The Call-On-Doc Guide to Sinus Infections

Symptoms can vary in severity and may include:

• Nasal congestion (stuffy or blocked nose)

• Thick nasal drainage (may drain from the nose or down the throat)

• Postnasal drip and cough, often worse at night

• Facial pressure or pain, especially around cheeks, eyes, or forehead

• Headache or pressure that worsens when bending forward

• Reduced smell or taste

• Fatigue

• Bad breath (often from trapped mucus and mouth breathing)

• Ear pressure/fullness

• Low-grade fever (more common early, especially with viral infections)

Note: Colored mucus (yellow/green) can occur with viral infections too and doesn’t automatically mean you need antibiotics.

Many cases start after a cold. Clinicians often consider acute bacterial rhinosinusitis more likely when one of these patterns occurs:

1. Persistent symptoms lasting 10 days or more without improvement

2. Severe symptoms for at least 3–4 days, such as high fever (≥102°F / 39°C) plus significant facial pain and purulent nasal discharge

3. “Double-worsening”: you begin to improve from a cold, then symptoms worsen again (often after 5–7 days), with increased congestion, facial pain, or fever

If you have chronic sinusitis, allergies, nasal polyps, or frequent colds, your risk of recurrent sinusitis may be higher.

Sinusitis can be triggered by more than one factor. Common causes include:

• Viral infections (most common)

• Allergies (pollen, dust, animal dander) causing inflammation and blockage

• Bacterial infections (less common; usually follows a viral illness)

• Dental infections (can spread into the maxillary sinuses)

• Deviated septum or structural blockage

• Nasal polyps causing obstruction and chronic inflammation

• Fungal sinusitis (rare; more likely in people with immune compromise)

A viral infection can inflame the sinuses and block drainage, creating conditions where bacteria may overgrow—this is why some cases “turn bacterial.”

• Acute viral sinusitis: commonly improves within 7–10 days, though cough and congestion may linger up to 2 weeks

• Acute bacterial sinusitis: may last longer and can improve with appropriate treatment

• Chronic sinusitis: symptoms lasting 12 weeks or longer, often related to ongoing inflammation rather than a single infection

Sinusitis itself isn’t always contagious, but the viruses that commonly trigger it are. If your sinusitis started with a cold, you can spread that virus through respiratory droplets and contaminated hands/surfaces.

Good prevention habits:

• Wash hands regularly

• Cover coughs/sneezes

• Avoid close contact when actively sick

Symptoms overlap, but these patterns can help:

More suggestive of viral sinusitis:

• Symptoms improve gradually within a week

• Mild fever or no fever

• Clear or slightly cloudy mucus (though it can still become colored)

More suggestive of bacterial sinusitis:

• Symptoms persist ≥10 days without improvement

• Severe symptoms early (high fever, significant facial pain)

• Double-worsening after initial improvement

A medical evaluation is the most reliable way to determine next steps.

Seek prompt medical care if you have:

• Fever ≥102°F / 39°C with severe facial pain

• Swelling or redness around the eyes

• Vision changes, double vision, or eye pain

• Severe headache, stiff neck, confusion, or worsening neurological symptoms

• Persistent symptoms beyond 10 days with no improvement

• Significant worsening after initial improvement

• Immune compromise or serious underlying conditions

Complications are rare but can occur if infection spreads. Potential complications include:

• Orbital cellulitis (infection around the eye)

• Abscess formation

• Meningitis (rare)

• Osteomyelitis (infection of facial bones)

• Worsening asthma or chronic airway irritation

Red-flag symptoms (eye swelling, vision changes, severe headache, confusion) require urgent evaluation.

Treatment depends on cause and severity:

Symptom relief (often first-line)

• Saline nasal irrigation or saline sprays

• Intranasal corticosteroid sprays (especially if allergies are a contributor)

• Pain/fever relief with acetaminophen or ibuprofen (as appropriate)

• Hydration and rest

Decongestants

• Oral decongestants may help some people but can raise blood pressure or worsen anxiety/insomnia

• Topical nasal decongestant sprays should be limited to 3 days to avoid rebound congestion

Antibiotics

Antibiotics are considered when bacterial sinusitis is likely (persistent ≥10 days, severe early symptoms, or double-worsening). Antibiotics won’t help viral sinusitis.

Other options

If symptoms are recurrent or chronic, clinicians may consider allergy management, imaging, ENT evaluation, or (in select cases) procedures.

Helpful home care includes:

• Saline rinses/irrigation

• Warm showers or steam to loosen mucus

• Warm compresses for facial pressure

• Staying hydrated (water, broths, tea)

• Avoiding smoke and strong irritants

• Rest and pacing activity

If symptoms persist, worsen, or you develop red-flag symptoms, seek medical care.