Sinus Pain and Congestion

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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

General Information

• Sinus pain and congestion: The opening from the nose into the sinus can become blocked by an infection or nasal allergy. The symptoms of sinus pain and congestion (pressure) result from trapped fluid in the sinus.
• Sinusitis: Sometimes fluid trapped in sinuses can become infected with bacteria. When this occurs it is called bacterial sinusitis.

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

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Difficulty breathing, and is not from a blocked or stuffy nose
• Severe pain
• Fever of 103 F (39.4 C) or higher
• Fever of 100.5 F (38.1 C) or higher and you  
  • Are over 60 years of age OR
  • Have diabetes mellitus or a weakened immune system (e.g. HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
  • Are bedridden (e.g. nursing home patient, stroke, chronic illness, recovering from surgery)
• Redness or swelling on the cheek, forehead or around the eye

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

• You think you need to be seen
• Lots of yellow or green nasal discharge present for more than 3 days, with sinus pain
• Sinus pain persists after using nasal washes and pain medications for 24 hours
• Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Fever returns after being gone for more than 24 hours
• Nasal discharge present for more than 10 days
• Sinus congestion and fullness persist longer than 1 week

Self Care at Home If

• Sinus congestion as part of a cold and you don't think you need to be seen

HOME CARE ADVICE FOR MILD SINUS PAIN AND CONGESTION

1. Reassurance: Sinus congestion is normally part of a cold. Usually home treatment can prevent a true sinus infection.
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 jelly to the nasal openings to protect them from irritation (cleanse the skin first).
3. For a Blocked Nose - Use Nasal Washes:
   • Use warm water or saline nose drops to loosen up the dried mucus, followed by blowing each nostril separately (pinch one nostril shut while blowing your nose then repeat while pinching the other nostril). Instill 2-3 drops of warm water or saline in each nostril. Blow your nose again and repeat nose drops and blowing until discharge is clear. Repeat this process at least four times a day or whenever you can't breathe through the nose.
   • Saline nose drops - add ½ tsp of table salt to 1 cup (8 oz) of warm water.
   • Other option: warm shower.
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 can't 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. Decongestant Nose Drops: If you think you need a medicine for stuffy nose, try a nasal decongestant. Use only if the sinus is still blocked after nasal washes.
   • Decongestant nose drops (e.g. phenylephrine/Neo-Synephrine) are available over-the-counter.
   • Do not take this medication if you have high blood pressure, heart disease or prostate enlargement.
   • Do not use this medication for more than 3 days (Reason: rebound nasal congestion)
   • Read and follow the package instructions carefully
7. Pain and Fever Medication: For pain and fever relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
   • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
8. Expected Course:
   • With treatment, sinus congestion from a cold virus usually resolves in 5 to 7 days.
   • The main complication is bacterial sinusitis. It occurs if bacteria multiply within the blocked-off sinus. This leads to a fever and increased pain. Antibiotic treatment is indicated.
9. Call Your Doctor If:
   • Fever or yellow/green discharge lasts more than 3 days
   • Sinus pain persists longer than 1 day after starting treatment
   • Sinus congestion and fullness persist longer than 1 week
   • You become worse

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