DEFINITIVE GUIDE

Sinusitis symptoms and treatment

Acute sinusitis is a common condition affecting up to 10% of UK adults. Symptoms can vary in severity, ranging from a painful condition to a mild irritation.

Usually, acute sinusitis is a self-limiting condition that does not need antibiotics, but persistent or severe cases may need them. Some cases of chronic sinusitis can even require surgery.

Although there are many causes of facial pain, if you have persistent facial pain it may be worth seeing a GP to learn if you have viral or bacterial acute sinusitis to get the right treatment.

Written by Dr Abby Hyams and Mr Simon Gane. Reviewed by Dr Faiza Khalid. Last reviewed on 01/03/2019. Next review date 01/03/2022.

Fast facts

What is acute sinusitis?

Sinuses are the hollow cavities in your skull that connect to the inside of your nose. Sinusitis is a common condition that causes the lining of your sinuses and nasal passages to become inflamed. This swelling stops mucus from draining properly into your nose and throat. Symptoms may include face pain or pressure, a blocked nose, headache, and fever.

Is acute sinusitis contagious?

Sinus pain can be due to viral or bacterial infection or due to an autoimmune condition. Viruses are the most common cause of acute sinusitis. Viral infections can be contagious and are spread when an infected person coughs or sneezes. Bacterial acute sinusitis is not contagious and affects only around 2% of cases.

CHAPTER ONE

Sinus infection symptoms

Acute sinusitis is common after the cold or flu. Most cases of acute sinusitis clear up in 2 to 3 weeks without any treatment. Most cases can be managed at home with remedies from the pharmacy.

Contrary to popular belief, the difference between acute and chronic sinusitis is the length a person has the condition, not the severity in symptoms. Keep a record of when your symptoms start to help with future diagnosis. We can help with:

How do you know if you have a sinus infection? And what does acute sinusitis feel like?

What are sinuses?

Sinuses are a connected system of air-filled cavities around the nasal passages in your face. When these become swollen or blocked, it is known as acute sinusitis or a sinus infection.

Frontal sinuses
Ethmoid sinuses
Sphenoid sinuses
Maxillary sinuses

Sinus infection symptoms

It is common to get acute sinusitis after having a cold or flu. Common acute sinusitis symptoms include congestion and blockage with any two of the following:

  • Pain or pressure, with swelling and tenderness around the cheeks, eyes or forehead
  • Reduced sense of smell
  • Sinus headache, often frontal
  • High temperature of over 38°C
  • Toothache
  • Bad breath

For signs of acute sinusitis in young children, see Chapter 7.

Sinus eye and face pain

Sinus pain in the eye and face are common sinus pressure symptoms and could indicate blocked sinuses. People with acute sinusitis usually experience discomfort in their face, especially when bending forwards. This is usually accompanied by a feeling of pressure or fullness. However, facial pain is not always due to acute sinusitis and can have many other causes including toothache, trauma, headache and cellulitis (skin infection).

Chronic sinusitis symptoms

To be diagnosed with chronic sinusitis, at least two of the following chronic sinusitis symptoms must be present for a least 12 weeks:

  • Thick, green or yellow mucus from the nose or drainage down the back of your throat.
  • Blocked nose restricting airflow.
  • Pain, pressure or tenderness around the cheeks, eyes or forehead.
  • Reduced sense of smell. If you are experiencing a persistent sinus pain, talk with your GP about managing your sinusitis.

Possible acute sinusitis complications

Acute sinusitis complications are rare but can include the following:

  • Meningitis. This is when the membranes and fluid surrounding your brain and spinal cord become infected and inflamed.
  • Infection spreading to the bones or skin.
  • Temporary or permanent loss of smell caused by the obstruction and inflammation of your nerve for smell.
  • Vision impairment and blindness if your infection spreads to the eyes.
Important

If you think that you or your child might be seriously ill, call 999 for an ambulance or visit A&E immediately.

CHAPTER TWO

Acute sinusitis or chronic sinusitis

Often, sinusitis will clear up on its own within 2 to 3 weeks. This is known as acute sinusitis. However, in some cases the inflammation in the nose and sinuses will persist for longer than this. This is called chronic sinusitis.

