Acute Sinusitis — most cases resolve; some require more.

Acute sinusitis is symptomatic inflammation of the paranasal sinuses that typically lasts up to four weeks. Most episodes begin after a viral upper respiratory infection and improve within 7–10 days. Symptoms that persist beyond 10 days or follow a pattern of initial improvement and then worsening suggest possible bacterial infection. Final diagnosis and management require clinical assessment and, when helpful, office nasal endoscopy.

Distinguishing viral from bacterial sinusitis is based on symptom trajectory rather than a single test. Viral illness usually improves by day 7–10; bacterial infection is more likely with symptoms lasting longer than 10 days, a severe onset (high fever with purulent drainage), or a double‑worsening pattern after initial improvement. Nasal endoscopy can show focal purulence or an occluded ostium and often changes management. In-person evaluation is necessary before starting antibiotics.

Antibiotics are reserved for patients who meet guideline-based criteria: severe symptoms at onset, symptoms lasting longer than 10 days without improvement, or a double‑worsening pattern. Recent antibiotic exposure, penicillin allergy, and prior culture results also inform agent selection. In many uncomplicated acute cases, symptomatic therapies and topical measures are appropriate. Decisions about antibiotics should follow in-person assessment and stewardship principles.

The core office rhinologic assessment is a focused history and nasal endoscopy to inspect the ostiomeatal complex, detect purulence, and evaluate mucosal edema or polyps. Endoscopic findings frequently change management by localizing disease. CT imaging is reserved for complicated presentations, failure of medical therapy, or procedural planning. Cultures taken endoscopically are used selectively for refractory or severe infections needing targeted therapy.

Yes. Allergic inflammation causes mucosal swelling that narrows sinus ostia and impairs ventilation and drainage. Structural issues such as a deviated septum, turbinate hypertrophy, or obstructing polyps create focal mechanical blockage. Evaluation includes allergy history, targeted endoscopy, and selective testing. Treating both inflammatory drivers and correctable structural contributors reduces the risk of recurrence.

See a sinus specialist when symptoms are severe, prolonged beyond 10 days, recurrent, or not responding to guideline-based medical therapy. Early referral is appropriate for visual symptoms, suspected complications, or when structural contributors are suspected. A rhinologist can perform office nasal endoscopy and plan selective imaging or procedural options. In-person specialist assessment clarifies candidacy for interventions such as balloon sinuplasty or FESS.

Nasal endoscopy provides direct visualization of the middle meatus and ostiomeatal complex, allowing identification of localized purulence, mucosal edema, polyps, or obstructing anatomy. These findings often alter treatment decisions by pinpointing where drainage is impaired. Endoscopy can also guide culture collection in refractory cases and refine procedural planning. It is performed in office under topical anesthesia and typically adds minimal time to the visit.

Procedural treatment is considered when recurrent or refractory episodes are driven by identifiable structural obstruction or when medical therapy fails despite adherence. Balloon sinuplasty is best for isolated ostial narrowing without significant polyp disease or bony pathology. FESS is indicated for more extensive disease, polyp burden, or when adjunctive procedures like septoplasty or turbinate reduction are required. Final candidacy requires endoscopic evaluation and, when useful, CT imaging.

Recovery varies by procedure but typically includes brief nasal congestion, crusting, and intermittent bloody drainage for several days to a few weeks. Follow-up visits involve endoscopic cleaning and topical irrigation to promote mucosal healing. Most patients resume light activity within 24–72 hours, with gradual return to normal exertion over one to two weeks depending on the procedure. Specific postoperative instructions and timelines are reviewed during in-person consultation.

Reducing recurrence requires addressing both inflammatory and structural drivers. Measures include regular saline irrigations, appropriate topical intranasal steroids for inflammatory disease, allergy management when indicated, smoking cessation, and treatment of obstructing anatomy if present. Optimizing nasal hygiene and following postoperative care instructions after any procedure also help. Discuss a personalized prevention plan during specialist evaluation.

Urgent evaluation is required for visual changes, new or worsening eye pain, eyelid swelling, double vision, neurologic symptoms, or severe headache with fever. These signs may indicate orbital or intracranial complications and require immediate imaging and hospital‑based management. Rapidly progressive systemic symptoms also warrant prompt attention. For routine sinus symptoms without these red flags, schedule timely outpatient specialist care.

CT imaging is not routinely required for a typical uncomplicated acute sinus infection expected to resolve with medical therapy. CT is reserved for complicated cases, atypical presentations, recurrent disease, or when planning procedures. Endoscopy often guides the need for imaging by localizing disease. Imaging decisions are made during in-person evaluation to minimize unnecessary radiation.