Sinus Infection Symptoms, Treatment, and When To Seek Medical Care

Sinus infections are extremely common. In fact, each year, they affect more than 31 million people in the U.S. and are the reason behind 16 million visits to a healthcare provider. Whether you've had one or not, you probably know that they're no fun and can cause symptoms such as:

• Increased mucus
• Nasal congestion
• Post-nasal drip
• Facial pain or pressure
  
• Decreased sense of smell
• Tooth pain

If you have allergies, asthma, or a weak immune system, you are at a greater risk for sinus infections.

What Is a Sinus Infection?

Sinuses—the air-filled pockets in the cheeks, forehead, and around the eyes—typically have healthy bacteria and mucus flow. They have several purposes, including:

• Humidifying the air we breathe
• Helping our voice to resonate
• Providing protection in the case of facial trauma

A sinus infection, called sinusitis, is when fluid builds up in your sinuses, allowing bacteria, fungi, or viruses to grow. When an infection occurs, the nose and sinuses can become swollen or inflamed—leading to a host of symptoms.

Common Symptoms of a Sinus Infection

An acute sinus infection can last anywhere from three to eight weeks. If the infection lasts longer than that, it is considered a chronic sinus infection. During that time, you may experience a several symptoms.

Increased Mucus

Most people know this is a common sinus infection symptom, but what exactly are you looking for?

When you're not sick, normal mucus is very thin and watery, said David A. Gudis, MD, chief of the Division of Rhinology and Anterior Skull Base Surgery at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital. Dr. Gudis said you probably don't notice it being produced throughout the day.

With a sinus infection, the nasal discharge will be thicker rather than watery, according to Dr. Gudis.

What about color? While a virus or bacteria can cause sinus infections, your mucus may look the same either way: "Contrary to popular belief, yellow and green nasal discharge from your nose does not mean you have a bacterial sinus infection. Viruses can also cause yellow or green nasal discharge," Dr. Gudis explained.

Therefore, the color of your nasal discharge cannot automatically tell you whether you have a bacterial sinus infection rather than a viral one that might need to be treated with antibiotics.

Nasal Congestion

A runny nose and congestion? It happens. Most people with sinus infections have the two simultaneously, Dana L. Crosby, MD, department chair and director of otolaryngic allergy at Southern Illinois University School of Medicine, told Health.

"Typically, when there is a pathogen (virus or bacteria) that has caused an infection in the nose, it causes inflammation which leads to swelling of the lining of the nose that causes congestion/stuffiness," said Dr. Crosby. When the tissue becomes inflamed, it also creates more mucus and discharge—the runny nose portion.

"Sometimes you could be more congested and have a less runny nose or vice versa, but usually both are present to some extent," explained Dr. Crosby.

Post-nasal Drip

Throughout the day, everyone's nose and sinuses produce clear, thin mucus that goes down the back of the throat and is swallowed. "It may sound gross, but it's important and healthy," explained Dr. Gudis. After all, the sinuses serve an essential function for the immune system.

"The total surface area of all the mucus membranes in the nose and sinuses allows our immune system to interact with the world around us. This process is part of how our bodies learn when to attack, like for a virus, and when not to, like against our own bodies."

Post-nasal drip is the sensation people feel when there is more or thicker mucus than usual. Besides the feeling of your mucus being drained, other symptoms of post-nasal drip include:

• Throat clearing
• Frequent swallowing
• A raspy or gurgling speech
• A sore, irritated throat
• A feeling of a lump in the throat

Facial Pain or Pressure

Another possible sign of a sinus infection: facial pain. "Sinus infections can cause a feeling of pressure, squeezing, or congestion in the cheeks, between the eyes, or in the forehead," said Dr. Gudis.

You may notice that the pressure worsens when you lean forward, like to tie your shoes, said Dr. Gudis.

Decreased Sense of Smell

You might lose your sense of smell during a sinus infection. There are a couple of reasons why it could happen.

The first possibility is congestion. The swelling blocks the smell molecules from getting into the nose, where the molecules would typically contact the smell nerve that hangs down from the brain into the nose, Dr. Crosby explained. "This is generally why we lose smell with colds or infections, and smell returns when congestion decreases," said Dr. Crosby.

The second potential culprit of the sensory change is damage to the smell nerve itself. "This can occur without congestion and is most commonly associated with viruses," said Dr. Crosby.

"Viruses seem to be able to cause injury to the smell nerve in a number of possible different ways. This is how people with COVID-19 who don't experience congestion can still lose their sense of smell." This can be temporary or permanent, Dr. Crosby added, but it usually resolves itself.

Tooth Pain

Believe it or not, a sinus infection can lead to tooth pain, typically in the top molars (back teeth). "It is possible to have pain in these teeth on one or both sides depending on the extent of infection," said Dr. Crosby.

Why? It's normal for the roots of the top molars to extend into the sinus, where there's inflammation during a sinus infection. "Because they are in such close proximity to the infection, they can hurt too," said Dr. Crosby. The reverse is also true: if you have an infection in a tooth, you may experience persistent sinusitis.