Others might experience acute sinusitis that keeps coming back, also known as recurrent acute sinusitis. How your sinusitis is managed depends on what type of sinusitis you have. We can help with:

What type of sinusitis do you have? And how is it managed?

What is acute sinusitis?

Acute sinusitis (also called acute rhinosinusitis or ARS) is when the membranes that line your nose and surrounding sinuses become infected for a short amount of time. This makes it difficult for mucus to drain from your nose and sinuses and can make your face feel uncomfortable.

What is chronic sinusitis?

Chronic sinusitis or chronic rhinosinusitis (also known as CRS) is when your sinuses become swollen and inflamed for at least 12 weeks. Chronic cases of sinusitis are common. They are usually a result of an infection, growths in your sinuses, or a deviated nasal septum.

What is recurrent acute sinusitis?

Recurrent acute sinusitis (RARS) is defined as when you have 4 or more significant episodes of acute sinusitis in a year which last longer than 10 days. In most cases, your GP will be able to manage recurrent acute sinusitis but a specialist referral might be necessary if your symptoms persist.

When should you see a doctor?

In cases of a severe sinus infection, you might experience intense or extreme sinus pain. You should visit your GP if your symptoms are severe and painkillers are not helping or your symptoms are becoming even worse. Symptoms of complications of sinusitis may need to be seen by your GP or A&E.

If you are unsure about whether your sinusitis symptoms are severe enough to see a GP, it’s usually worth talking it through with them and they can advise you.

Management of acute sinusitis

Most cases of acute sinusitis can be managed within primary care by your GP and pharmacist. However, if you have a severe and systemic infection or any complications with your acute sinusitis, it might be necessary for you to be referred to hospital for treatment. You might also be referred to have your acute sinusitis managed by a specialist if your GP believes you’re at a high level of risk or if your treatment isn’t working.

CHAPTER THREE

Acute sinusitis treatment

Most episodes of acute sinusitis will clear up on their own within two to three weeks. However, there are some things that you can do to help relieve your symptoms and speed up this process.

Acute sinusitis can be treated in many different ways. There’s plenty of things you can do at home to help deal with your sinusitis. We can help with:

What treatment is there for acute sinusitis? And how can you clear blocked sinuses?

How to treat viral acute sinusitis?

Acute sinusitis can often be treated at home. Try the following acute sinusitis treatment:

  • Warm, moist flannel. Hold this over your sinuses to help relieve the pain.
  • Humidify the air. This helps keep moisture in the air, making it more comfortable to breathe.
  • Saline nasal spray. You can use saline nasal sprays from your local pharmacy several times throughout the day to help clear your nasal passages.
  • Drink plenty of water. Staying hydrated can help to reduce thick mucus.
  • Nasal corticosteroid spray. These can be bought over-the-counter at your pharmacy and help to reduce intranasal and sinus infection.
  • Oral decongestants. Over-the-counter oral decongestant therapy can help to dry up mucus.
  • Nasal decongestants. Although these can cause a lot of trouble if overused, they can safely be used for about three days to relieve the swelling in the nose and open the nasal airways.
  • Painkillers. Paracetamol and ibuprofen can help to deal with the pain of acute sinusitis.

Medicines for acute sinusitis

There are many different over-the-counter medicines that you can try to help relieve the symptoms of your sinus infection. Popular medications for acute sinusitis that can be bought from your local pharmacy include:

  • Sudafed. Also known as pseudoephedrine, this medicine helps to decongest and allow you to breathe more easily.
  • Antihistamines such as Zirtec, Allegra or Claritin can help to relieve allergy symptoms.
  • Intranasal decongestant sprays such as Otrivine (Xylometazoline). Used cautiously (up to twice a day and only for a few days in a row), these can be useful in helping with the obstructive symptoms of ARS.
Tip

Only use one type of antihistamine at a time. If a medication is not working for you after 7 days then speak with your pharmacist who can recommend another.

Important

Do not use nasal decongestant sprays such as Otrivine (xylometazoline) for longer than three to four days in a row. Nasal steroid sprays like Pirinase (Fluticasone propionate), are safe to use long term.

How to clear blocked sinuses?

