Sinusitis

Your sinuses are air-filled pockets in the bones of your face, lined with the same moist membrane as your nose. When that lining swells, the drainage channels close, mucus backs up, and you get the heavy, blocked, achy feeling most people recognise as sinusitis. If it has dragged on past ten days without shifting, our NHS Pharmacy First sinusitis consultation in Timperley is built for exactly this stage.

Why a cold turns into sinusitis

Nearly every case begins as an ordinary viral cold. The virus inflames the nasal lining, which swells into the sinus openings so they can no longer drain. In most people this settles as the cold does; in a minority the trapped mucus lets bacteria multiply and the illness takes a second turn for the worse. Less often, hay fever, nasal polyps, a deviated septum, swimming, or an infection in an upper back tooth sets it off.

Acute sinusitis means an episode lasting under twelve weeks. Beyond that it is chronic, which the pathway does not cover. Several episodes a year count as recurrent; the pharmacist can still assess an individual episode, but repeated bouts need a GP to look at what keeps causing them.

How to tell sinusitis from things that mimic it

A plain cold and early sinusitis feel identical, which is why the pathway does not treat anything under ten days old. Hay fever and other allergies bring sneezing, itchy eyes and clear watery discharge that comes and goes with exposure; face pain is unusual. A dental abscess centres on one tooth with gum swelling and pain on biting, though the two overlap because the upper back teeth sit beneath the cheek sinuses. Migraine and tension headache cause facial pressure but rarely a blocked nose with discoloured mucus. If your picture does not fit sinusitis, the pharmacist will tell you what it more likely is and who should see you.

What happens in the Pharmacy First sinusitis consultation

The consultation is face to face in our private room, because the pharmacist needs to examine you. They will:

• confirm the pathway’s diagnostic pattern — a blocked or runny nose plus facial pain or pressure, a dulled sense of smell, or (in a child) a persistent cough;
• pin down when it began and whether it has improved or worsened since;
• check your temperature and look at your face and around your eyes, and may look inside your nose and throat;
• ask about pregnancy, immune-suppressing conditions or medicines, previous episodes, allergies, and anything else you take;
• screen for the warning signs listed below, which take priority over everything else.

With your consent they can view your NHS record, and your GP surgery receives a short summary of what was found and done.

Who the pathway covers, and who it does not

The NHS pathway is for anyone aged 12 or over with a one-off episode of acute sinusitis. It excludes children under 12, anyone whose symptoms have lasted more than twelve weeks, anyone who is immunosuppressed — for example through chemotherapy, high-dose steroids or biologic medicines — and anyone under 16 who is pregnant. These groups need investigation or carry a higher risk of complications than a pharmacy pathway is built for. If you are 16 or over and pregnant or breastfeeding you can still be seen; it simply changes which options are open to you.

How the pharmacist decides on treatment

The single most important fact is the calendar. Under the current pathway (updated October 2025), if you have had symptoms for ten days or fewer an antibiotic is not appropriate — the overwhelming majority of cases are viral, and trials show antibiotics barely change how long they last while adding side effects and resistance. You get tailored self-care advice and a plan to return if things have not improved a week later.

Once symptoms have gone past ten days with no improvement, you cross what the pathway calls the gateway. The pharmacist then looks for features that make a bacterial infection more likely. Two or more of these count:

• a marked worsening after an initial milder phase;
• a fever above 38°C;
• unremitting thick, discoloured discharge;
• severe pain on one side of the face, particularly over the upper teeth and jaw.

Even here, the first-line NHS treatment is a high-dose steroid nasal spray, stronger than the hay-fever sprays sold over the counter, to shrink the swollen lining so the sinuses drain. An antibiotic is only considered where bacterial features are present and the spray has not worked or is unsuitable for you. The decision is shared — the pharmacist explains benefit and downsides and you decide together — and nothing is supplied automatically.

What recovery realistically looks like

Most episodes are gone within two to three weeks; a few grumble on for a month. Blockage and pressure usually fade before your sense of smell fully returns, and a post-nasal-drip cough is often the last thing to clear. Steroid sprays build up gradually, so allow several days before judging them.

Self-care that is actually worth doing

• Simple pain relief from the pharmacy shelf eases face pain and lowers a temperature — ask us which suits you.
• Salt-water nasal rinsing, with a sachet or home-made solution, physically clears mucus and is safe to repeat through the day.
• A warm flannel over the cheeks loosens pressure; sleeping propped up helps drainage.
• Drink well, rest, and avoid smoke, which paralyses the tiny hairs that move mucus along.
• Decongestant sprays help briefly but cause rebound congestion if overused. Antihistamines do not help unless allergy is the driver, and evidence for steam inhalation is weak.

Sinusitis itself is not contagious, but the cold virus behind it is — wash hands and bin tissues.

Warning signs that need urgent medical attention

Serious complications are rare but move quickly, because the sinuses sit beside the eyes and brain. Call 999 or go to A&E for swelling or redness around an eye, a bulging or displaced eye, double or blurred vision, a severe headache over the forehead, swelling over the forehead bone, a stiff neck with dislike of bright light, confusion, weakness or numbness, or a fit. The pharmacist checks for each of these and uses the NHS early-warning score if you seem unwell.

Ring your GP or NHS 111 if symptoms worsen sharply, pain relief is not working, you are no better a week after any treatment, or a new fever appears partway through.