Sinus Infection or Cold? How to Tell and When to Be Seen

What it involves

MedlinePlus defines sinusitis as swelling or inflammation of the tissue lining the sinuses, the air-filled spaces behind the forehead, nasal bones, cheeks, and eyes. It can follow a virus, bacteria, or fungus, or an allergic reaction. A common cold is a viral illness that usually clears by itself. The useful question is not which name fits, but how long the symptoms have lasted and whether they are getting worse.

Who this is for

• Adults whose cold has lasted more than a week and who now have face pain or pressure
• Patients with a stuffy nose, thick discharge, or postnasal drip that keeps coming back
• Patients with allergies, smoking exposure, or a deviated septum who get frequent sinus trouble
• Patients unsure whether they need a visit, an over-the-counter plan, or a referral

What to expect

• Questions about how many days you have been sick and whether you felt better before feeling worse
• A look at your nose, throat, and face, including tenderness over the sinuses
• A plain explanation of whether your symptoms fit a cold, sinusitis, or allergies
• A plan for comfort care, follow-up, and any referral to an ear, nose, and throat or allergy specialist

Where the sinuses sit and why they get blocked

MedlinePlus says the sinuses normally drain mucus into the nose and let air flow through. When the openings are blocked, or too much mucus builds up, bacteria and other germs can grow more easily. It lists colds and allergies, a deviated nasal septum, a nasal bone spur, nasal polyps, and cilia that fail to move mucus out as causes. That is why the same stuffy nose can have very different explanations from one person to the next. Pressure in the ears is common when the nose is blocked, and the ear pain and ear infection guide explains how a blocked eustachian tube can lead to fluid and infection behind the eardrum.

Acute, subacute, and chronic: the calendar matters

MedlinePlus separates sinusitis by how long it lasts:

• Acute sinusitis lasts up to 4 weeks and is caused by viruses or bacteria
• Subacute sinusitis lasts from about 1 to 3 months
• Chronic sinusitis lasts longer than 3 months and may involve bacteria or a fungus
• Recurrent sinusitis means several separate attacks within a year

The pattern that points past a cold

MedlinePlus says acute sinusitis in adults very often follows a cold that does not get better, or that gets worse after 7 to 10 days. The symptoms it lists include pressure-like pain, pain behind the eyes, toothache, tenderness of the face, nasal stuffiness and discharge, bad breath, loss of smell, cough that is often worse at night, headache, fever, and fatigue. A cold that steadily improves is behaving like a cold. The cold versus flu guide covers that side, and the sore throat guide covers throat pain on its own. A cold that brings red, watery eyes along with a stuffy nose is covered in the pink eye guide, which explains how viral, bacterial, and allergic pink eye differ.

What helps at home

MedlinePlus suggests a warm, moist washcloth on the face several times a day, plenty of fluids to thin mucus, steam inhaled two to four times a day, saline nasal spray, a humidifier, and a saline rinse bottle or Neti pot. It cautions that over-the-counter decongestant nasal sprays can make stuffiness worse and lead to dependence when used for more than three to five days. MedlinePlus also lists acetaminophen, ibuprofen, and naproxen for pain or pressure. Ask your provider first if you have other conditions or take other medicines.

Do you need an antibiotic?

MedlinePlus says antibiotics are not needed most of the time for acute sinusitis, because most of these infections go away on their own, and that when antibiotics do help they may only slightly shorten the illness. It names fever higher than 102.2 degrees Fahrenheit, headache or pain in the face, and severe swelling around the eyes as reasons they are prescribed sooner. When one is prescribed, it says acute sinusitis is treated for 5 to 10 days. Finish a prescribed course unless your provider tells you otherwise. When a cold moves from the nose and sinuses into the chest with a cough that brings up mucus, the acute bronchitis guide explains what is happening and when to be seen.

When sinus trouble keeps returning

If sinusitis lasts or keeps coming back, MedlinePlus says tests may include allergy testing, blood tests for immune function, or a nasal culture, and your provider may consider a referral to an ear, nose, and throat or allergy specialist. Frequent flare-ups are often tied to allergies, so the seasonal allergies guide may fit. A cough that outlasts the congestion has its own causes, covered in the persistent cough evaluation. Frequent nosebleeds that come with a stuffy or irritated nose are covered in the nosebleeds guide, which lists what MedlinePlus says to do at home and when to get emergency care.

Sources

• MedlinePlus — Sinusitis (Medical Encyclopedia)
• MedlinePlus — Sinusitis (Health Topic)