Decreased Energy

When you have a sinus infection, you might also experience a general sense of fatigue and less energy to spend on your normal activities. "Even though the infection might be isolated to the sinuses, it has full body/systemic effects of making people feel tired or run down," said Dr. Crosby.

Fatigue comes from the energy required for your body to fight an infection, Dr. Crosby explained. "Also, the body releases substances as part of the response to an infection, and while the goal of these substances is to fight the infection, they also can cause fatigue," said Dr. Crosby.

Ear Fullness

The Eustachian tube is an opening that connects the middle ear to your throat. It helps keep air pressure and fluid from building up inside your ear. The inflammation that comes with a sinus infection can cause the tube itself to get inflamed and mucus or fluid to build up.

"When the tube is blocked or has diminished function, you'll experience ear fullness and pressure," said C. Matthew Stewart, MD, Ph.D., associate professor of otolaryngology, head and neck surgery at Johns Hopkins Medicine.

That's why, with a sinus infection, you may feel like your ears are full. It's called Eustachian tube dysfunction. Besides a "full" or "plugged" feeling in your ears, you might also experience:

• Popping sounds
• Reduced hearing
• Ringing in your ears (tinnitus)
• Trouble keeping balance

Fever

You may develop a fever with a sinus infection—a sign that your body is trying to fight off an infection.

Low-grade fevers—under 101 degrees Fahrenheit—are common from viral sinus infections, said Dr. Gudis. If you have a fever for more than three to four days, you should see a healthcare provider.

When To Seek Medical Care

Seeking medical care is important so that a healthcare provider can help evaluate you based on test results and determine if you have a sinus infection, cold, COVID-19, or something else. If a sinus infection is suspected, they can also decide whether or not it's a viral or bacterial infection.

Here's how to know when you should see a healthcare provider.

If You Have Severe Symptoms

In addition to a fever that lasts longer than three to four days, you should see a healthcare provider if you have:

• Severe symptoms, such as severe headache or facial pain
• Symptoms that get worse after initially improving
• Symptoms lasting more than 10 days without improvement
  

If You Have Had Multiple Sinus Infections

You should also seek medical care if you have had multiple sinus infections in the past year. That, or feeling as though your sinus infections never completely go away, may be signs of chronic rhinosinusitis (CRS), or chronic sinusitis.

A sinus infection is considered "acute" when it goes away before eight weeks, but it's considered "chronic" when it lasts longer than that.

CRS is not always related to infections and instead often represents a chronic inflammatory condition similar to asthma, said Dr. Gudis. "If you feel that your symptoms last for months rather than days or weeks, then it is worth seeing an otolaryngologist, or ear, nose, and throat specialist," said Dr. Gudis.

"There are also sub-specialized otolaryngologists, called rhinologists, who focus specifically on the treatment of such conditions," said Dr. Gudis.

Sinus Infection Treatment

Sinus infection treatment varies depending on what is causing your infection. If your infection is bacterial, you may need an antibiotic. If your infection is viral, you'll just have to wait it out. But there are some things you can do to help your symptoms.

Treatment for Viral Sinus Infections

Most sinus infections are caused by viruses and start to get better on their own within the first four or five days of symptoms. With a viral infection, you might get some symptom relief by turning to:

• Over-the-counter pain medication
• Nasal saline rinses
• Nasal irrigation
• Steroid nasal sprays

Putting a warm compress over the nose and forehead to help relieve sinus pressure or breathing in steam from a bowl of hot water or the shower might also help you manage your symptoms.

One thing that won't help you if you have a sinus infection caused by a virus are antibiotics, according to Dr. Stewart, as antibiotics aren't effective against viral infections.

Treatment for Bacterial Sinus Infections

What if it's not a viral sinus infection? "Bacterial sinusitis is suspected when the symptoms continue for at least 10 days or if the symptoms worsen with or without initial improvement," said Dr. Stewart. Only a healthcare provider can delineate between a viral and bacterial sinus infection.

In the case of a bacterial sinus infection, antibiotics are sometimes the answer—but even then, you may be able to clear a bacterial sinus infection without antibiotics.

This is why one of the options for treatment is a shared decision-making model with patients in which the physician and patient might decide to wait to proceed with an antibiotic, Dr. Crosby explained.

"The patient can call back if symptoms persist," said Dr. Crosby. "Often, even if a patient has had a sinus infection for two weeks or so if the patient is reliable and has the means, the physician and patient can discuss holding off on an antibiotic for a few more days."

This is reasonable when symptoms are tolerable, said Dr. Crosby. "I recommend saline irrigations at the outset of any upper respiratory illness, whether viral or bacterial, as they are very helpful," said Dr. Crosby.

A Quick Review

Sinus infections can be irritating and cause symptoms like Increased mucus, nasal congestion, post-nasal drip, facial pain or pressure, decreased sense of smell, and tooth pain.

Most sinus infections will get better on their own, but some may need antibiotics. Treatment will depend on what kind of sinus infection you have and how severe it is. If you have been having sinus infection symptoms for over 10 days, talk to a healthcare provider.