The Difference Between a Sinus Infection and a Cold

Nope, they're not the same thing.

At least once a year, Anna Lord, a 32-year-old from Seattle, has "almost unbearable pain" behind her eyes, cheeks, and forehead. Sometimes she has sinus drainage, and occasionally the discomfort arrives with a low-grade fever. Her symptoms often occur after she has had a cold or allergy symptoms. She rarely takes antibiotics, preferring to rest and soldier through her sickness.

Lord's symptoms sound a lot like your run-of-the-mill cold, but she's actually prone to acute bacterial sinusitis, a type of sinus infection. But the two conditions—the common cold and sinus infections—have similar enough symptoms that they're often confused.

So how do you tell if you have a cold versus a sinus infection? Unfortunately, it's not a clear-cut answer. "The distinction can be difficult and no one rule applies to everybody," said Neil Bhattacharyya, MD, a professor of otolaryngology at Harvard Medical School. "Only about 2% to 6% of common colds progress to become a true bacterial sinus infection that could benefit from antibiotics," Dr. Bhattacharyya told Health. Here's what you need to know about both types of illnesses.

Defining Sinus Infection and a Cold

According to the American College of Allergy, Asthma, and Immunology, each year, about 31 million people experience sinus infections—also called sinusitis—which is usually caused by germs growing in the sinuses, the hollow cavities found behind the nose, eyes, brows, and cheekbones.

Most often, viruses cause sinus infections, but bacterial infections can cause sinusitis too, according to the Centers for Disease Control and Prevention (CDC). The CDC says that bacterial or viral infection causes mucous membranes in the sinuses to swell and block the tiny openings into the sinuses, which interferes with their ability to drain. The trapped mucus allows bacteria to breed, causing pain and pressure in the head and face.

Colds are mild viral upper respiratory infections, and they are not caused by a buildup of germs and inflammation in the sinuses. However, a cold can lead to a sinus infection.

And according to the CDC, antibiotics can be helpful for those with bacterial sinus infections, but these medications are useless when it comes to fighting cold viruses or viral sinus infections.

Symptoms

While some symptoms of a cold and a sinus infection may be similar—runny nose, headache, fatigue—there are some differences.

The main difference between the symptoms of a cold and sinus infection is how long they linger. Dr. Bhattacharyya said cold sufferers typically have a runny nose for two to three days, followed by a stuffy nose for two to three days. After that, most people begin to feel better.

The CDC notes that the following symptoms are common with colds:

  • Sneezing
  • Stuffy nose
  • Runny nose
  • Sore throat
  • Coughing
  • Mucus dripping down your throat (post-nasal drip)
  • Watery eyes
  • Fever (although most people with colds do not have fever)

Alternately, sinus infections usually last a bit longer than a common cold and may hang around for seven days or more. A fever may also signal a bacterial infection. As Lord can attest, sinus infections are sometimes accompanied by a low-grade fever, while colds typically are not. Other viral infections (such as the flu) do cause fevers, however.

Here's what the CDC says about the other symptoms of sinus infections:

  • Runny nose
  • Stuffy nose
  • Facial pain or pressure
  • Headache
  • Mucus dripping down the throat (post-nasal drip)
  • Sore throat
  • Cough
  • Bad breath

The color of your nasal discharge can clue you in about whether you have a cold or sinusitis. According to a 2022 review published in Marine Drugs, unlike colds, which generally produce clear mucus, bacterial infections can produce greenish or yellow mucus. However, viruses sometimes produce colorful discharge as well, so this isn't considered a fail-safe test.

Dr. Bhattacharyya said there is no rhyme or reason as to why some people tend to develop sinus infections and others don't. But, according to the Marine Drugs review, some people have nasal polyps or other problems, including allergies, which can increase their risk of chronic sinus infections.

Treatment

For most people, there are some preventive measures that can help stave off a sinus infection, or, if one occurs, help relieve symptoms, William Marshall, MD, an infectious disease specialist previously on staff at the Mayo Clinic, told Health. Dr. Marshall recommended the same things "mothers recommend for a cold," like rest, drinking lots of fluids, breathing steam, and irrigating the sinuses with saline spray or a neti pot, a container used to rinse the sinuses with saline solution.

Over-the-counter decongestants can also be helpful, but Dr. Marshall said they should not be used for more than three days because some products can exacerbate congestion and raise patients' blood pressure and heart rate.

Bacterial sinus infections typically last for about 14 days, but the use of antibiotics speeds up the recovery process by up to five days. Still, according to Dr. Bhattacharyya, about 70% of sinus infections resolve on their own, and many patients, like Lord, prefer to let them run their course.

"Antibiotics mainly help to speed up the healing process," Dr. Bhattacharyya said. "But before antibiotics were around, people weren't dropping dead of sinus infections—and they still aren't," Dr. Bhattacharyya explained.

If left untreated, however, sinusitis can cause permanent damage to the sinuses and, in very rare cases, can lead to meningitis, Dr. Marshall said. If patients miss work or other activities due to sinus infections, or if their symptoms recur frequently, they should see a healthcare provider for evaluation.

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