Sinus infection symptoms: What are the early signs of sinus infection?

Overview: What does a sinus infection feel like?

Sinus infections are common and, except in rare cases, not a serious health threat. The sinuses are air-filled spaces in various parts of the head: between the eyes and behind the nasal passages, above the eyes and behind the forehead, and below the eyes and behind the cheeks. A sinus infection, also known as sinusitis or rhinosinusitis, can cause symptoms similar to the common cold, but it is unique in several ways. 

Infected and swollen sinuses can cause pain or pressure in the face as well as a feeling of fullness or congestion. The nose may feel blocked or runny, and nasal discharge may have an unusual color. Mucus may also run down the back of the throat. Other symptoms of a sinus infection may include a low-grade fever, tooth pain, headache, and ear pain.

What are the early signs of a sinus infection?

The early signs of a sinus infection are typically a stuffy nose, runny nose, nasal swelling, and postnasal drip. As the infection spreads throughout the sinuses, other symptoms like facial pain, sinus pressure, headache, and fever can occur. Many people with a sinus infection start with a common cold. About 90% of people with a common cold develop some form of sinus infection, a condition called rhinosinusitis. So, for many people, the earliest symptoms may be reminiscent of cold symptoms.

Other sinus infection symptoms

While the early signs of a sinus infection are nasal congestion, runny nose, nasal swelling, and postnasal drip, other sinus infection symptoms may include:

• Fever

• Sinus pain or pressure

• Sinus congestion (a feeling of fullness in the face)

• Facial swelling

• Darkened or colored nasal discharge

• Thick nasal discharge

• Headache

• Earache

• Loss of smell

• Weakness

• Fatigue

• Tooth pain

• Cough

• Sore throat

• Bad breath

• Swollen lymph nodes in the neck

Many of these symptoms are common symptoms of seasonal allergies or allergic rhinitis. Seasonal allergies, however, have other symptoms, such as watery, itchy eyes and sneezing. Symptoms of allergies often improve by taking an OTC oral antihistamine. The same, however, is not true for a sinus infection caused by bacteria or viruses. In fact, one of the diagnostic criteria for a sinus infection is a poor response to antihistamines or decongestants.

Sinus infection vs. cold vs. COVID-19 symptoms

The symptoms of a sinus infection, common cold, and COVID-19 illness can overlap, but these illnesses are not the same. A sinus infection is concentrated in the sinuses, and it is often caused by bacteria or viruses. The common cold and COVID-19 are caused by viruses. The common cold typically affects the upper respiratory tract, while COVID-19 can affect the upper and lower respiratory tract. In some cases, the common cold or COVID-19 may lead to a sinus infection.

Types of a sinus infection: How can I tell which one I have? 

A sinus infection can be classified based on the microbe responsible for the infection: bacterial, viral, or fungal. Unfortunately, it’s not possible to determine if a sinus infection is viral, bacterial, or fungal from symptoms alone. Only a healthcare professional can identify the cause of a sinus infection based on symptoms, certain tests, and a physical exam.

Sinus infections are also divided into four stages depending on their onset and duration:

• An acute sinus infection comes on suddenly and produces upper respiratory tract symptoms for two to four weeks.

• A subacute sinus infection lasts for four to 12 weeks.

• A chronic sinus infection has symptoms that last for 12 weeks or longer.

• Recurrent sinus infections are defined as four or more sinus infections in a given year.

When to see a doctor for sinus infection symptoms

See a doctor if symptoms worsen after 10 days or start to worsen after improving. If you are taking antibiotics, call a doctor if symptoms don’t improve or get worse after a week of therapy. This may be a sign that the bacteria are resistant to the drugs.

