Sinuses are air-filled spaces within the facial bones, connected to the nose by narrow passages, like a series of caves underneath the surface of the face. Their main function is to produce mucus, which keeps the nasal passages healthy, but they also serve to reduce the weight of the skull.

Sometimes the sinuses can fill up with excessive mucus and get blocked, like with a common cold. If a secondary infection sets in this can cause facial pain or pressure, loss of smell, and production of thickened mucus, which in turn can lead to post-nasal drip and cough. This is called acute sinusitis, and usually lasts one to two weeks In most cases this will resolve without antibiotics.

Acute Sinusitis can be treated with simple painkillers like paracetamol or ibuprofen. Over-the counter decongestants (tablet or nasal spray) and sinus rinses with saline and bicarbonate solution  are available from pharmacies eg NeilMed, or can be made at home. In severe cases antibiotics and oral steroids may be prescribed, but these can have side effects so medical assessment is essential.

Some people are prone to getting repeated attacks of sinusitis, either because they have narrow nasal spaces, allergic diseases like hay-fever which cause persistent inflammation of the nasal passages, or even polyps which are benign growths from the nasal lining which block the sinuses.

Sometimes Acute Sinusitis can lead on to Chronic Sinusitis. This is defined as nasal blockage, obstruction or congestion, facial pain or pressure, anterior (front) or posterior (back) nasal discharge and reduction or loss of sense of smell lasting at least twelve weeks.

Chronic Sinusitis is usually treated with sinus rinses, regular steroid nasal sprays which reduce inflammation, such as Alanase or Flixonase, antibiotics and symptomatic treatments like painkillers as required. Decongestants are not appropriate for longer term use as they can cause tolerance and rebound symptoms when taken for more than five days continuously.

People who do not respond to these treatments sometimes require surgery to remove polyps or widen the nasal passages and clear out the sinuses, but surgical availability  is very limited in the New Zealand public system and can be out of reach for people who do not have private medical insurance.

Dr Joanna Joseph
GP and P3 Investigator, Wellington Unit