Blocked sinuses can be treated with nasal corticosteroid spray. This can be purchased over-the-counter at a pharmacy. This spray helps to reduce the sinus and intranasal inflammation. By reducing this inflammation, your sinuses can drain and become cleared.

How to relieve sinus pain?

Sinus pain can be treated in a variety of ways. Over-the-counter painkillers such as paracetamol and ibuprofen can help to relieve some of the pain. Placing a warm, moist flannel over your sinuses is another way of relieving the symptoms of sinus pain and pressure.

Bacterial acute sinusitis treatment

Most cases of acute sinusitis are viral so antibiotics will not help with nasal congestion symptoms. However, in cases of bacterial acute sinusitis, antibiotics can help to quickly fight the infection. Your GP will be able assess your type of acute sinusitis and prescribe you with antibiotics.

CHAPTER FOUR

Chronic sinusitis treatment

Chronic sinusitis (CRS) is a term which covers a number of conditions and is usually subdivided into those with (called CRSwNP) and without (CRSsNP) nasal polyps.

It can be difficult to have sinusitis for a long period of time. This common condition is known as chronic sinusitis and is a struggle for many people.

Unfortunately, there is no single cure, but there are lots of different treatment options available to manage your chronic sinusitis. We can help with:

How to treat chronic sinusitis? And should you have surgery?

How to treat chronic sinusitis?

Chronic sinusitis treatment involves:

  • Saline nasal wash, either a spray or douche such as NeilMed SinusRinse or a Neti pot. These sprays or solutions can help to clear irritants and allergens.
  • Nasal corticosteroids. These nasal sprays or drops can help to treat inflammation, reducing intranasal and sinus congestion.
  • Oral corticosteroids. For severe chronic rhinosinusitis, these medications can help reduce inflammation. This is particularly effective for those who have nasal polyps. It’s important to note that these are only used to treat severe symptoms due to potential serious side effects.
  • Long-term antibiotics. Some antibiotics have an effect on the immune system and have been shown to help with CRS.
  • Surgery. If other treatments fail, endoscopic surgery might be necessary.

Sinus surgery

Sinus surgery is rare and only considered when other treatments fail and you are suffering with long-term sinusitis or it keeps coming back. This surgery can help to remove tissue or shave away at a polyp which is obstructing your sinuses. Sinus surgery removes the obstruction and improves the drainage of the sinuses as well as allowing the surgeon to reshape the sinuses to improve the access to the sinuses for topical therapies such as sprays or drops.

Important

Having sinus surgery is not a guaranteed cure for sinusitis and can sometimes make you even more susceptible to the condition.

Can you cure sinusitis permanently?

While many might see sinus surgery as a cure for sinusitis, unfortunately this is not always the case. While it might help many people who are suffering from sinusitis, it can also make some others more susceptible to the condition. As acute sinusitis can have many different causes, there is not a single cure for it. However, there are many different treatment options to relieve your symptoms.

CHAPTER FIVE

Home remedies for sinus infection

Acute sinusitis can often be treated at home without prescription medication. You can help to relieve your symptoms and drain your sinuses using things you might have in the house or over-the-counter medication from your local pharmacy.

Simple things like resting and stopping smoking can all also help to fast-track your acute sinusitis recovery. We can help with:

How can you treat acute sinusitis at home? And should you smoke with acute sinusitis?

Acute sinusitis home treatment

There are many natural ways to drain sinuses. Home remedies for acute sinusitis include:

  • Saline nasal spray. These can be bought from your local pharmacy and can help to clear your nose.
  • Sleep with a couple of pillows. This can help to elevate your head and allow some of the mucus to drain and for you to breathe easier through the night.
  • Use a cold pack on your forehead to help relieve a sinus headache.
  • Neti pots. Some people might find that neti pots help to clear your nasal passages. It is important to use sterile water, not tap water. This can be purchased in a pharmacy or you can boil some water and allow it to cool.
  • Drinking plenty of water. Staying hydrated can help thin your mucus.
  • Essential oils. Menthol can help to create a sensation that your nasal passages are opening. However, there is no evidence to prove that menthol does actually open your nasal passages.
  • Take a break. Getting some rest can help your body to recover.

