When Is a Sinus Infection Serious?

Find out how you can tell the difference between a viral and bacterial sinusitis – plus what to do if you suspect an infection.

Sanaz Majd, MD,
June 6, 2013
Episode #125

When Is a Sinus Infection Serious?

I’ve been seeing a big surge of viral upper respiratory infections. There was a peak in the usual winter season, but suddenly patients are filing into my waiting room one-by-one, sniffling and coughing. Some who say they “never get sick” may understandably get a tad panicked when experiencing a few days of nasal congestion (those cold gurus who get exposed frequently already know the drill). I don’t blame them – how do you know it’s serious when you rarely get sick in the first place? 

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So I decided to devote today’s episode to acute sinusitis to really help patients delineate what is simply a viral-common-cold-nasal-congestion-thing and what is a true bacterial sinus infection.

What is Acute Sinusitis?

Sinuses are the little pocket holes inside your facial bones that have a connection to your nose. Sinusitis refers to the inflammation of those pocket holes and nasal passages. In fact, as a general rule, any term in medicine that ends in “-itis” refers to inflammation. For instance, bronchitis is inflammation of the bronchials (upper lungs), colitis is inflammation of the colon, bursitis is inflammation of the bursa surrounding joints, etc.

What Causes Sinusitis?

  • Viruses: By far the most common causes of inflammation in the sinuses are viruses that cause the common cold. Viruses are notorious for causing nasal congestion (and runny noses), and hence, inflammation of the sinuses. These nasal symptoms can take 7-10 days to resolve on their own, and often worsen daily until reaching peak discomfort on the 4th or 5th day. The illness begins to improve gradually daily after that. With the common cold, most patients have some improvement after 7-10 days (although they may not be 100% back to their normal baseline state).

See also: What Is the Flu Virus?

  • Bacteria: Bacterial sinusitis can occur when fluid collections within the sinuses don’t drain well, like after the common cold that commonly causes this fluid overload. Then bacteria begin to grow in these moist, wet, fluid-filled sinus pockets. This typically happens after the 7-to-10-day timeframe of the common cold.

Symptoms of Bacterial Sinusitis

Most patients who develop a bacterial sinusitis after a cold describe their nasal congestion improving sometime between the 5th and 10th day, and then boom, all of a sudden get severe facial pain. Again, the timing is very important, as sinusitis does not develop within the first 7 days after a viral infection.

Sinus infections may cause the following symptoms:

  • Facial pain or pressure, may be worse with bending forward

  • Thick nasal discharge

  • Tooth pain

  • Fevers

  • Ear discomfort or clogging sensation

Treatment of Sinusitis

If the inflammation of the sinuses is simply due to the common cold (which can actually be pretty nasty, hence nothing “simple” about it), it will self-resolve. There is no cure for viruses, and antibiotics only help bacterial infections, not viruses. Therefore, it’s highly recommended that you don’t jump to antibiotics during the first 7 days of a cold.

See also: Antibiotic Use and Overuse

If your sinusitis is deemed bacterial in nature by your doctor, sometimes antibiotics may be necessary. I still say sometimes, because even mild bacterial sinus infections can improve on their own without antibiotics. The severity of your symptoms will really determine whether the benefits of antibiotics outweigh the risks, and only your doctor can determine that for you. The antibiotic amoxicillin is often the first choice by most doctors for sinus infections (unless you are allergic to it or penicillin).

Here are some ways to treat your sinus symptoms without antibiotics (just check with your doctor first to make sure you can take some of these over-the-counter treatments):

  • Oral decongestants like phenylephrine or pseudoephedrine

  • Nasal sinus rinses with saline

  • Anti-inflammatory medications, like ibuprofen (again, please check with your doc first since it is not safe for everyone)

  • Vaporizer or humidifier

  • Hot baths/showers

  • Hot liquids to sip on all day long

Quick and Dirty Tip: Avoid over-the-counter medicated nasal sprays because they can actually worsen nasal congestion when the effects wear off.

My advice to most of my patient is to tough it out for 7-10 days after first developing nasal congestion using over-the-counter and non-prescription methods, but be seen after that if you are still feeling super snotty.

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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

Sinuses and Woman with Sinus Pain images from Shutterstock

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