. *Curr Opin Otolaryngol Head Neck Surg*. 2022 Feb 1;30(1):1-6. doi: 10.1097/MOO.0000000000000780. PMID: 34966144.
* Kollert S, Mösges R, Klimek L. Topical and Systemic Corticosteroids in the Treatment of Nasal Polyps. *Rhinology*. 2021 Jun 1;59(3):230-244. doi: 10.4193/Rhin21.053. PMID: 34091090.
Q.
Constant Pressure? Why Your Sinuses Won’t Clear & Medically Approved Next Steps
A.
Persistent facial pressure and congestion that will not clear is most often sinusitis, where inflammation blocks drainage after a cold or due to allergies, nasal polyps, structural issues, or chronic inflammation; bacterial sinusitis is more likely if symptoms last over 10 days, worsen after brief improvement, or include fever with thick yellow or green discharge. Medically approved next steps include saline nasal irrigation and consistent intranasal steroid sprays, short term decongestants or antihistamines for allergies, antibiotics only when bacterial criteria are met, and evaluation for polyps or surgery if symptoms persist, with urgent care for red flags like eye swelling, vision changes, or a severe headache. There are several factors to consider, and important details that can change your next steps are explained below.
References:
* Soler ZM, Ramakrishnan VR, Palmer JN, Schlosser RJ. Chronic Rhinosinusitis: Definition, Epidemiology, Pathophysiology, Diagnosis, and Management. J Allergy Clin Immunol Pract. 2017 Jul-Aug;5(4):862-872. doi: 10.1016/j.jacip.2017.03.003. Epub 2017 Apr 26. PMID: 28689710.
* Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt J, Barham HP, Bell K, Bhagat S, Chandra RK, Chilukuri K, Clark J, Davis GE, DelGaudio JM, Dixon B, Dodgion CM, Edmiston N, Field J, Fiorella R, Friedel ME, Getz AE, Goldberg AN, Gray ST, Han JK, Harshbarger RJ, Houser SM, Hwang PS, Ikeda K, Iloreta AM, Jafari A, Kuperan AB, Langworthy J, Lee JT, Levy JM, Loehrl TA, Luong A, Mackinnon CA, McMains KC, Miller R, Monroy JA, More Y, Most SP, Nguyen S, Oakley GM, Ow RA, Palmer JN, Patel ZM, Pettey A, Poetker DM, Ramakrishnan VR, Ramanand P, Raval N, Rosenfeld RM, Snyderman CH, Soler ZM, Stamm C, Stegman R, Storck K, St-Pierre M, Tang X, Tawfik KO, Teo P, Thamboo A, W Chang E, Wang MB, W Duncavage E, Woodard TD, Zanation AM, Zoological. International Consensus Statement on Allergy and Rhinology: Chronic Rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021 Mar;11(3):213-214. doi: 10.1002/alr.22729. Epub 2020 Nov 3. PMID: 33145714.
* Loehrl TA, Poetker DM. Management of refractory chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2018 Feb;26(1):1-7. doi: 10.1097/MOO.0000000000000424. PMID: 29215357.
* Tan BK, Kern RC. The Pathophysiology of Chronic Rhinosinusitis. Otolaryngol Clin North Am. 2020 Jun;53(3):365-376. doi: 10.1016/j.otc.2020.02.001. Epub 2020 Mar 26. PMID: 32223708.
* Wiese CW, Smith TL. Biologics for chronic rhinosinusitis with nasal polyps: an update on current and emerging treatments. Curr Opin Otolaryngol Head Neck Surg. 2023 Feb 1;31(1):15-20. doi: 10.1097/MOO.0000000000000858. Epub 2022 Dec 12. PMID: 36584674.
Q.
Is Phenylephrine Failing? Why Your Nose Stays Blocked & Medically Approved Next Steps
A.
Phenylephrine often does not relieve nasal congestion at approved oral doses, per a 2023 FDA advisory panel, so a still-blocked nose may reflect other issues like sinusitis, allergies, or rebound congestion. Better next steps can include nasal steroid sprays, saline rinses, short-term topical decongestants, and in some cases pseudoephedrine or antihistamines. There are several factors to consider; see below for key details on safety, red flags, and when to talk to a doctor.