Smoking with acute sinusitis

Smoking cigarettes has been shown to damage your sinuses, increasing your risk of both acute and chronic sinusitis. Smoking damages your sinuses in a similar way to how it damages your lungs, by preventing your cilia (lining) from working. When your cilia fail to work, mucus can build up in your sinuses, allowing bacteria to thrive. This makes you more susceptible to a sinus infection.

CHAPTER SIX

Sinus infection causes

Acute sinusitis can be caused by a number of different factors. However, it is usually caused by viral infections, similar to those that cause the common cold or flu.

By learning about what causes a sinus infection, you can better understand how to prevent acute sinusitis. We can help with:

What causes acute sinusitis? And how can you prevent acute sinusitis?

What causes acute sinusitis?

Sinus infections can be caused by:

  • Respiratory tract infections. These can be viral, usually the common cold; bacterial; or fungal infections.
  • Allergies. Some people are more sensitive to allergens than others. This can lead to sinus inflammation and swelling in the nose.
  • Nasal obstruction by polyps stops the usual flow of mucus and air into the sinuses and increases the chance of acute sinusitis developing.
  • Deviated nasal septum. This is the wall of bone and cartilage between your nostrils. This is usually in the centre of your nose, but some people might have it skewed to one side due to genetics or an injury. This narrows your nasal passage on one side and can increase your chances of sinus problems.
  • Narrow sinuses. Some people are born with sinuses that are narrower which can lead to them becoming blocked more easily.
  • An extra sinus. Around 1 in 10 people have one more sinus than usual which can increase your risk of sinus problems.
  • Medical conditions. Cystic fibrosis, gastroesophageal reflux, HIV and other medical conditions can increase your likelihood of acute sinusitis.

What is viral acute sinusitis?

Viral infections are the most common cause of acute sinusitis. This is usually a result of catching the common cold. The symptoms of viral acute sinusitis will typically last between 7 and 10 days.

What is bacterial acute sinusitis?

Bacterial acute sinusitis is when you get acute sinusitis as the result of a bacterial infection. This is much less common than viral acute sinusitis. Treatment of bacterial acute sinusitis will usually involve a course of antibiotics after being diagnosed by a GP.

Who is more susceptible to acute sinusitis?

You are more likely to develop acute sinusitis if you:

  • Suffer from intranasal allergies
  • Have cystic fibrosis
  • Have abnormalities of the nasal passage, including a deviated septum or nasal polyp
  • Smoke or frequently breathe in pollutants
  • Have a weakened immune system, e.g. from undergoing chemotherapy or any illness or medication which affects your immune system
  • Your adenoids (the glands at the roof of your mouth) are large or inflamed
  • Spend a lot of time in a place where germs are present, such as a nursery or school
  • Participate in activities that result in pressure changes such as scuba diving or flying

How to prevent a sinus infection from developing?

Tips for acute sinusitis prevention include:

  • Quit smoking and avoid inhaling any other pollutants. Smoking has been shown to increase your risk of acute sinusitis by damaging the lining of your sinuses.
  • Maintain good hygiene. Washing your hands regularly can help to prevent the spread of sinus infections.
  • Disinfect surfaces in your home. Keeping surfaces disinfected can help to prevent viruses or bacteria that may cause a sinus infection being spread around the home.
CHAPTER SEVEN

For parents: acute sinusitis in children

If your child is suffering with acute sinusitis, there are some things that you can do to help relieve their symptoms, including at-home children’s sinus relief and children’s sinus medication.

It’s also important to remember that acute sinusitis is common in children and they will often recover within a few days on their own. Often, parents are advised to wait a few days and keep an eye on their child’s symptoms. We can help with:

Does your child have acute sinusitis? And what signs are there to look out for?

Signs of a sinus infection in children

Signs of a sinus infection in toddlers and young children include:

  • irritability
  • breathing through their mouth instead of nose
  • difficulty feeding

These symptoms are in addition to the symptoms listed in Chapter 1.

Complications of acute sinusitis in children

The most common complication of acute sinusitis in children is that it can develop into chronic sinusitis. Chronic sinusitis has similar symptoms to acute sinusitis but lasts longer.

Other complications of acute sinusitis in children are rare but children are more likely to have complications than adults. It’s possible for a sinusitis infection to spread to the eye, bones, blood or brain which can be very serious. If your child experiences swelling of the eye or cheek with acute sinusitis, report this to your GP immediately.

