Sniffling, coughing, watery eyes. Of all the potential culprits behind these misery-making symptoms, a sinus infection (aka, sinusitis) is arguably the most misunderstood. It can masquerade as a bad cold, with the same stuffed-up nose, headache and mucus dripping down the back of your throat. It can produce the same runny nose and watery eyes that go along with seasonal allergies. It can even mimic COVID-19 caused by the omicron variant by way of fever and fatigue.
With all the overlap in symptoms, how can you know if sinusitis — which is most often caused by a virus but sometimes bacteria — is the culprit? Here’s what you need to know about sinus infections, including how to spot them, treat them and, better yet, prevent them.
Is it a sinus infection?
Symptoms may send mixed signals at first, but time will often tell. Whereas cold symptoms tend to improve within a week to 10 days, a sinus infection (particularly a bacterial sinus infection) lingers longer and without much improvement in symptoms. Sinus infections also tend to bring pressure — you may feel pain or tenderness in the face — as well as bad breath and yellow or green mucus (a cold is more likely to produce clear mucus).
Symptoms of a sinus infection
Common symptoms include:
- Runny nose
- Stuffy nose
- Facial pain or pressure
- Post-nasal drip
- Sore throat
- Bad breath
If it’s allergies (allergic rhinitis, or hay fever), symptoms arise after you come into contact with whatever you’re allergic to; dust, animal dander and pollen are common triggers. It’s important to know, too, that both a cold and allergies can morph into a sinus infection.
What is a sinus infection?
Your sinuses — those air-filled pockets located in your forehead, cheeks, at the bridge of your nose and way behind your eyes — are designed to warm, moisten and filter the air passing through. But when fluid builds up in these hard-to-reach spaces, germs can linger and multiply, resulting in an infection.
Say, for instance, you have an allergic response to pollen. “The inside of your nose has a ramped-up immune response, and that overreaction to the environment creates secretions in your nose, and those secretions build up over time,” explains Alfred Iloreta Jr., M.D., assistant professor of otolaryngology at the Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai in New York City. When that happens, the mucus in your nose becomes “a petri dish for a lot of other things to grow.”
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Sinus infections are surprisingly common (practically as common as an ordinary cold), affecting around 1 in 8 adults in the U.S. The following raise your risk of being that 1 in 8:
- A cold
- Smoking and exposure to secondhand smoke
- Structural problems within the sinuses (such as growths on the lining of the nose or sinuses, known as nasal polyps)
And although experts can’t say for certain, there’s reason to believe that people become more susceptible to sinus infections with age. “There are many ideas about why some older adults might be more prone to sinus infections or might have a more difficult time clearing a sinus infection,” says David Conley, M.D., associate professor of otolaryngology at Northwestern University’s Feinberg School of Medicine. Among the potential reasons is that the lining of the nose and sinuses, which provides a barrier against infections, becomes thinner over time, Conley says. And for some older adults, mucus often becomes thicker. Plus, a weakened immune system or taking drugs that weaken the immune system increases your risk of sinusitis.
How to treat sinusitis
The best way to get over a sinus infection? Wait it out. A viral sinus infection — the kind that’s caused by, say, a cold that progresses — usually gets better on its own within 14 days. To treat symptoms, the American Academy of Otolaryngology-Head and Neck Surgery recommends the usual suspects: acetaminophen or ibuprofen for pain and fever, decongestants to help you breathe easier and nasal saline sprays or what’s known as sinus irrigation with a neti pot to help remove mucus.
If your sinus woes last longer than 14 days, however, you probably have a bacterial sinus infection, which is “caused by a structural issue in your nose, a viral issue or an inflammatory/allergic issue,” Iloreta says. One of these typically sets the stage for a bacterial infection, “and there’s a domino effect.” At that point, you should see your doctor.
An antibiotic isn’t always the answer
Although antibiotics are often the go-to treatment for all sinus infections, they’re effective in treating only bacterial infections.
Research published in Annals of Family Medicine found that bacteria cause around 1 in 3 sinus infections, yet the majority of sinusitis sufferers are prescribed antibiotics. That sort of unnecessary antibiotic use is more than just pointless; it’s one of the leading contributors to antibiotic-resistant infections, according to the Centers for Disease Control and Prevention. Probably 7 in 10 people with a sinus infection who seek treatment from their doctor are prescribed an antibiotic and shouldn’t be, Iloreta says.
“The over-prescription of antibiotics is setting patients up for worse infections in the future if they don’t truly have a bacterial infection,” he adds. “The microbiome is the normal bacteria in your nose — we have hundreds of thousands of species of bacteria in our body that are good for us — and even just one dose [of antibiotics] changes it significantly. Oftentimes that change will predispose you to having worse bacterial infections.”
To diagnose a bacterial sinus infection, your doctor will typically look at the symptom duration. Both viral and bacterial infections tend to produce the same symptoms; a combination of headache, fatigue, ear pain, cough, loss of smell, general malaise and difficulty sleeping is common, Iloreta says. But sinusitis caused by a virus tends to clear faster.
Preventing a sinus infection
To prevent sinus infections altogether, borrow strategies from your cold-prevention playbook. Most notably, “practicing hand hygiene is the easiest way to prevent a sinus infection,” Iloreta says. “Sinus infections come from chronic allergies, or chronic inflammation in the nose, so by treating your allergies — taking antihistamines, avoiding pollen exposure — you’ll also help prevent subsequent sinus infections.”
Kimberly Goad is a New York–based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Men’s Health and Reader’s Digest.