How do I know if I have sinus problems?

Short answer: Common signs of a sinus problem include a blocked nose, thick yellow or green mucus, facial pressure around the cheeks, eyes or forehead, mucus dripping down the throat, reduced smell and a heavy head that worsens on bending forward. Symptoms lasting over 10 days, or 12 weeks for chronic sinusitis, make sinusitis more likely.

Key takeaways

• Sinusitis usually causes nasal symptoms plus facial pressure, not headache alone.
• Symptoms lasting more than 10 days, or improving and then worsening, suggest sinusitis rather than a simple cold.
• Chronic sinusitis is generally defined as symptoms lasting 12 weeks or longer.
• An ENT can confirm the diagnosis with nasal endoscopy and, if needed, a CT scan.

Dr. Prashanth's perspective

The best way to know whether you have a sinus problem is to have your nose assessed by an ENT surgeon. The most common complaint is post-nasal drip, which patients feel at the back of the throat. The other symptoms my patients describe are heaviness of the head and nasal blockage.

— Dr. Prashanth R. Reddy, ENT Surgeon, ENTHealth360

What is actually happening in a sinus problem?

A sinus problem means the lining of the sinuses is inflamed and the sinuses are not draining properly.

The sinuses are air-filled spaces behind the cheeks, between the eyes and above the eyebrows. Their lining makes mucus that normally drains into the nose through small openings.

When the lining swells, from a cold, allergy, pollution or narrow drainage, those openings close. Mucus builds up, pressure rises and infection may follow. This inflammation is called sinusitis.

What are the symptoms, and how do you tell sinus apart from a cold or allergy?

The most reliable clues are the combination of symptoms and how long they last.

Typical sinus symptoms include:

• A blocked or stuffy nose, sometimes on one side more than the other.
• Thick yellow or green discharge from the nose or down the back of the throat (post-nasal drip).
• Pressure, fullness or ache over the cheeks, around the eyes or across the forehead.
• Pain that feels heavier when you bend forward or lie down.
• A reduced sense of smell or taste.

A common cold usually peaks in two to three days and improves within 7 to 10 days. Allergy tends to cause sneezing, itching and clear discharge. Sinusitis is more likely if symptoms last beyond 10 days, or if you start improving and then get worse again. Symptoms lasting 12 weeks or longer usually fit chronic sinusitis.

A headache on its own, with no blocked or runny nose, is often not sinus-related. Migraine and tension-type headaches frequently cause facial pressure and are commonly mistaken for sinus problems.

What can you do at home if you suspect a sinus problem?

Simple, safe measures can ease symptoms while you watch how things progress.

• Saline rinse once or twice a day using boiled-and-cooled, distilled or sterile water.
• Steam inhalation for five to ten minutes with plain hot water, at a safe distance.
• Drink enough fluids to keep mucus thin.
• Avoid smoke and dust, which are common triggers in Bangalore with its traffic, construction and seasonal pollen.
• Use decongestant sprays for no more than three to five days, to avoid rebound blockage.

How are breathing, sleep and energy connected here?

A sinus problem can affect more than your nose, because it often affects how you breathe at night.

When the nose is blocked, many people breathe through the mouth during sleep. This can cause snoring, a dry mouth and lighter, more fragmented sleep. Patients often describe waking up tired and foggy.

Treating a sinus problem early may help restore nasal breathing, which for many people means more restful sleep and steadier daytime energy.

How does nose breathing support energy and BMR?

Your basal metabolic rate (BMR) is the energy your body burns at rest to keep the heart beating, the brain working and cells repairing. Your cells make that energy using oxygen, so how well you breathe matters.

Nose breathing helps in two ways:

• Warm, moist, filtered air. The nose warms, humidifies and filters each breath before it reaches the lungs. Conditioned air is gentler on the airway lining, which matters in Bangalore's air-conditioned offices and traffic dust. Mouth breathing skips this step and can leave the throat and airways dry.
• Nitric oxide from the sinuses. The paranasal sinuses continuously make nitric oxide (NO), a natural gas. When you breathe in through your nose, small amounts of this NO travel to the lungs, where studies suggest it may help widen tiny blood vessels and improve oxygen uptake. Mouth breathing largely bypasses it.

Nose breathing does not "boost" your BMR. That is set mainly by muscle mass, age, body size and hormones such as thyroid. But comfortable nasal breathing by day, and undisturbed breathing at night, support efficient oxygen supply and deeper sleep, which your body needs to use energy well and recover.

A simple check: sit quietly and breathe through your nose with your mouth closed for two minutes. If that feels difficult, or one side is always blocked, it is worth having your nose examined.

When should you see an ENT?

See an ENT if symptoms are persistent, recurring or unusual.

• Symptoms lasting more than 10 days without improvement, or worsening after initial improvement.
• Symptoms continuing for 12 weeks or more.
• Several sinus episodes a year.
• Blockage, bleeding or discharge on one side only, or lasting loss of smell.
• Seek urgent medical care for swelling or redness around the eyes, double or reduced vision, a severe headache with neck stiffness, confusion, or high fever. These can be signs of a spreading infection.

How an ENT evaluates and treats it

An ENT confirms whether the sinuses are truly involved and why.

Assessment begins with your history and an examination of the nose. A nasal endoscopy, where a thin camera is gently passed into the nose in the clinic, shows swelling, pus, polyps or a deviated septum that cannot be seen from outside. A CT scan of the sinuses may be advised for chronic or complicated cases. If allergy is suspected, allergy evaluation may be suggested.

Treatment may include saline irrigation, steroid nasal sprays, allergy management and, when clearly indicated, antibiotics. If structural problems or polyps keep the sinuses from draining and medicines are not enough, endoscopic sinus surgery may be considered. The right option depends on the cause.

Frequently asked questions

Does nose breathing give me more energy? It does not add energy by itself, but it delivers warm, humidified air and sinus nitric oxide to the lungs, which may help oxygen uptake. Together with better sleep, that supports the energy your body uses at rest (BMR) and during activity.

Can I have sinusitis without a runny nose? Yes. Some people mainly have blockage, facial pressure and post-nasal drip rather than a runny nose. Thick mucus may drain backwards into the throat instead of out of the nose.

Do I need an X-ray to diagnose sinusitis? Usually not. Diagnosis is mainly based on symptoms and nasal endoscopy, and a CT scan is more useful when imaging is needed.

Is a sinus problem the same as an allergy? No, but allergy swells the nasal lining, which can block sinus drainage and lead to sinusitis.

References

• Lundberg JO, Farkas-Szallasi T, Weitzberg E, et al. High nitric oxide production in human paranasal sinuses. Nature Medicine. 1995;1(4):370-373.
• Lundberg JO, Settergren G, Gelinder S, et al. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiologica Scandinavica. 1996;158(4):343-347.
• Keck T, Leiacker R, Heinrich A, Kühnemann S, Rettinger G. Humidity and temperature profile in the nasal cavity. Rhinology. 2000;38(4):167-171.

About the author

Dr. Prashanth R Reddy is an ENT surgeon at ENTHealth360, Bangalore (MS ENT; MBA, IIM Bangalore; Seoul Rhinoplasty Fellowship), seeing patients at Sakra World Hospital, Marathahalli and in Koramangala. His practice focuses on how breathing affects sleep, energy and everyday performance.

Related reading: Sinusitis: Causes, Symptoms, Home Care & When You Need an ENT (Bangalore Guide)

For educational purposes only. Not a substitute for medical advice. Please consult a qualified ENT specialist.