Last week, my nose got sore to the point that it hurt to touch it. It also began to swell from the bridge to the middle of my nose. I had not suffered any physical injury. I had very little discharge from my nose and what was there was clear. I also had a dull headache. By the second day, I had pressure behind one of my eyes. My general practitioner diagnosed me with acute sinusitis. I have had sinus infections before, but not like this. Plus, I usually have had cloudy mucous discharge and a sore throat, which I don't have now. Is it likely a person's nose would swell from sinusitis?

Jacque

Yes. Thanks to commercials for antihistamines and nasal steroid sprays, the public equates sinusitis with nasal congestion, facial pain and postnasal drainage. While this can certainly occur with sinusitis, the real world is quite a bit more complex. Here are some myths associated with sinusitis:

1. My doctor should be able to diagnose this by looking up my nose. The diagnosis of acute or chronic sinusitis is based primarily on history. Nevertheless, if you have inflamed nasal tissues, pus in the nose, pus running down the throat, tenderness of the face and facial redness and/or swelling, then the diagnosis of acute sinusitis is obvious. But all of these findings may be absent, and the patient could still have acute sinusitis.
   
   

2. If I am not congested, and have nothing dripping out of my nose or down the back of my throat, then it can't be sinusitis. Acute sinusitis can be a viral or bacterial infection within one or more of the facial sinuses or "air pockets." If the infected sinus is not draining, then you will not have any foul nasal mucus or postnasal drainage. In non-draining acute sinusitis, the facial pain and swelling are typically much worse than if the sinuses were draining.

   For that matter, congestion can have many other causes: allergy, a change in the weather, bad anatomy and so forth. Congestion and sinusitis do not always go hand in hand.
   

3. I can treat this with over-the counter-medications. Over-the-counter sinus remedies usually contain a combination of an antihistamine and a decongestant. Antihistamines will be helpful only if allergies have contributed to your infection, which is often not the case. Topical decongestants may help, but oral ones can worsen symptoms because they cause excessive nasal dryness and thickening of sinus/nasal mucus. These remedies are riddled with side effects, and they do little to treat the actual problem. If your acute sinusitis is a bacterial infection (only about 10 percent of cases), it may need antibiotics. Other remedies may include saline sinus washes and anti-inflammatory medications.
   

4. My face hurts and my nose is congested. It must be sinusitis. Other conditions can cause these symptoms, including migraine, cluster headache and inhalant allergies.
   

5. I'll just tough it out. It'll get better. Maybe it will, maybe it won't. Untreated, acute sinusitis can develop into becoming chronic sinusitis, which is considerably more difficult to treat. Worse yet, acute sinusitis can lead to a number of serious complications, which are a direct result of worsening sinus infection: Facial cellulitis (infection of facial skin), periorbital and orbital abscess (infection near the eye, which can even lead to blindness) and meningitis. Acute sinusitis is a serious condition that requires prompt medical attention.