Medically reviewed
We’ve all experienced the common cold symptoms of a runny nose, nasal congestion, and sinus pressure. But sometimes these symptoms can indicate something different: sinusitis, or a sinus infection. Sinusitis can be viral or bacterial. Knowing which one you have can be helpful for treating sinus infection symptoms and helping ensure you feel better fast.
In this article, I will describe the symptoms of both viral and bacterial sinusitis. I will also talk about the causes of each, how they’re diagnosed, and what your treatment options are.
What Is Sinusitis? (Bacterial vs. Viral)
Sinusitis is caused by the inflammation of your sinuses, which are air-filled cavities around your facial and nasal passages. It can be divided into different subcategories, based on how long it lasts.
- Acute: Acute sinusitis lasts a month or less
- Subacute: Subacute sinusitis lasts 1-3 months
- Chronic: Chronic sinusitis lasts at least three months, and can last for years
- Recurrent: Recurrent sinusitis occurs when there are several acute attacks within a year
Bacterial vs. viral sinusitis
Sinusitis is also classified by whether it’s viral or bacterial.
A viral sinus infection is much more common than a bacterial one. With viral sinusitis, a virus infects the lining of your facial and nasal cavities. It is typically caused by a viral upper respiratory infection.
A bacterial sinus infection is caused by bacteria infecting the lining of your facial and nasal cavities. It is usually caused by a virus first, with the bacterial infection coming later. This often starts in the nasal cavity before spreading to the sinuses.
Did You Know?
Bacterial sinusitis is much less common than viral sinusitis—0.5-2.0% of cases are bacterial and they usually occur as a complication of viral sinusitis.
Sinusitis Symptoms
Both bacterial and viral sinusitis share common symptoms, including:
- Postnasal drip
- Congestion
- Pain or swelling in the sinus area (on your cheeks and forehead)
- Fever
- Yellow or green nasal discharge
- Runny or stuffy nose
- Sore throat
- Toothache
- Bad breath
- Cough
- Fatigue
However, the two vary considerably in their durations. If you have a viral sinus infection, you’ll typically start to feel better in 5-7 days. Symptoms unique to bacterial sinusitis include:
- Your condition gets much worse after you seem to be improving
- You have a high fever of 100° F (37.8°C) or higher
- Symptoms lasting longer than 7-10 days
How to tell if it’s more than a cold
I tell my patients that a common cold’s initial symptoms usually only last for a few days before they start to improve. The symptoms of viral and especially bacterial sinusitis will last longer, and can linger anywhere from two weeks to over three months in the case of chronic sinusitis.
Causes of Sinusitis
Sinusitis can be caused by a number of conditions. These can include:
- Nasal polyps: These are small growths in the lining of the nose. They may be asymptomatic, but larger polyps can block the normal sinus pathways and predispose to sinusitis. They can be caused by long-term inflammation but can also be hereditary.
- Having a cold: The swelling inside the nose from a cold can cause sinusitis.
- Nasal cavity structure: Any structural difference that changes the ducts, such as a deviated septum, which is a shift in the nasal cavity, can cause sinusitis.
- Allergic rhinitis: Also known as hay fever, allergic rhinitis is a swelling of the nose’s lining and can be seasonal or year-round. Symptoms can include a runny nose, fatigue, itchy eyes, and sneezing.
How Are Bacterial and Viral Sinusitis Diagnosed?
Although most cases are viral, it’s important to appropriately identify whether your sinus infection is viral or bacterial. Differentiating between the two often comes down to the duration and severity of their symptoms. When meeting with a patient who has sinusitis, I first ask about their health history, as well as what their symptoms are and how long they’ve had them. More tests aren’t usually needed, though if a patient has had several bouts of acute sinusitis the following tests might be used:
- CT scan: A CT scan can show more information regarding your sinuses and nasal cavity.
- Nasal endoscopy: A nasal endoscopy is a procedure where a doctor places a thin tube with a camera into the nasal cavity and sinuses. It can show whether a blockage is responsible for the symptoms, such as a tumor or polyp. A culture can show which type of bacteria is causing the infection, and the best antibiotic to treat it.
The Infectious Disease Society of America’s clinical practice guidelines state that a sinus infection is likely bacterial in nature if the following are present:
- The infection lasts at least 10 days without evidence of clinical improvement.
- The infection is severe, including a fever exceeding 102° F (38.9° C). There is also post nasal drip and tenderness in the face that lasts for at least 3-4 consecutive days at the beginning of the illness.
- The symptoms worsen after initially improving, characterized by onset of a new fever, headache, or nasal discharge, typically following a viral upper respiratory infection that lasted 5-6 days.
Did You Know?
Distinguishing an upper respiratory infection (URI) from viral sinusitis is challenging. 20-40% of children diagnosed with viral sinusitis most likely just have a URI, according to this study.
Sinusitis Treatment Options
I often see patients who think that antibiotics will solve their symptoms and want to begin a round immediately. However, at home remedies can improve symptoms in the vast majority of cases. One in seven adults has sinusitis every year, with most having viral sinusitis and not needing antibiotics. Home treatment options can include:
- Drinking plenty of water: Staying hydrated can help clear congestion and loosen mucus.
- Rest: Many people feel tired. Ample rest can help your body heal.
- Neti pot: A Neti pot is a small container with a spout that you fill with warm, sterile salt water. You pour the water in one nostril and let the mucus/discharge come out the other.
- Saline spray: Saline can help rinse the nasal passages. Frequent doses of saline can help decongest the mucus.
- Nasal decongestant: An over-the-counter nasal decongestant can be a short-term way to improve sinus infection symptoms. However, they should not be used for more than three consecutive days.
Treatment for bacterial sinusitis
Antibiotics might be used as a treatment option if it’s a bacterial infection. The IDSA guidelines advise a five to seven-day course of antibiotics to treat the infection.
Treatment for viral sinusitis
Viral sinusitis typically goes away on its own and can’t be helped with antibiotics. Symptoms can be alleviated by home treatment options outlined above.
Sinusitis Prevention
To avoid sinusitis, you should be sure to:
- Wash your hands: Washing your hands can help prevent the spread of germs and colds that can lead to sinusitis
- Don’t smoke: Smoking can irritate your nose and sinuses
- Manage your allergies: Keeping your allergies under control can help you avoid sinusitis
- Swim in salt water, not chlorine: Salt water pools are less irritating to your sinuses than chlorinated pools
- Stay hydrated: Drinking plenty of water will help keep your mucus thin
Related Conditions and Risk Factors
Sinusitis is a type of upper respiratory infection. Upper respiratory infections are infections that occur in your upper respiratory tract, which consists of your nose, sinuses, and throat. The common cold is a type of URI. Others types of URI’s, besides the common cold, include:
- Laryngitis: Inflammation of the larynx, which is an organ that contains our vocal cords.
- Pharyngitis: Inflammation of the pharynx, which is the part of the throat behind your nose and mouth.
If left untreated, there can be rare but serious complications. A sinus infection can spread to the eyes, causing a range of symptoms ranging from swelling to (in especially severe cases) blindness. Infectious sinusitis can also, uncommonly, lead to meningitis, the inflammation of the membranes surrounding the brain and spinal cord, or osteomyelitis, an infection to the bones of the skull.
When to See a Doctor
You should make an appointment to see your doctor if your symptoms last longer than five to seven days, persist despite trying the home remedies outlined above, include high fever or severe facial pain, or keep returning. You should also call a doctor or go to an emergency room immediately if you experience the following:
- Confusion: This could be a sign of a serious condition
- Swelling around the eyes or vision abnormalities: This could indicate that your sinusitis is spreading to the eyes
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