References:
* Khouri, J. T., et al. (2023). Oral Phenylephrine for Nasal Decongestion: A Systematic Review. *The Laryngoscope*, 133(12), 3042-3051.
* Hueston, W. J., et al. (2023). The efficacy of oral phenylephrine as a nasal decongestant: a critical review of the evidence. *Annals of Allergy, Asthma & Immunology*, 131(4), 481-487.
* Koussa, K., et al. (2023). Efficacy and Safety of Pseudoephedrine versus Phenylephrine as Nasal Decongestants: A Systematic Review and Meta-Analysis. *International Journal of Environmental Research and Public Health*, 20(10), 5897.
* Hanania, N. A., et al. (2018). Phenylephrine: a review of pharmacology, clinical use, and controversy. *Journal of Clinical Pharmacy and Therapeutics*, 43(3), 307-314.
* Brożek, J. L., et al. (2020). Pharmacological management of allergic rhinitis: an updated review. *Allergy*, 75(11), 2736-2751.
Q.
Sinus Infection Symptoms? Why Your Face Hurts & Medically Approved Next Steps
A.
Sinus infection symptoms often include facial pressure or pain in the cheeks, forehead, or teeth, nasal congestion, thick yellow or green mucus, headache, postnasal drip, and a reduced sense of smell, most commonly from a virus that improves within 7 to 10 days. Bacterial sinusitis is more likely if symptoms last over 10 days, are severe with high fever, or worsen after initial improvement; first-line care includes saline rinses, hydration, warm compresses, pain relievers, nasal steroid sprays, and short-term decongestants, and urgent signs like eye swelling, vision changes, or a severe new headache need immediate care. There are several factors to consider that can affect your next steps, including when antibiotics help and when to see an ENT; see below for complete guidance.
References:
* Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt J, Apel F, Boss WK, Casiano R, Chacko T, Chi J, Citardi MJ, Coticchia J, DelGaudio JM, Duncavage J, Eloy JA, Farrell NF, Ferdinand S, Fields L, Flanagan M, Floreani S, Forner D, Fong K, Gardon S, Gliklich RE, Gunturu N, Hord R, Humphreys I, Ishman SL, Janz TA, Johnson JR, Jumean HG, Kelsberg G, Lal D, Lanz MJ, Laryngoscope V, Lee JT, Levy J, Lieu JE, Lumley A, Mackinnon S, Man LX, Margolin A, Matos-Cruz C, McCoul ED, McMains KC, Merati AL, Messina L, Metson RB, Moberly AC, Moniz K, Mountford W, Murr AH, Nardone HC, Nyquist GG, Obana T, O'Brien J, Palmer JN, Patel ZM, Pettey A, Poetker DM, Pukhalskaya T, Raab CA, Ramezanpour A, Rampp R, Riley D, Rittberg BR, Saary J, Sacks R, Schlosser RJ, Sedaghat AR, Sheikh S, Siegel NS, Singh S, Snyder ED, Stearns JN, Stewart MG, Stillman J, Stringer SP, Suh JD, Sykes KJ, Taliercio RM, Terrell JE, Tunkel DE, Valentine SM, Vaughn DD, Villwock JA, Wagner RL, Wawrose SF, Weinberger PM, Whitney MS, Wise SK, Wong KK, Wrobel B, Zevallos JP. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021 Mar;11(3):217-739. doi: 10.1002/alr.22741. PMID: 33646626.
* Spector M. Acute Rhinosinusitis: A Primary Care Perspective. J Clin Otolaryngol. 2022 Mar;1(1):101. doi: 10.3390/jco1010008. Epub 2022 Mar 22. PMID: 36082103; PMCID: PMC9448100.
* Fokkens WJ, Lund VJ, Mullol J. Rhinosinusitis. Nat Rev Dis Primers. 2017 Jul 27;3:17082. doi: 10.1038/nrdp.2017.82. PMID: 28748924.
