Recurrent sinus infections: why they keep coming back and what to do

The NHS describes sinusitis as swelling of the sinuses, usually caused by an infection. It is common, often follows a cold or flu and usually clears on its own within 4 weeks. The sinuses are small, empty spaces behind the cheekbones and forehead that connect to the inside of the nose; when their lining swells, mucus does not drain properly and you feel blocked up.

NICE Clinical Knowledge Summaries separates the patterns. Acute sinusitis is defined by symptoms that completely resolve within 12 weeks and is subdivided into acute viral (less than 10 days), acute post-viral (worsening after 5 days or persisting beyond 10 days but under 12 weeks) and acute bacterial, a secondary bacterial infection that develops in about 0.5 to 2 percent of people with acute viral sinusitis. Chronic sinusitis is defined by symptoms lasting 12 weeks or longer.

So when people say they keep getting sinus infections, there are really two different stories. One is a series of separate acute episodes with clear recovery in between. The other is a continuous, lower-grade problem that never fully settles. The second pattern is more likely to need investigation and a different kind of treatment.

The NHS lists the main symptoms as pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked or runny nose, a reduced sense of smell, green or yellow mucus and a high temperature. Other symptoms can include headache, toothache, bad breath, a cough, pressure in the ears, snoring and sounding nasal when you speak.

NICE CKS describes the diagnostic symptoms in adults as nasal blockage, obstruction or congestion, or nasal discharge, together with facial pain or pressure and/or reduced or lost sense of smell. In children the diagnostic symptoms are nasal blockage with discoloured discharge and/or cough. Chronic sinusitis requires a combination of symptoms and objective evidence of inflammation in the nose and sinuses.

The NHS and NICE sources point to several themes. First, because most acute sinusitis follows a viral cold, a run of colds can look like a run of sinus infections. Second, allergy: the NHS advises avoiding things that trigger allergies and lists antihistamines when allergy is causing symptoms, and NICE CKS includes managing associated disorders such as allergic rhinitis or asthma and avoiding allergic triggers in chronic sinusitis. Third, smoking: the NHS lists not smoking among the self-care measures.

There can also be structural reasons, such as blocked drainage pathways in the nose, which is why the NHS says ENT specialists may recommend surgery for some people. NICE CKS notes that referral should be considered when the diagnosis is in doubt, when symptoms are recurrent or refractory to antibiotic treatment or when they significantly affect quality of life.

A weakened immune system can also play a part. The NHS lists having a weakened immune system, for example because of chemotherapy, as a reason to ask for an urgent GP appointment or NHS 111 advice when you have sinusitis symptoms.

The NHS says you can usually treat mild sinusitis yourself, and the same measures are sensible between attacks of recurrent sinusitis.

• Get plenty of rest and drink plenty of fluids.

• Take painkillers such as paracetamol or ibuprofen (the NHS says not to give aspirin to children under 16).

• Avoid things that trigger your allergies.

• Do not smoke.

• Clean your nose with a salt water solution; the NHS gives a homemade recipe using cooled boiled water, salt and bicarbonate of soda, repeated up to 3 times a day with a fresh solution each time.

• If you have a high temperature or feel too unwell for normal activities, stay at home and avoid contact with other people until you feel better.

A pharmacist can give the same treatments as a GP for sinusitis, according to the NHS, for adults and for children aged 12 or over. Medicines that may be prescribed include steroid nasal sprays or drops, which might be needed for a few months, and antihistamines if an allergy is the cause.

Antibiotics are rarely needed. The NHS says this is not common as sinusitis is usually caused by a virus, and NICE guideline NG79 on acute sinusitis aims to limit antibiotic use and reduce antimicrobial resistance, noting that withholding antibiotics rarely leads to complications. NICE CKS adds that for chronic sinusitis a high-dose nasal corticosteroid should be considered for adults and children aged 12 years and over with persistent symptoms.

The NHS advises seeing a GP if you or a child have sinusitis symptoms and you do not get better after 7 days of treatment from a pharmacy or GP, you do not get better after 3 weeks of treating symptoms yourself, you keep getting sinusitis, or the child is aged 11 or younger.

It advises asking for an urgent GP appointment or getting help from NHS 111 if you are very unwell, if painkillers do not help or symptoms get worse, or if you have a weakened immune system. NICE CKS lists urgent hospital admission for severe systemic infection, signs of sepsis, complications such as orbital or intracranial involvement and reduced consciousness. In practical terms, swelling or redness around an eye, double vision, a severe headache with stiff neck or confusion should be treated as an emergency via 999 or A&E.

The NHS says a GP may refer you to an ENT specialist if you still have sinusitis after 3 months of treatment, keep getting sinusitis or only have symptoms on one side of the face. An ENT specialist may recommend surgery for some people.

Surgery for chronic sinusitis is called functional endoscopic sinus surgery (FESS). The NHS says it is carried out under general anaesthetic and that the surgeon can widen the sinuses either by removing some of the blocked tissue or by inflating a tiny balloon in the blocked sinuses and then removing it.

ENT assessment commonly includes looking inside the nose with a thin camera and sometimes a CT scan of the sinuses, which helps separate chronic sinusitis, nasal polyps and a deviated septum from other causes of facial pain and blockage. Your specialist will explain which test applies to you.

On the NHS, a pharmacist or GP is the first step and ENT referral follows if the NHS criteria above are met. Some people see a private ENT consultant for faster access to nasal endoscopy or CT; it is reasonable to ask what the procedure is expected to show and whether nasal steroid spray and allergy control have been tried first, because these are the steps the NHS and NICE place before surgery.