Sinus Problems in Delhi’s Smog Season: Symptoms, Home Care and When to See an ENT

Every winter, sinus problems fill my OPD in South Delhi. From October to February, smog, Diwali smoke and cold, dry air all hit the same place: the lining of your nose and sinuses.

I’m Dr. (Major) Rajesh Kumar Bhardwaj, an ENT surgeon with over 35 years of practice, 15 of them in the Indian Army Medical Corps. Most of the sinusitis I see in this season gets better without antibiotics or surgery, once people know what is going on and what to avoid.

This guide covers what your sinuses are, why Delhi’s winter air sets them off, and how to tell a cold from a sinus infection or an allergy. It also covers what helps at home, what makes things worse, and when a blocked nose needs a doctor.

What are the sinuses, and why do they get blocked?

Your sinuses are air-filled spaces in the bones of your face, and each one opens into your nose. There are four pairs: the frontal sinuses behind the forehead, the ethmoid sinuses between the eyes, the maxillary sinuses behind the cheeks, and the sphenoid sinuses deep behind the nose.

They are lined with the same moist lining as the inside of your nose. The mucus they make drains into the nose through small openings, carrying dust and germs out with it.

Sinusitis starts when that lining swells. A cold, an allergy or smoggy air can all set it off. The openings narrow, mucus collects behind them, and you feel the pressure in your forehead and cheeks.

Why Delhi’s smog season makes sinus problems worse

Sinus complaints peak in my clinic between late October and January, the same months Delhi’s air is at its worst. Fine particles (PM2.5) from stubble burning, traffic, construction dust and firecracker smoke irritate the lining of the nose and sinuses. The lining swells and makes more mucus.

Cold, dry winter air dries the lining further and slows the tiny hairs that sweep mucus out. People with allergies, a deviated septum or nasal polyps feel it first and worst.

Indoor air matters too. Cigarette smoke, agarbatti and mosquito coils irritate the nose all night, when you breathe the same air for hours. A coal angithi in a closed room does the same, and it is also a carbon monoxide risk.

Cold, sinus infection or allergy? How to tell them apart

For the first few days all three feel alike. The difference shows in how long it lasts and what comes with it.

Condition

Typical signs

How long it lasts

What to do

Common cold

Runny or blocked nose, sore throat, sometimes a mild fever

7 to 10 days, then it gets better on its own

Home care

Bacterial sinus infection

Blocked nose, thick discharge, facial pain or pressure; sometimes high fever with facial pain for 3 to 4 days from the start

Beyond 10 days without improving, or better and then suddenly worse

See a doctor, who decides if you need antibiotics

Allergy

Sneezing in bouts, itchy nose and eyes, watery discharge, no fever

Returns in the same season every year, or after dusting the house

See a doctor to find the trigger and the right spray

Most sinus infections are caused by viruses and clear up the way a cold does. Yellow or green mucus on its own does not mean you need antibiotics.

Is it really a sinus headache?

Many people who believe they get sinus headaches actually have migraine. In a study of nearly 3,000 people with a history of “sinus headache”, 88% turned out to have migraine-type headaches.

Sinus pain usually comes with a blocked nose and thick discharge, and it eases as the blockage clears. A headache with sensitivity to light or sound, nausea, or no nasal symptoms at all points towards migraine. That needs a proper headache assessment, not repeated antibiotics or sinus surgery.

What actually helps at home

Most blocked noses in this season settle with simple care at home. These are the steps I give my own patients:

• Rinse with saline once or twice a day. Use boiled and cooled water, never water straight from the tap. Ready-made saline sprays from a chemist work too.

• Breathe plain steam for a few minutes at a time. Keep hot bowls well away from children, who get scalded more often than you would think.

• Drink plenty of fluids and sleep with your head slightly raised. Both help mucus drain overnight.

• Protect yourself on bad AQI days. Wear a well-fitted N95 mask outdoors, run an air purifier in the bedroom, and rinse your nose after your commute.

• Keep the bedroom smoke-free. No smoking, agarbatti or mosquito coils in the room where you sleep.

Give it 7 to 10 days. If you are not getting better by then, the sections below explain when to see a doctor.

What makes sinus problems worse

Two habits make sinus trouble worse: antibiotics taken without a doctor, and nose-opening sprays used for too long.

Antibiotics without a doctor. Antibiotics do nothing against viruses, which cause most sinus infections. Even when an infection is bacterial, the latest American guideline on adult sinusitis allows many adults to be watched for a few days before starting antibiotics. A course picked up from the chemist “just in case” brings side effects and adds to antibiotic resistance, a growing problem in India.

