Sinus Infection Symptoms: What They Are, How to Manage Them, and When to See a Doctor

Sinus infections can last anywhere from days to weeks, and during that time, you might experience a host of symptoms.

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Sinus infections are extremely common. In fact, each year, they affect more than 31 million people in the US and are the reason behind 16 million doctor visits, according to the American College of Allergy, Asthma, & Immunology (ACAAI).

And whether you've had one or not, you probably know that they're no fun. "A sinus infection is an uncomfortable condition that occurs when fluid and inflammation accumulate in one or more sinuses as a result of a virus, bacteria, or fungus," David A. Gudis, MD, chief of the Division of Rhinology and Anterior Skull Base Surgery at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, tells Health.

Sinuses—the air-filled pockets in the cheeks and forehead, as well as around the eyes—normally have healthy bacteria and mucus flow, he says. They have several purposes, including humidifying the air we breathe, helping our voice to resonate, and providing protection in the case of facial trauma. But when an infection occurs, the nose and sinuses can become swollen or inflamed—leading to a host of symptoms.

What are the most common symptoms of a sinus infection?

A sinus infection (aka, sinusitis) can last anywhere from 10 days to eight weeks, according to the ACAAI. During that time, you may experience a smattering of symptoms, such as:

Increased mucus from the nose

Most people already know this is a common sinus infection symptom, but what exactly are you looking for? With a sinus infection, the nasal discharge will be thicker rather than watery, according to Dr. Gudis. When you're not sick, normal mucus is very thin and watery, he explains—you probably don't even notice that it's being produced throughout the day.

And how about color? While sinus infections can be caused by a virus or bacteria, your mucus may look the same either way: "Contrary to popular belief, yellow and green nasal discharge from your nose does not mean that you have a bacterial sinus infection. Viruses can also cause yellow or green nasal discharge," he explains. Therefore, the color of your nasal discharge cannot automatically tell you whether you have a bacterial sinus infection—rather than a viral sinus infection—that might need to be treated with antibiotics.

Nasal congestion

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

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," Dr. Crosby explains.

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," Dr. Gudis explains. After all, the sinuses serve a very important function for the immune system, he says. "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, he says, is the sensation that people feel when there is more mucus or thicker mucus than usual.

Besides the feeling of your mucus being drained, the American Academy of Otolaryngology-Head and Neck Surgery reports that other symptoms of post-nasal drip include throat clearing, frequent swallowing, a raspy or gurgling speech, a sore irritated throat, and 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," says Dr. Gudis. You may notice that the pressure worsens when you lean forward, like to do something like tie your shoes, he says.

Decreased sense of smell

You might lose your sense of smell during a sinus infection. There are a couple reasons why it could happen. One is from 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 explains. "This is generally why we lose smell with colds or infections and smell returns when congestion decreases," she says.

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," Dr. Crosby says. "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, she adds, 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," Dr. Crosby explains.

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," she says. The reverse is also true: if you have an infection in a tooth, you may experience persistent sinusitis, per the Mayo Clinic.

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," Dr. Crosby says.

Fatigue comes from the energy required for your body to fight an infection, she explains. "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," Dr. Crosby says.

Ear fullness

A quick lesson on the Eustachian tube: It's 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 for mucus or fluid to build up.

"When the tube is blocked or has diminished function, you'll experience ear fullness and pressure," C. Matthew Stewart, MD, PhD, associate professor of otolaryngology, head and neck surgery at Johns Hopkins Medicine, tells Health. 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 a popping or clicking sensation, pain in one or both ears, ringing in your ears (aka, tinnitus), and trouble keeping your balance, per the American Academy of Family Physicians. Sounds might also seem muffled.

Fever

With a sinus infection, you may develop a fever—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, Dr. Gudis says. If your fever runs higher than that, it's worth calling a doctor, he adds.

How can you manage sinus infection symptoms?

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, or 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, per the Centers for Disease Control and Prevention (CDC). 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.

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," says Dr. Stewart. Only a health care 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 explains. "The patient can call back if symptoms persist. 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, she adds. "I recommend saline irrigations at the outset of any upper respiratory illness whether viral or bacterial as they are very helpful," Dr. Crosby says.

When should you see a doctor for sinus infection symptoms?

The CDC recommends that you see a doctor 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
  • Fever longer than three to four days

Right now, it's best to see a doctor sooner rather than later. "In the era of COVID-19, COVID testing for acute upper respiratory infections is wise and may help prevent exposure to others and guide care decisions when symptoms worsen," Dr. Stewart advises. A care provider can then help evaluate patients based on those test results and, if a sinus infection is suspected, they can also determine whether it's a viral or bacterial infection.

You should also seek medical care if you have had multiple sinus infections in the past year, the CDC suggests. That, or feeling as though your sinus infections never completely go away, may be signs of chronic rhinosinusitis (CRS), or chronic sinusitis, according to Dr. Gudis. A sinus infection is considered "acute" when it goes away before eight weeks, but it's considered "chronic" when it lasts longer than that, per the ACAAI.

CRS is not always related to infections and instead often represents a chronic inflammatory condition similar to asthma, explains 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," he says. "There are also sub-specialized otolaryngologists, called rhinologists, who focus specifically on the treatment of such conditions."

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