Sinusitis in adults: what to do and when to see a doctor

Sinusitis is an inflammation of the maxillary sinuses that occurs due to swelling of the mucosa and impaired mucus or pus drainage. A person may experience pain in the cheeks and nose, congestion, head pressure, purulent discharge, and general malaise. Correct treatment depends on the cause and form of sinusitis, so it is important to consult an ENT doctor in time.

How sinusitis develops and which symptoms require attention

Sinusitis develops when the sinuses fail to ventilate and drain properly. Mucosal swelling, viral infection, allergy, anatomical features, or bacterial involvement leads to the accumulation of secretions. This causes cheek pain, pressure under the eyes, headache, difficulty breathing through the nose, and reduced sense of smell.

Purulent discharge, high fever, or sudden worsening of condition indicate a bacterial process that requires medical attention.

How sinusitis is diagnosed

Diagnosis includes an ENT examination, which evaluates the mucosa, type of discharge, swelling, and nasal passage patency. Endoscopy, X-ray, or CT scans of the sinuses, blood tests, and if necessary — bacteriological culture of discharge — may be used to clarify the diagnosis.

Comprehensive diagnostics help determine the form of sinusitis — viral, bacterial, allergic, or chronic — and select effective therapy.

Treatment methods for adult sinusitis

Treatment always starts with conservative measures. Invasive methods are applied only when traditional therapy fails or complications arise.

Conservative treatment: first stage of therapy

The main goal is to reduce swelling, restore sinus drainage, and eliminate inflammation.

1. Reducing swelling and restoring breathing
   Decongestant sprays may be used for short-term relief to reduce mucosal swelling. It is important not to use them for more than 5 days to avoid medication-induced rhinitis.
   For prolonged or allergic processes, the ENT may prescribe intranasal corticosteroids — hormonal sprays that safely reduce inflammation and improve sinus ventilation.
2. Antibiotics for bacterial sinusitis
   Antibiotics are not always indicated. They are prescribed only for bacterial sinusitis with purulent discharge, high fever, severe pain, or changes in tests. Amoxicillin-based drugs or cephalosporins are most commonly used. It is important that the antibiotic is chosen by a doctor, not by the patient independently.
3. Nasal irrigation
   Saline solutions help moisturize the mucosa and remove excess secretions. In medical centers, irrigation by the Proetz method (“cuckoo”) is used, which effectively cleanses the sinuses and reduces inflammation symptoms.
4. Antihistamines and anti-inflammatory agents
   For allergic sinusitis, antihistamines are used to reduce swelling and discharge. Pain and fever are treated with anti-inflammatory drugs in safe doses.
5. Physiotherapy
   During the stage of reducing acute inflammation, the doctor may recommend laser therapy, ultrasound, or other physiotherapy procedures to improve microcirculation and accelerate recovery.

Invasive methods: when they are necessary

If conservative treatment is ineffective or pus accumulates in the sinuses, more intensive methods are applied.

1. Sinus puncture
   This procedure removes pus, rinses the sinus with antiseptic, and relieves internal pressure. It is performed under local anesthesia and provides quick symptom relief.
2. Endoscopic sinus surgery
   A modern minimally invasive surgical method indicated for chronic sinusitis, polyps, or significant drainage obstruction. Surgery restores normal nasal breathing and reduces the risk of repeated inflammation.
3. Outpatient or inpatient treatment
   Mild to moderate forms are treated on an outpatient basis under ENT supervision.
   Severe cases, pronounced intoxication, high fever, complications, or the need for invasive procedures may require hospitalization.

When to see a doctor immediately

Although mild forms of sinusitis can be treated outpatient, certain symptoms indicate a complicated or aggressive course. In such cases, delaying is dangerous — the inflammatory process can spread to neighboring structures and require urgent ENT intervention.

Urgent help is needed if:

• sinus pain sharply increases;

• temperature remains above 38°C;

• swelling of eyelids or face appears;

• purulent discharge with a foul odor occurs;

• severe headaches or vision problems occur;

• treatment does not relieve symptoms within 48–72 hours.

These symptoms may indicate complications that require medical intervention.

What not to do with sinusitis

During sinusitis, it is important to avoid actions that may worsen inflammation, increase complication risk, or delay recovery.

• Starting antibiotics on your own
  Antibiotics only work for bacterial sinusitis. Incorrect drug selection or duration can lead to bacterial resistance and complicate treatment.

• Applying heat to the nose if pus is suspected
  Heat increases blood flow and may spread the infection. In purulent sinusitis, warming can worsen the condition and cause complications.

• Prolonged use of decongestant drops
  These help relieve swelling temporarily but can cause medication rhinitis, dependence, and worsened breathing if used more than 5 days.

• Self-treatment without ENT consultation
  Sinusitis has different forms — viral, bacterial, allergic. Without examination and diagnosis, it is difficult to determine the correct treatment, increasing the risk of chronic disease.

Incorrect treatment can worsen the condition and lead to chronic sinusitis.

Conclusion

Sinusitis requires careful management and properly selected therapy. Most cases begin with conservative treatment — reducing swelling, irrigation, anti-inflammatory agents, and antibiotics if necessary. If inflammation persists or complications occur, invasive methods are applied to quickly restore sinus drainage. It is important not to self-medicate: only an ENT doctor can determine the form of sinusitis and prescribe an effective and safe treatment plan. Seeking medical help early significantly accelerates recovery and reduces complication risks.