Your head is full of holes. No, really, it is. Not just your nostrils, mouth and ear openings, there are also big openings behind the nose, inside the face. Called sinuses, these chambers are “empty spaces in the bones of the face and skull that surround the nose,” says Dr. Richard A. Lebowitz, a rhinologist — a subspecialty of otolaryngology that focuses specifically on treating conditions of the nose — with NYU Langone Health in New York.
“If you could picture it from the outside, the sinuses would almost look like a butterfly-shaped area, with the nose as the center of the body and the wings as the sinuses,” Lebowitz says. There are additional sinuses located behind the forehead just above the eyebrows and much smaller ones along each side of the nose between the eyes.
The sinuses exist to help lighten the skull, improve the voice and, most importantly, humidify and filter the air you breathe in. They’re lined with a layer of mucus that traps and helps move along dirt and other inhaled particles to help keep your airways healthy.
But sometimes, they encounter a pathogen that they can’t properly combat, and that can lead to a sinus infection. Called sinusitis or rhinosinusitis, this infection can be acute — which usually clears up in one to three weeks — or become chronic and last for many weeks or months.
“Sinus infections can be viral or bacterial, and they occur because of inflammation in the nasal cavity around where some of the sinus drainage pathways occur,” says Dr. Brad DeSilva, an otolaryngologist with the Ohio State University Wexner Medical Center in Columbus.
Those pathways are “relatively narrow and small, and inflammation can obstruct those, leading to thicker mucus, pain and pressure in the face and nasal cavity and other symptoms,” he says.
Symptoms of a Sinus Infection
Symptoms of a sinus infection include:
— Pain and pressure in the sinuses. You’ll feel a dull ache or pain coming from behind the nose and cheeks, between the eyes and sometimes the forehead area. You may also have a sinus headache that can trigger earaches or pain in the jaw and cheek. “Often patients will have some dental pain in the upper teeth because the cheek sinuses are right next to the dental roots of the upper jaw,” DeSilva says.
— A feeling of fullness or congestion. In addition to pain and pressure in the sinus cavities, you may also feel like that space is all stuffed up, which it is because of inflammation, swelling and increased production of mucus in response to the irritant. This nasal congestion can make it hard to breathe through your nose, and it can “impact your sense of smell,” DeSilva says.
— Runny nose. A sinus infection typically causes a buildup of mucus as the body tries to rid itself of the infectious agent. That shows up as discharge — snot or mucus — that may dribble out of the nose. It can also run down the back of the throat, a condition called postnasal drip, which can lead to a sore throat and a cough.
— A hoarse voice, sore throat and cough. As the mucus moves around in the sinuses and runs down the throat it can actually cause your voice to sound different and cause a sore throat. If your nose is all plugged up, you may be breathing through your mouth, which can also irritate the throat. As these symptoms develop, they may contribute to the development of a cough as the body tries to expel the excess mucus. These symptoms are typically worse first thing in the morning, as lying in bed can cause excess mucus to pool in the back of the throat causing irritation.
The Cause of the Infection Is Important
“It all starts with inflammation,” DeSilva says, and that inflammation can be triggered by exposure to both viruses and bacteria.
But there’s a big difference between the two, Lebowitz says. “A real distinction needs to be made” between a bacterial infection and one caused by a virus when diagnosing a sinus infection because the two have different treatment protocols.
Often, when a patient turns up at a primary care provider’s office or an urgent care clinic with the complaint of a suspected sinus infection, they expect to be given an antibiotic to treat it. But this is bad, Lebowitz explains, because “the vast, vast majority of rhinosinusitis is viral.”
Overprescribing of antibiotics is a major problem that’s leading various types of bacteria to evolve into “superbugs” that are resistant to antibiotic treatment. “We’re just giving way too many antibiotics to people who don’t need them,” Lebowitz says. “Oftentimes when people come in, they want an antibiotic, and they leave with one. But it’s not really doing them a favor. It’s not the best treatment.”
Definitively determining whether you have a viral or bacterial infection is difficult to do without testing, but nearly always, the length of time you have symptoms will offer a clue. “If it’s less than 10 days, it’s very unlikely that it’s going to be a bacterial infection,” Lebowitz says. That’s unless you had the symptoms for three or four days and they started to clear up, but then started to get worse at day five or six. “That would suggest that this may be a secondary bacterial infection,” he says.
Still, “unless it’s been 10 days or more, by definition it’s not likely to be a bacterial infection.”
However, many people start to feel better soon after starting antibiotics for a sinus infection. This is often coincidence and not directly connected, Lebowitz says. “They would have been feeling better in a few days anyway. But that reinforces this practice of ‘I went to the doctor. I got an antibiotic. I felt better, therefore, I needed that antibiotic.’ That’s not really true.”
Treating Viral Sinus Infections
But avoiding antibiotics for a viral sinus infection doesn’t mean there’s nothing you can do. Indeed, there are several things you can do to help ease symptoms of an acute sinus infection that don’t involve a prescription:
— Nasal rinses. Using a nasal irrigation system such as a neti pot or an over-the-counter saline spray can help you move out excess congestion and mucus from the sinuses and open up your nasal passages.
— Over-the-counter decongestants. Whether taken as a pill or as a nasal spray, decongestants can help reduce inflammation and eliminate some of the pain, pressure and stuffiness of a sinus infection.
— Over-the-counter pain relievers. An anti-inflammatory such as ibuprofen can also reduce inflammation and help ease pain associated with sinus infections.
When to See a Doctor
DeSilva says that if your sinus infection doesn’t clear up in about five to seven days, it’s time to check in with your doctor. Don’t expect to be given an antibiotic, but your health care provider can help you find ways to ease symptoms and decide on the best path forward.
“If you’re getting facial pain and pressure and dental pain that basically isn’t improving after five days, that’s when you may want to go see your primary care provider or an ear, nose and throat physician to determine whether you need to have antibiotic therapy.”
If you get sinus infections frequently, you should also see your doctor to determine why. Recurrent acute infections where you get four or more episodes per year could signal there’s something structural contributing to their development such as a deviated septum, nasal polyps or another obstruction. These problems may require surgery to correct.
And if you have another medical condition, such as asthma, that could be exacerbated by a sinus infection, DeSilva says it’s probably best to check in with your doctor. “Some patients may have a diagnosis already that sets them up for a bacterial sinus infection,” so getting in with your doctor sooner rather than later may be a smart move.
How to Prevent a Sinus Infection
The best treatment is prevention, and a lot of people have noticed during the coronavirus pandemic that they’ve had fewer cases of colds, flu or sinus infections. That’s because the same public health measures that have been promoted to help stop the spread of COVID-19 work against the respiratory viruses that can lead to a sinus infection. Namely:
— Wash your hands frequently.
— Keep your distance from people who are sick.
— Wear a mask when in public. This becomes especially important if you’re sick to prevent spreading your germs onward.
If you start to feel like you’re coming down with a cold, try irrigating the nasal passages with a neti pot or a nasal spray to help move any contaminants along and help you breathe easier.
“Oftentimes you’ll prevent it from developing into a bacterial infection,” Lebowitz says. “That’s basically the best prevention — early treatment before it becomes a bacterial infection.”
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