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), fexofenadine (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

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 ointment to the nasal openings to protect them from irritation (cleanse the skin first).
3. For a Stuffy Nose - Use Nasal Washes:

   • Introduction: Saline (salt water) nasal irrigation is an effective and simple home remedy for treating cold symptoms and other conditions involving the nasal and sinus passages. Nasal irrigation consists of pouring, spraying, or squirting salt water into the nose and then letting it run back out.

   • How it Helps:The salt water rinses out excess mucus, washes out any irritants (dust, allergens) that might be present, and moisturizes the nasal cavity.

   • Methods: There are several ways to perform nasal irrigation. You can use a saline nasal spray bottle (available over-the-counter), a rubber ear syringe, a medical syringe without the needle, or a Neti Pot.

   • Step-by-Step Instructions:

     • Step 1: Lean over sink

     • Step 2: Gently squirt or spray warm salt water into one of your nostrils.

     • Step 3: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water it will not hurt you.

     • Step 4: Blow your nose to clean out the water and mucus.

     • Step 5: Repeat steps 1-4 for the other nostril. You can do this a couple times a day if it seems to help you.

   • How to Make Saline (Salt Water) Nasal Wash: Add 1/2 tsp of table salt to 1 cup (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. Pain Medicines:
   • For pain relief, take acetaminophen, ibuprofen or naproxen.
   • Acetaminophen (e.g., Tylenol):
     • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.
     • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.
     • The most you should take each day is 3,000 mg.

   • Ibuprofen (e.g., Motrin, Advil):

     • Take 400 mg by mouth every 6 hours

     • Another choice is to take or 600 mg by mouth every 8 hours.

     • Use the lowest amount that makes your pain feel better.

   • Naproxen (e.g., Aleve)

     • Take 250-500 mg by mouth every 12 hours.

     • Use the lowest amount that makes your pain feel better.

   • Extra Notes

     • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An overdose can hurt the liver.

     • Before taking any medicine, read all the instructions on the package.

8. 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.
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.

Neti Pot for Sinus Symptoms

• The Neti Pot is a small ceramic or plastic pot with a narrow spout. It looks like a small tea pot. Two manufacturers of the Neti Pot are the Himalayan Institute in Pennsylvania and SinuCleanse in Wisconsin.
• How it Helps: The neti pot performs nasal washing (also called nasal irrigation or "jala neti"). The salt water rinses out excess mucus, washes out any irritants (dust, allergens) that might be present, and moisturizes the nasal cavity.
• Indications: The neti pot is widely used as a home remedy to relieve conditions such as colds, sinus infections, and hay fever (nasal allergies).
• Adverse reactions: None. Though, not everyone likes the sensation of pouring water into their nose.
• YouTube Instructional Video: There are instructional videos on how to use a neti pot both on manufacturers websites and also on YouTube.

Neti Pot STEP-BY-STEP Instructions:

• Step 1: Follow the directions on the salt package to make warm salt walter.
• Step 2: Lean forward and turn your head to one side over the sink. Keep your forehead slightly higher than your chin.
• Step 3: Gently insert the spout of the neti pot into the higher nostril. Put it far enough so that it forms a comfortable seal.
• Step 4: Raise the Neti Pot gradually so the salt water flows in through your higher nostril and out of the lower nostril. Breathe through your mouth.
• Step 5: When the Neti Pot is empty, blow your nose to clean out the water and mucus.
• Step 6: Some of the water may run into the back of your throat. Spit this out. If you swallow the salt water it will not hurt you.
• Step 7: Refill the Neti Pot and repeat on the other side. Again, exhale vigorously to clear the nasal passages.

How to Make Saline (Salt Water) Nasal Wash:

• You can make your own saline nasal wash.  Add 1/2 tsp of table salt to 1 cup (8 oz; 240 ml) of warm water.

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