The nasal spray trap. Nose-opening sprays such as xylometazoline and oxymetazoline clear a blocked nose within minutes. Used for longer than the pack advises, usually 3 to 7 days, the nose can block up again as each dose wears off. Many people then spray more and more often, sometimes for years. If you cannot sleep without one, that alone is worth a doctor’s visit.

The nasal spray trap: 4 steps and the way out

Stopping the spray is what breaks the loop. A doctor can help you come off it, often with a steroid spray to ease the blockage while the nose recovers.

Steroid nasal sprays are different. They work slowly over several days, calm the swelling instead of squeezing it shut, and are safe for long-term use under a doctor’s care. They are the main treatment for nasal allergies and long-standing sinusitis.

Warning signs: see a doctor the same day

Complications of sinusitis are rare, but an infection can spread to the eye or the brain. See a doctor the same day, or go to an emergency department, if you notice any of these:

• Swelling or redness around the eye

• Double vision, blurred vision or loss of vision

• A severe headache with a stiff neck, confusion or unusual drowsiness

• Swelling over the forehead

• A high fever that does not come down

In children, also watch for a swollen eyelid, or an eye that looks pushed forward or is hard to move.

When to book an ENT visit, and what happens there

Book an appointment with an ENT specialist if any of these apply to you:

• Your symptoms have lasted more than 12 weeks, even if they come and go

• You get four or more bad episodes in a year

• You have lost your sense of smell

• Only one side of your nose stays blocked, especially with blood-stained discharge

• You have nasal polyps or asthma, or you rely on a nasal spray to breathe

At the visit, I take a careful history and then look inside the nose with a thin camera called an endoscope. It takes a few minutes in the clinic chair after a numbing spray, and it shows swelling, pus, polyps or a bent septum directly.

A CT scan of the sinuses is needed only in some cases: when symptoms continue despite treatment, when surgery is being considered, or when a complication is suspected. Allergy testing helps when sneezing and itching are the main problem.

Treatment: medicines first, surgery only for a few

Most sinusitis is treated without surgery. Depending on the cause, treatment includes saline rinses, a steroid nasal spray, control of allergies, and antibiotics only when a bacterial infection needs them.

Surgery is considered only when long-standing sinusitis or nasal polyps do not settle after a proper trial of medicines. The usual operation is FESS (Functional Endoscopic Sinus Surgery). It is done through the nostrils with an endoscope, leaves no cut on the face, and widens the natural drainage openings of the sinuses. Most patients go home the same day or the next morning.

I would rather a patient leave my clinic with a clear plan and no operation than be booked for surgery too early. If you have been advised sinus surgery and are unsure, asking for a second opinion is reasonable.

Frequently asked questions

Can air pollution cause sinusitis?

Pollution rarely causes sinusitis on its own, but it irritates and swells the lining of the nose and sinuses. That makes blockage and infection more likely. People with allergies or long-standing sinusitis often feel worse on high AQI days.

How long does sinusitis last?

Sinusitis that follows a cold usually settles within 7 to 10 days. When symptoms last 12 weeks or longer, it is called chronic sinusitis and needs an ENT assessment.

Is steam inhalation good for a blocked nose?

Plain steam can loosen mucus and give short relief. Keep each session to a few minutes and keep hot water well away from children. Balms and oils in the water are not needed.

Can I use a nasal decongestant spray every day?

Use it only for as long as the pack says, usually 3 to 7 days. Longer use can make the nose block up again each time a dose wears off. Steroid nasal sprays are different and can be used daily on a doctor’s advice.

Do I need antibiotics for a sinus infection?

Usually not. Most sinus infections are caused by viruses and get better on their own. A doctor may advise antibiotics if symptoms last beyond 10 days, get worse after improving, or come with a high fever and facial pain.

When is sinus surgery needed?

Only when long-standing sinusitis or nasal polyps do not improve after a proper course of medicines, or when there is a complication. A nasal endoscopy and a CT scan help decide.

About the author

Dr. (Major) Rajesh Kumar Bhardwaj is a Senior ENT Specialist at MedFirst ENT Centre, Vasant Vihar, New Delhi, with more than 35 years of clinical and surgical experience. He completed his MS in ENT at AFMC Pune with a Silver Medal, holds a DNB, and served 15 years in the Indian Army Medical Corps. He is Professor Emeritus at TMU, Moradabad.

Book a sinus check at MedFirst ENT Centre. D 3/14, Vasant Vihar, New Delhi 110057. Call +91 98711 50032, Monday to Saturday, 9:30 am to 6:30 pm, or visit entdelhi.com