* Pynnonen MA, Hooten CN. Diagnosis and Management of Acute Rhinosinusitis. JAMA. 2020 Jan 21;323(3):263-264. doi: 10.1001/jama.2019.20818. PMID: 31961445.
* Tsetsou S, Vargami C, Kapnisi I, Karakalpakis E, Gaki G, Stravou E. Sinusitis and facial pain: a differential diagnosis. J Clin Diagn Res. 2015 Jun;9(6):MJ01-4. doi: 10.7860/JCDR/2015/12716.6083. Epub 2015 Jun 1. PMID: 26266289; PMCID: PMC4525624.
Q.
Sinus Infection? Why Your Face is Thumping + Medically Approved Next Steps
A.
Sinus infection is a common cause of face thumping, pressure, or aching with congestion, usually from inflamed, blocked sinuses, and it often improves within 7 to 10 days. Medically approved next steps include saline nasal rinses, OTC steroid sprays, pain relievers, fluids, humidified air, and rest, while antibiotics are typically reserved for symptoms that persist beyond 10 days or worsen after initial improvement. There are several factors to consider, including red-flag symptoms that may require urgent care, so see the complete guidance below for details that could affect your next steps.
References:
* Gupta V, Singh D. Acute Bacterial Rhinosinusitis: A Review of Diagnosis and Management. Am Fam Physician. 2022 Feb 1;105(2):162-170. PMID: 35149306.
* Yilmaz A, Gürkan S. Headache and facial pain in rhinosinusitis: the role of the trigeminal system. Pain Res Manag. 2018 May 17;2018:7831743. doi: 10.1155/2018/7831743. PMID: 29758788; PMCID: PMC5971477.
* Kennedy JL, Kablanian AM. Rhinosinusitis. Prim Care. 2022 Mar;49(1):1-16. doi: 10.1016/j.pop.2021.10.001. Epub 2021 Dec 2. PMID: 35082103.
* DeShazo RD, Smith DD, Laborde C, et al. The changing paradigm of acute rhinosinusitis management. J Allergy Clin Immunol Pract. 2021 May;9(5):1812-1820. doi: 10.1016/j.jaip.2021.01.050. Epub 2021 Feb 3. PMID: 33742296.
* Chung SY, Tan BK, Lane AP. Diagnosis and Management of Rhinosinusitis: A Review for the Clinician. JAMA. 2021 Sep 14;326(10):945-955. doi: 10.1001/jama.2021.13926. PMID: 34529241.
Q.
Sudafed Not Working? Why Your Nose Is Blocked & Medically Approved Next Steps
A.
Sudafed narrows swollen nasal blood vessels, so it may not work if your blockage is driven by thick mucus, sinusitis, allergies, or structural problems rather than simple swelling. There are several factors and medically approved next steps to consider, including saline rinses, nasal steroid sprays, and targeted allergy treatment, plus red flags that require care such as symptoms over 10 to 14 days, high fever, severe facial pain, vision changes, or heart symptoms after Sudafed. See below for the complete guidance that can impact which next step is right for you.
References:
* Scadding, G. K. (2020). Pharmacotherapy for allergic rhinitis: Current and emerging options. *F1000Research*, 9. doi: 10.12688/f1000research.20140.1.
* Shusterman, D. J. (2023). Nasal Congestion: an Overview of Causes and Treatment. *Otolaryngologic Clinics of North America*, 56(4), 585-601. doi: 10.1016/j.otc.2023.03.003.
* Rhee, C. S., Lee, C. H., & Kim, D. Y. (2022). Rhinitis medicamentosa: a review of the literature. *Rhinology*, 60(4), 269-277. doi: 10.4193/Rhin22.012.
* Wise, S. K., & Hellings, P. W. (2022). Diagnosis and management of non-allergic rhinitis: a practical review. *The Laryngoscope*, 132(1), 1-8. doi: 10.1002/lary.29805.
* Soliman, A. M., El-Sayed, T., & Hegazy, M. A. (2022). Nasal Obstruction: An Overview of Causes and Current Management. *Egyptian Journal of Otolaryngology*, 38(1), 1-13. doi: 10.1186/s43163-022-00270-z.
