Sinus Pain or Congestion

Definition

• A sensation of fullness, pressure or pain on the face overlying a sinus cavity
• The sinuses are located above the eyebrow, behind the eye, around the eye, and over the cheekbone

Symptoms

• The pain or pressure usually is just on one side of the face.
• Puffiness or swelling around just one eye.
• Commonly associated symptoms are a congested nose, blocked nose, nasal discharge, and/or postnasal sinus drip.
• Less common symptoms are bad breath, mouth breathing, sore throat from postnasal drip and throat clearing.
• Age limitation: sinus pain is not a reliable symptom before 5 years of age.

Causes of Sinus Congestion

• Viral Sinusitis: part of the common cold. Viral inflammation of the lining of the nose also involves the lining of all the sinuses.
• Bacterial Sinusitis: A complication where viral sinusitis becomes secondarily infected with bacteria. (occurs in 5% of colds). Main symptoms are increased sinus pain, the return of fever or the overlying skin (around the eyelids or cheeks) becomes red or swollen. In younger children, the main symptoms are thick nasal secretions that last longer than 14 days or return of fever.
• Allergic Sinusitis: Sinus congestion commonly occurs with nasal allergies (e.g. from pollens). Associated sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of Sinusitis

• Viral Sinusitis: Nasal washes with saline.  Antibiotics are not helpful.
• Bacterial sinusitis: Oral antibiotics
• Allergic sinusitis: Treatment of the nasal allergy with antihistamines also usually relieves the sinus symptoms.

Color of Nasal Discharge with Colds

• The nasal discharge normally changes color during different stages of a cold.
• It starts as a clear discharge and later becomes cloudy.
• Sometimes it becomes yellow or green colored for a few days; and this is still normal.
• Intermittent yellow or green discharge is more common with sleep, antihistamines or low humidity. (Reason: All of these events reduce the production of normal nasal secretions.)
• Yellow or green nasal secretions suggest the presence of a bacterial sinusitis ONLY if they occur in combination with [1] sinus pain OR [2] the return of a fever after it has been gone for over 24 hours OR [3] nasal discharge lasts over 14 days without improvement.
• Nasal secretions need treatment with nasal washes when they block the nose and interfere with breathing through the nose. During a cold, if nasal breathing is noisy but you can't see blockage in the nose, it usually means the dried mucus is farther back. Nasal washes can remove it.

Return to School

• Sinus infections are not contagious. If the sinus pain or congestion is associated with a cold or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

See More Appropriate Topic (instead of this one) IF

• Age less than 5 years old or doesn't sound like sinus congestion, see COLDS
• Also has active nasal allergies, see HAY FEVER (NASAL ALLERGIES)

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