Is a sinus infection contagious in toddlers?

Acute sinusitis can be contagious in toddlers if the infection is viral, but not if the infection is bacterial. It’s possible for children to pass on a sinus infection similar to how they would pass on a cold or flu, by sneezing or coughing near another person.

How do you treat a sinus infection in children?

A sinus infection can be treated in children and toddlers by:

  • Placing a warm flannel on their face for a few minutes at a time.
  • Watchful waiting. It might be advised that you give your child some time to recover on their own while keeping an eye on their symptoms.
  • If your child has bacterial acute sinusitis, your GP might prescribe them with suitable antibiotics to help fight the infection.

When to take your child to see a doctor?

You should first take your child to see a pharmacist who will be able to advise you on which medicines are best for your child. Depending on your child’s symptoms, they might suggest a nasal spray or decongestant. Decongestants should not be used in children under the age of 6.

If your child’s symptoms do not improve after a week and painkillers aren’t helping, you should take your child to see a GP. You should also take your child to see a GP if they keep getting acute sinusitis.

How to prevent acute sinusitis in children?

It can be difficult to prevent acute sinusitis in children as it is easily spread. However, there are some things that parents can do to reduce the chances of their children getting acute sinusitis. This includes:

  • Humidify the air. Adding moisture to the air with a humidifier can help prevent dry air from irritating the sinuses and making them more prone to infection, especially in the winter months.
  • Washing hands regularly. By making sure you and your children are washing hands, it can help to prevent germs from spreading that cause acute sinusitis.
  • Blowing your nose or sneezing straight into a tissue and throwing it straight in the bin and then washing your hands.
  • Disinfecting surfaces. By keeping surfaces in the home disinfected, it can help to prevent the spread of acute sinusitis.
CHAPTER EIGHT

For parents: acute sinusitis in babies

Acute sinusitis in babies can be worrisome for parents, especially since it can be tricky to tell the difference between sinus infections in babies and the cold or flu. It’s important to know what signs to look out for.

While babies do not develop sinuses in the forehead and behind the nose until they are older, they can still get infections in their sinuses behind the eyes and cheeks. We can help with:

Does your baby have acute sinusitis? And when should you see a GP?

Is a sinus infection contagious to babies?

It is possible for babies to get acute sinusitis. Although sinuses do not develop in the forehead and behind the nose until a child is older, babies are born with sinuses behind their eyes and cheek which can still become infected.

How to treat acute sinusitis in babies?

Sinus infection treatments for babies include:

  • Saline drops. These salt water drops can be bought from your local pharmacy and help to thin your baby’s mucus.
  • Remove your baby’s mucus. Sometimes your baby’s mucus will harden or turn crusty. Gently remove this from your baby’s nose using a cotton ball with warm water, gently wiping the area.
  • Watchful waiting. Often, acute sinusitis will clear up on its own and it’s best to just wait it out whilst keeping close attention to your baby’s symptoms.

How to tell if your baby has a sinus infection?

It can be difficult to tell if your baby has a sinus infection when they can’t tell you how they are feeling, especially as the symptoms are very similar to the common cold or flu. However, there are some signs that you can look out for:

  • cold symptoms lasting for more than 10 days without improvement
  • swelling around the eyes (especially in the morning)
  • bad breath

How to prevent acute sinusitis in babies?

Parents can help to reduce the chances of their baby getting a sinus infection if they:

  • Humidify the air. By using a humidifier, you can help reduce the chances of dry air irritating your baby’s sinuses and making them more susceptible to getting a sinus infection.
  • Wash hands regularly. By keeping good hygiene, you can help reduce the chances of a sinus infection from spreading.
  • Disinfect surfaces in the home. By keeping surfaces disinfected, infections which cause acute sinusitis are less likely to be spread around the home.

When to see a GP about acute sinusitis in babies?

If your baby has any of the following, you should urgently take them to see a GP:

  • swelling or redness around the eyes that lasts all day
  • vomiting persistently
  • light sensitivity
  • severe headache or pain in the back of their neck
  • increasing irritability
  • if you are worried about your baby
CHAPTER NINE

What to do: sinus infection when pregnant

Pregnancy comes with morning sickness, tiredness and back pain. It can be exhausting for the body to also have to deal with a sinus infection. Pregnancy comes with changes to your blood vessels, immune system, and membranes in the nose.