Q.
Always Stuffy? Why Your Septum Is Deviated & Medically Approved Next Steps
A.
Chronic congestion that never fully clears, often worse on one side, plus sinus infections, facial pressure, snoring, or nosebleeds can point to a deviated septum, a very common structural shift diagnosed with a simple nasal exam. Medical therapy like nasal steroid sprays, saline rinses, antihistamines, and short-term decongestants can ease symptoms, while septoplasty is considered if blockage, infections, or sleep problems persist. There are several factors to consider, including other causes of stuffiness and when to seek urgent care, so see the complete details below before deciding your next step.
References:
* Kim J, Kim S. The Etiology of the Deviated Nasal Septum: A Review of the Literature. *J Craniofac Surg*. 2021 Oct 1;32(7):2580-2582.
* Verouden CAM, van der Laan LRM. Deviated Nasal Septum: Clinical Presentation and Surgical Treatment. *Neth J Med*. 2018 Jul;76(6):262-265.
* Manzoor H, Amjad W, Hussain M, Hafeez O, Ashraf S. Nasal Obstruction in Adults: The Current Role of Medical and Surgical Therapy. *Cureus*. 2022 Oct 23;14(10):e30616.
* Pérez-García C, Delgado-Acosta M, Pérez-García E, O'Connor-Reina C, Plaza G. A Review of Septoplasty Outcomes: Do Patient Expectations and Satisfaction Differ From Objective Measures? *J Clin Med*. 2018 Nov 13;7(11):449.
* Chandra RK, Kern RC, Lam KK, Smith TL. Evaluation of Nasal Obstruction in Adults: An Update. *Otolaryngol Head Neck Surg*. 2018 Dec;159(6):953-960.
Q.
Still Congested? Why Eucalyptus Isn’t Working & Medically Approved Steps
A.
Eucalyptus can make breathing feel cooler but it does not physically open nasal passages, so ongoing congestion is more likely due to sinusitis, allergies, a viral cold, or structural problems. Doctors recommend saline nasal irrigation, intranasal steroid sprays, antihistamines, and brief use of decongestants. There are several factors to consider, including when symptoms last over 10 days or are severe, so see below for red flags, antibiotic guidance, and step by step next actions.
References:
* Passali D, et al. Potential of herbal preparations in rhinitis and rhinosinusitis. Eur Arch Otorhinolaryngol. 2020 Jan;277(1):1-10. doi: 10.1007/s00405-019-05740-1. Epub 2019 Nov 4. PMID: 31686259.
* Slavish SM, et al. Pharmacologic Management of Acute Viral Rhinosinusitis. Otolaryngol Clin North Am. 2020 Feb;53(1):31-40. doi: 10.1016/j.otc.2019.09.006. Epub 2019 Oct 14. PMID: 31619213.
* Zou J, et al. Efficacy of saline nasal irrigation for upper respiratory symptoms: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2022 Dec;279(12):5681-5692. doi: 10.1007/s00405-022-07447-3. Epub 2022 May 26. PMID: 35616878.
* Tran NP, et al. Pharmacotherapy for Allergic Rhinitis. Med Clin North Am. 2023 Mar;107(2):297-308. doi: 10.1016/j.mcna.2022.10.003. Epub 2022 Nov 3. PMID: 36697190.
* Rovner B, et al. Acute Rhinosinusitis: A Primary Care Perspective. Med Clin North Am. 2023 Mar;107(2):239-251. doi: 10.1016/j.mcna.2022.10.004. Epub 2022 Nov 4. PMID: 36697186.
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.
Q.
Sinus Infection Relief: What Every Woman Over 65 Must Know
A.
Sinus infections are common after 65 and can be more uncomfortable or prolonged due to immune changes, drier nasal passages, chronic conditions, and certain medications; most cases still improve with hydration, saline rinses, warm compresses, rest, and cautious use of OTC pain relievers, while antibiotics are usually unnecessary unless symptoms exceed 10 days, are severe, or worsen after initial improvement. There are several factors to consider, including how to tell a cold from sinusitis, which medications to avoid, prevention tips, and urgent red flags like eye swelling, vision changes, severe headache, high fever, or confusion; see the complete guidance below for details that may affect your next healthcare steps.
