Sinus Pain and Congestion

Symptoms

DEFINITION

• Sensation of fullness, pressure and pain on the face overlying a sinus cavity (e.g., above the eyebrow, behind the eye, around the eye, or over the cheekbone)
• Pain or pressure may be bilateral (on both sides of face), but more often is unilateral (on one side of the face)
• Associated symptoms are a blocked nose, nasal discharge, and/or postnasal drip

Causes of Sinus Pain and Congestion

• Sinus opening(s) becomes blocked by an infection or nasal allergy.
• Viral Sinusitis: Sinusitis can occur as part of a viral upper respiratory infection (e.g., rhinosinusitis or the "common cold"). The viral infection and inflammation of the lining of the nose can also affect the lining of all the paranasal sinuses. 
• Bacterial Sinusitis: Approximately 1-2% of viral sinusitis cases progress to become bacterial sinusitis; one or more of the sinuses affected with viral sinusitis becomes secondarily infected with bacteria. Distinguishing symptoms are symptoms lasting longer than 10 days, increasing sinus pain, and the return of fever.
• Allergic Sinusitis: When an allergen (e.g., pollen) activates the lining of the nose (allergic rhinitis), sinus congestion may occur due to swelling of the sinus passage openings (ostia). Symptoms suggesting an allergic etiology include sneezing, itchy nose, clear nasal discharge, and itchy watery eyes. 
• Rhinitis Medicamentosa: Prolonged continuous use (> 5 days) of decongestant nose drops can lead to "rebound" congestion where the nose becomes even more stuffy.

Treatment of Sinusitis

• Viral Sinusitis: Saline nasal washes. Antibiotics are not helpful.
• Bacterial Sinusitis: Saline nasal washes. Oral antibiotics may be needed.
• Allergic Sinusitis (Hay Fever): Oral antihistamines can relieve mild to moderate symptoms. Examples include diphenhydramine (Benadryl), loratadine (Claritin, Alavert), fexodenadine (Allegra), and cetirizine (Zyrtec). Nasal corticosteroid sprays are probably the most effective treatment for allergic rhinitis. Saline nasal washes are also helpful.

See More Appropriate Topic (instead of this one) If

• You have a common cold, see COLDS
• COUGH is the main symptom
• SORE THROAT is the main symptom

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Difficulty breathing, and is not from a blocked or stuffy nose
• Severe pain
• Fever of 103° F (39.4° C) or higher
• Fever of 100.5° F (38.1° C) or higher and you
  • Are over 60 years of age OR
  • Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
  • Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery)
• Redness or swelling on the cheek, forehead or around the eye

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Sinus pain (not just congestion) and fever
• Sinus pain persists after using nasal washes and pain medications for 24 hours
• Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Fever returns after being gone for more than 24 hours
• Nasal discharge present for more than 10 days
• Sinus congestion and fullness persist longer than 1 week

Self Care at Home If

• Sinus congestion as part of a cold and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR MILD SINUS PAIN AND CONGESTION

1. Reassurance:
   • Sinus congestion is a normal part of a cold.
   • Usually home treatment with nasal washes can prevent an actual bacterial sinus infection.
   • Antibiotics are not helpful for the sinus congestion that occurs with colds.
2. For a Runny Nose With Profuse Discharge: Blow the Nose.
   • Nasal mucus and discharge helps to wash viruses and bacteria out of the nose and sinuses.
   • Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).
3. For a Blocked Nose - Use Nasal Washes:
   • Step 1: Put 2-3 drops of warm water or saline in each nostril (Reason: To loosen up the dried mucus)
   • Step 2: Blow each nostril separately (Pinch one nostril shut while blowing your nose then repeat while pinching the other nostril).
   • Step 3. Repeat nose drops and blowing until discharge is clear.
   • Notes: Use a medicine dropper so you have control over how many drops you put in the nose. If you don't have one, you can use a dropper that came with ear drops, eye drops, or another medicine. You can purchase a dropper at a pharmacy. Do nasal washes four times a day or whenever you can't breathe through your nose. Another option instead of nasal washes is to take a hot shower. Breathe in the moist air through the nose and then blow each nostril.
   • How to Make Saline Nose Drops: Add 1/2 tsp of table salt to 8 oz (240 ml) of warm water.
4. Hydration: Drink plenty of liquids (6-8 glasses of water daily). If the air in your home is dry, use a cool mist humidifier
5. Cold Medicines: Most "cold" medicines are not helpful. They cannot remove dried mucus from the nose. Antihistamines are only helpful if you also have nasal allergies. Antibiotics are not helpful unless you develop an ear or sinus infection.
6. Nasal Decongestants for a Very Stuffy Nose:
   • If you have a very stuffy nose, nasal decongestant medicines can shrink the swollen nasal mucosa and allow for easier breathing. If you have a very runny nose, these medicines can reduce the amount of drainage. They may be taken as pills by mouth or as a nasal spray.
   • Most people do NOT need to use these medicines. If your nose feels blocked, you should try using nasal washes first.
   • Pseudoephedrine (Sudafed) is available OTC in pill form. Typical adult dosage is two 30 mg tablets every 6 hours. Read package instructions.
   • Phenylephrine (Sudafed PE) is available OTC in pill form. Typical adult dosage is two 30 mg tablets every 6 hours. Read package instructions.
   • Oxymetazoline Nose Drops (Afrin) are available OTC. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.
   • Phenylephrine Nose Drops (Neo-Synephrine) are available OTC. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time. Read package instructions.
7. Expected Course:
   • Sinus congestion from viral upper respiratory infections (colds) usually lasts 5-10 days.
   • Occasionally a cold can worsen and turn into bacterial sinusitis. Clues to this are sinus symptoms lasting longer than 10 days, fever lasting longer than 3 days and worsening pain. Bacterial sinusitis may need antibiotic treatment.
8. Pain and Fever Medication:
   • For pain and fever relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
9. Call Your Doctor If:
   • Severe pain persists longer than 2 hours after pain medicine
   • Sinus pain persists longer than 1 day after starting treatment using nasal washes
   • Sinus congestion (fullness) persists longer than 10 days
   • Fever lasts longer than 3 days
   • You become worse.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.