Other signs that a sinus infection needs medical attention include:

• High fever

• Persistent fever, lasting longer than three to four days

• Severe headache that does not respond to OTC pain relievers

• Facial pain

• Vision changes

• Confusion, disorientation, or cognitive problems

A sinus infection is primarily diagnosed based on symptoms and a physical examination. The healthcare provider may shine a light directly against the face to see the outlines of the inside of the sinus. An ear, nose, and throat specialist may insert a fiberoptic scope into the sinus to get a precise look. These tests can aid a provider in knowing whether the sinuses are open or filled with mucus or pus. An X-ray, CT scan, or MRI may be taken to get a better image of the sinuses. For chronic or antibiotic-resistant infections, a nasal culture may be needed to identify the microbe causing the infection. Other possible tests include allergy and blood tests.

Complications of sinus infections

Possible complications of sinus infections include:

• Chronic sinus infection

• Infection of the frontal bone

• Blood clots

• Vision problems

• Blindness

• Skin infection around the eyes (periorbital cellulitis)

• Abscess or infection around or in the brain

• Infections of the tissue surrounding the brain (meningitis)

How to treat sinus infection symptoms

Most sinus infections can be treated at home with OTC nasal decongestants, such as Sudafed (pseudoephedrine), and analgesics, such as Tylenol (acetaminophen) or Advil (ibuprofen). Other effective home treatments include warm compresses, steam, nasal saline sprays, humidifiers, and drinking plenty of fluids.

Medical treatment is rarely required for a sinus infection. However, a bacterial infection of the sinuses will need to be treated with antibiotics. Acute sinusitis usually requires five to seven days of antibiotics, but chronic sinusitis may require three or more weeks of antibiotics. For severe sinus infections, oral corticosteroids may help reduce swelling. For chronic sinus infections, surgery may be needed to widen the sinus opening or fix structural defects that increase the risk of sinus infections. Surgery may be used for fungal infections, which can also be treated with antifungal medications, a nasal wash, or steroids. 

Living with sinus infections 

If sinus infections keep recurring, a few at-home tips may help relieve symptoms or keep them at bay:

• Avoid allergens that trigger allergic rhinitis

• Avoid people with respiratory illnesses through safe distancing

• Avoid irritants like cigarette smoke or pollution

• Use an air purifier to reduce allergens or irritants

• Use a humidifier to keep nasal passages and sinuses from drying out

• Use saline nasal sprays or a saltwater neti pot to keep nostrils clear of irritants and allergens

• Consider surgery if there’s a structural problem with the nasal passages, such as nasal growths

• Consider sinus surgery to widen the sinus openings

FAQs about sinus infection symptoms

How long do sinus infection symptoms last?

The duration of a sinus infection depends on the cause. Viral sinus infections generally last for less than two weeks, while bacterial sinus infections can last for 10 days to several weeks. Fungal infections are usually chronic and can last for about three months or longer. 

What are the symptoms of a fungal sinus infection?

Fungal sinus infections can cause similar symptoms as viral or bacterial sinus infections. These symptoms include swelling of the sinuses, nasal congestion, pain or discomfort in and around the sinus area, headache, and fever. Serious symptoms may include eye swelling, vision changes, skin color changes, severe swelling of the face, and behavioral or mental changes. Some types of fungal sinus infections have no symptoms until the infection invades the bone, blood vessels, or nerves in the head. At that point, symptoms can become severe.

What are the signs of a sinus infection getting better?

An improvement in the symptoms of sinusitis usually means the infection is getting better. Breathing should become easier as nasal blockage clears and inflammation improves. If symptoms get better and then start to worsen, talk to a healthcare professional.

What’s next? Additional resources for people with sinus infection symptoms

Test and diagnostics

• Fungal sinusitis, StatPearls

• Sinusitis, StatPearls

Treatments

• Sinus infections treatments and medications, SingleCare

Scientific studies and clinical trials

• Invasive and non-invasive fungal rhinosinusitis—a review and update of the evidence, Medicina

More information on related health conditions

• Allergy treatments and medications, SingleCare

• Common cold treatments and medications, SingleCare

• Is it allergies or a sinus infection?, SingleCare

• Is it a sinus infection or COVID-19?, SingleCare