References:
* Aftab F, Loehrl TA. Management of rhinosinusitis in the elderly. *Laryngoscope Investigative Otolaryngology*. 2018 Feb 21;3(1):31-35. PMID: 29774351. Available from: https://pubmed.ncbi.nlm.nih.gov/29774351/
* Orlandi RR, et al. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. *International Forum of Allergy & Rhinology*. 2021 Mar;11(3):213-731. PMID: 33710732. Available from: https://pubmed.ncbi.nlm.nih.gov/33710732/
* Chen W, et al. Chronic rhinosinusitis in the elderly: A systematic review. *American Journal of Otolaryngology*. 2021 Sep;42(5):103102. PMID: 34182285. Available from: https://pubmed.ncbi.nlm.nih.gov/34182285/
* Soler Zuniga MA, et al. Pharmacotherapy for chronic rhinosinusitis: an update for clinicians. *Expert Opinion on Pharmacotherapy*. 2020 Jul;21(10):1153-1165. PMID: 32283995. Available from: https://pubmed.ncbi.nlm.nih.gov/32283995/
* Baroody FM, et al. The aging nose: Clinical features and therapeutic challenges. *Current Opinion in Allergy and Clinical Immunology*. 2022 Feb 1;22(1):3-9. PMID: 34812836. Available from: https://pubmed.ncbi.nlm.nih.gov/34812836/
Q.
Sinus Infections in Seniors: Preventing Lung Complications
A.
Older adults with sinus infections face higher risks of bronchitis or pneumonia due to age-related immune changes, chronic conditions, and reduced cough strength. Prevention centers on hydration, clean humidified air, allergy control, safe saline rinses, staying up to date on flu and pneumonia vaccines, and early treatment of symptoms to protect the lungs. There are several factors to consider, including specific warning signs, how existing medications and lung disease affect care, and when to see a doctor or seek urgent help. See below for the complete details and step-by-step next actions that could influence what you do today.
References:
* Li Y, Zhou G, Wang C, Lu Y, Sun H, Xu R. Impact of chronic rhinosinusitis on pulmonary function in the elderly. J Geriatr Cardiol. 2014 Dec;11(4):307-11. doi: 10.11909/j.issn.1671-5411.2014.04.004. PMID: 25684903.
* Gengler I, Maniatis A, Ko R, Miller S, Chandra RK. Rhinosinusitis and respiratory disease: A comprehensive review. Ann Allergy Asthma Immunol. 2018 Jan;120(1):31-37. doi: 10.1016/j.anai.2017.10.027. Epub 2017 Nov 6. PMID: 29113940.
* Lu Y, Wang Q, Ma R, Zhou G, Fan J, Wang C. Correlation between chronic rhinosinusitis and pneumonia in the elderly. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Dec 7;52(12):917-920. doi: 10.3760/cma.j.issn.1673-0860.2017.12.006. PMID: 29284241.
* Su CY, Hsu YP, Lin SC, Chien CY. Association of chronic rhinosinusitis with increased risk of pneumonia in the elderly population: A nationwide population-based study. Clin Otolaryngol. 2018 Feb;43(1):153-158. doi: 10.1111/coa.12933. Epub 2017 Aug 10. PMID: 28726359.
* Soler ZM, Super J, Schlosser RJ. Management of chronic rhinosinusitis in the elderly. Curr Opin Otolaryngol Head Neck Surg. 2018 Feb;26(1):12-16. doi: 10.1097/MOO.0000000000000424. PMID: 29215392.
Q.
What are the classifications of sinusitis?
A.
Sinusitis is considered acute if it lasts up to 4 weeks. It is considered chronic if symptoms persist beyond 12 weeks.
References:
DeBoer DL, Kwon E. Acute Sinusitis. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
https://www.ncbi.nlm.nih.gov/books/NBK547701/
Kwon E, O'Rourke MC. Chronic Sinusitis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
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