Symptoms of a Sinus Infection

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sinus infection is one of the most common complications that can occur after a cold or allergy attack. It can be difficult to tell when a regular cold has turned into a sinus infection, which is also called sinusitis, but some key indications include pain and pressure in the face; thick green or yellow mucus; and upper/back toothache. While most symptoms resolve in two weeks or less (with or without treatment, depending on the cause), you may also develop a chronic sinus infection that can linger for months.

acute sinusitis symptoms
© Verywell, 2018

Frequent Symptoms

The symptoms of a sinus infection often develop following a respiratory infection like a cold or after a bout of allergic rhinitis. Sinusitis is classified based on how long you have had the symptoms:

  • Acute sinusitis: Symptoms for less than four weeks
  • Subacute sinusitis: Symptoms for four to 12 weeks
  • Chronic sinusitis: Symptoms for 12 weeks or more, often with milder symptoms that may be mistaken for allergies
  • Recurrent sinusitis: Four or more sinus infections in a year, each lasting at least seven days but getting completely better between episodes 

Acute Sinus Infection

Symptoms of an acute sinus infection include:

  • Pain, pressure, and tenderness in the face, often around your eyes, forehead, and cheeks, which may also display swelling. It often worsens when you lean forward.
  • Nasal congestion that makes it hard to breathe through your nose
  • Thick greenish or yellow mucus draining from your nose and down your throat
  • Postnasal drip that may taste bad
  • A sore throat
  • A headache
  • A cough that can worsen at night
  • An upper/back toothache
  • Bad breath
  • Reduction or loss of the sense of smell
  • A general feeling of being sick and fatigued
  • Fever (occasionally)

Symptoms of an acute sinus infection in children are similar to those in adults, although it's important for parents to remember that kids may not always be able to adequately explain how they are feeling. Other symptoms to look out for in children include:

  • Irritability or fatigue
  • Nausea or vomiting
  • Fever lasting for three days or more paired with a dark nasal discharge

Many of these symptoms overlap with those of a cold, and if you've had them for a few days to a week, you probably don't have sinusitis. However, if you have some of the above symptoms and they have persisted for more than 10 days or worsened, you may have a sinus infection.

If your acute symptoms have continued past four weeks, it is defined as subacute sinusitis. The symptoms of recurrent sinusitis are the same as for acute sinusitis. The symptoms resolve completely between episodes.

Chronic Sinus Infection

Symptoms of chronic sinusitis are similar to acute sinusitis, but milder, and have been present for more than 12 weeks. You must have two or more of these symptoms to be diagnosed:

  • Nasal congestion
  • Postnasal drip or a runny nose with mucus
  • Feeling of pain or pressure in the face
  • Decreased sense of smell and taste
  • A cough (in children)

Other symptoms of chronic sinus infection may include tooth and jaw pain, ear pain, bad breath, and a cough that gets worse at night. Very often, people report fatigue.

Rare Symptoms

Acute sinusitis is usually caused by a virus, but bacteria can get trapped in the congested sinus and produce a bacterial infection. It's estimated that only about 2 percent of acute sinus infections are bacterial. Because viral inflammation should improve and go away after a few days, a bacterial infection is suspected if symptoms have lasted more than 10 days without improvement or they got better, then worse (what's known as "double sickening").

This is the kind of sinus infection that may need an antibiotic. The sinuses are adjacent to important structures including the eyes and brain. A bacterial sinus infection has a small possibility of spreading to these areas.

Signs and symptoms of a serious infection requiring immediate doctor evaluation include:

  • Fever above 101 degrees
  • Swelling or redness around the eyes or eyelids; difficulty opening or moving your eye; a protruding eyeball
  • Changes in your vision, including loss of acuity or double vision
  • Confusion
  • Excessive sleepiness or difficulty waking up 
  • Stiff neck
  • A severe headache in the front of your head, one you might classify as one of the worst of your life

Complications

Your sense of smell can be reduced or you may lose it completely with sinusitis. This can be due to the blockage, or it may be due to damage to olfactory nerve and other structures. While the loss of smell is often temporary, you can have permanent alterations or loss.

With acute bacterial sinusitis specifically, serious complications are rare and seen in about one in 1,000 cases. The most common of these is the spread of infection to the eye sockets and related eye structures. Any swelling, redness, or vision changes should be assessed immediately by a doctor so you can get treatment. The infection may involve the soft tissues (cellulitis) or form an abscess in the eye socket. The most concerning rare eye complication is the formation of clots in the blood vessels behind the eye. This can lead to permanent vision impairment or blindness. Acute or chronic invasive fungal sinusitis can also damage the structures of the eye and around the eye.

Rarely, a bacterial or fungal sinus infection can spread to the bones of the skull (osteomyelitis) or into the brain, causing meningitis or an abscess in the brain. The signs of confusion, sleepiness, severe headache, or stiff neck may point to this complication.

A type of cyst called a paranasal sinus mucocele can develop if you have chronic sinusitis. It can grow and put pressure on the sinuses and nearby structures. It may not be resolved by antibiotics or corticosteroids because it has formed a wall around itself. It may need to be drained surgically.

Nasal polyps are non-cancerous growths in the nose and sinuses that occur more often in people with chronic sinus inflammation or sinus infections. These growths make it more difficult for the sinuses to drain, which increases the risk of further sinus infections. A patient may have other sinus problems such as enlarged turbinates (concha bullosa) or a deviated septum. Sinus surgery may be needed to remove the polyps or correct the problem to allow better sinus drainage.

When to See a Doctor

Most of the time sinusitis will resolve in 10 days or less without the need to see your healthcare provider for treatment or a prescription. If you have been dealing with your symptoms for 10 days to two weeks and your symptoms are not improving, it is time to consider contacting your doctor.

You should see your doctor as soon as possible if you have any of these symptoms:

  • Your symptoms are severe or they are getting worse after seven days.
  • Your headache is severe and over-the-counter pain relievers don't put a dent in it.
  • You are running a fever of 100.4 degrees or more.
  • You finished a course of prescribed antibiotics, but you still have symptoms.

If you have been having frequent bouts of sinusitis, you should see your doctor to get a full diagnosis and check for problems that might be contributing to your episodes.

See What Could Be Causing Your Sinus Trouble
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Article Sources
  • American College of Allergy, Asthma & Immunology. Sinus Infection. https://acaai.org/allergies/types/sinus-infection.
  • Litvack, J. Complications of Sinusitis. American Rhinologic Society. http://care.american-rhinologic.org/complications_sinusitis. 
  • MedlinePlus. Sinusitis.  https://medlineplus.gov/ency/article/000647.htm.
  • NHS Inform. Sinusitis. https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/sinusitis.