Luckily, there’s some things you can do to reduce the chances of getting acute sinusitis while pregnant. We can help with:

How can you treat acute sinusitis while pregnant? And what can you take for sinus infections?

How to treat a sinus infection while pregnant?

Getting a sinus infection can feel like the last thing you need while pregnant. Here are some natural ways you can clear your sinuses when pregnant:

  • Use a saline nasal spray. These sprays are safe to use during pregnancy and can help to flush out mucus.
  • It's generally best to avoid painkillers such as ibuprofen and aspirin because they might cause harm to your baby. Instead, try taking paracetamol to help deal with sinus headaches.
  • Drink plenty of fluids. This can be water, soups, broths and juices. Keeping hydrated is especially important when fighting an infection.
  • Use a humidifier. This can help to add moisture to the air to prevent dry air further irritating your sinuses.
  • Sleep with a couple of pillows to help elevate your head and allow you to breathe more easily.
  • Make sure you are getting plenty of sleep. You might be feeling somewhat restless while pregnant but it's important to get a good night's sleep to help your body fight off a sinus infection.
  • Often pregnancy will cause your appetite for food to diminish. However, it's important to eat well to improve your body's defence against acute sinusitis.
  • Use a cold pack on your forehead to help relieve a sinus headache.

What can you take for sinus congestion while pregnant?

Before taking decongestants or antihistamines, you should first consult with your GP who will be able to advise you on which medications are appropriate for your stage in pregnancy.

Can a sinus infection during pregnancy hurt the baby?

Acute sinusitis will not harm your baby. However, you might need to be more careful when taking medications for acute sinusitis when pregnant as some might cause harm to your baby. Talk to your pharmacist or GP first before using decongestants or antihistamines.

When to see a GP about acute sinusitis when pregnant?

If your symptoms are not improving, you should consult with your GP. Your doctor will be able to diagnose you and prescribe you with the best treatment for you and your baby.

How can you prevent acute sinusitis when pregnant?

Acute sinusitis is difficult to prevent as it can be very common. When you are pregnant, changes to your blood vessels and membranes in the nose can increase your chances of a sinus infection. However, there are some things you can do to help prevent acute sinusitis while pregnant:

  • Get lots of rest, drink plenty of fluid, and eat well
  • Washing hands regularly. This can help to prevent the spread of infection.
  • Disinfecting surfaces around the home.
CHAPTER TEN

Get same day treatment with Medicspot

With same day private GP appointments in over 150 locations across the UK, Medicspot can help you with a sinus infection.

Using our unique clinical stations, you can get seen by a GP at your local pharmacy via video consultation. Medicspot has diagnostic devices so our doctors can also provide a clinical examination. We can help with:

How can you get a private GP appointment? And can you get a same day appointment with Medicspot?

How it works

Our doctors can provide same day treatment at your local pharmacy. Simply book online, have your consultation with one of our expert doctors and pick up any prescriptions from the same location. Medicspot private GPs can examine you with a range of diagnostic devices.

Find your nearest clinic.

CHAPTER ELEVEN

About the authors

Dr Abby Hyams

Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because the wide spectrum of people she encounters every day.

Mr Simon Gane

Mr Simon Gane is a Consultant ENT Surgeon, appointed to the Royal National Throat Nose and Ear Hospital in 2017. He graduated from the University of Cape Town, South Africa and completed his Higher Surgical training in the North Thames Deanery.

Simon has a subspecialty interest in Rhinology, Medical Rhinology, Olfaction and Hereditary Haemorrhagic Telangiectasia (HHT). His research has been published in various journals including The British Medical Journal, the Proceedings of the National Academy of Sciences (PNAS), Public Library of Science (PLOS ONE) and World Allergy Organization Journal among others.

Dr Faiza Khalid

Dr Faiza Khalid is a Medicspot GP with 12 years of experience. Born and raised in the Home Counties, she pursued her passion for medical sciences at The University of Leeds and proceeded to read her degree in Medicine at The Leicester-Warwick Medical School. In addition to being a GP, she is a qualified GP trainer.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.