A stuffy nose, facial pressure and congestion can make simple tasks feel exhausting. When these symptoms set in, it’s easy to assume it's just a common cold or seasonal allergies. But what happens when that "cold" doesn't go away or you start to feel worse?
When the cold-like symptoms linger, it might be a sinus infection.
“The difference between a typical viral cold and a bacterial sinus infection usually comes down to timing,” says ear, nose and throat specialist Dr. Omar G. Ahmed. "If your symptoms last more than a week and then start getting worse, see a doctor. There’s a higher chance of a sinus infection at that point."
Knowing when to wait out symptoms and when to get medical care can help you recover faster and reduce the risk of complications like pneumonia.
Most sinus infections start as viral illnesses
Sinus infections typically cause sinusitis, the sinus tissues' inflammatory response to a foreign invader. Symptoms often include nasal congestion, facial pressure, headache and sometimes fever or a temporarily reduced sense of smell.
Most acute sinus infections start as simple viral infections and typically resolve on their own within 7-10 days. However, persistent inflammation can trap bacteria in the sinuses, leading to a secondary bacterial infection.
(Related: How to Tell If It's a Sinus Infection or Allergies)
7 signs it’s time to see a doctor
If your cold persists or worsens after a week, it may be a bacterial sinus infection. You might notice these common symptoms:
Energy levels going downhill
Increasing facial pressure or sinus pain
Thick nasal discharge that becomes yellow or green
Worsening congestion
Fever or chills
Headache that intensifies
If you notice any of these, schedule a doctor’s appointment or start a virtual urgent care visit. The provider can give you a proper diagnosis and a plan to start feeling better.
What to do if sinus infections are frequent
Having four or more sinus infections a year may be a condition called recurrent acute sinusitis. When symptoms last for 12 weeks or longer, it’s considered chronic sinusitis.
In these cases, a primary care physician may refer you to an ear, nose and throat (ENT) specialist. An ENT can use a small camera (endoscope) to look for structural issues such as a deviated septum or nasal polyps that might be blocking the drainage pathways in your sinuses.
Dr. Ahmed advises against trying to push through chronic sinusitis symptoms, even when work, family or school obligations pile up. Waiting too long can prolong recovery, he says, and can allow the infection to spread to the lower airways, causing bronchitis or pneumonia.
"Often times, people wait months to come in for evaluation," says Dr. Ahmed. "They've gotten somewhat accustomed to dealing with it, but severe, chronic sinusitis can actually have a significant impact on quality of life."
(Related: 5 Signs to See an Ear, Nose & Throat (ENT) Specialist)
How a doctor can help — even if antibiotics aren’t needed
Because most cases of sinusitis start as a viral illness, taking antibiotics that target bacterial infections won’t help you recover faster. Instead, it’s more effective to focus on relieving symptoms.
“Rest, hydration and appropriate over-the-counter medications can help you feel better while your immune system does its job.” Dr. Ahmed says.
Saline nasal irrigation remains one of the most effective ways to clear mucus and reduce congestion. Short-term use of nasal decongestant sprays may help with sleep and allow saline rinses to work more effectively. However, you should limit the use of these sprays to no more than three days to avoid rebound congestion.
Emerging research suggests that the certain antihistamine nasal sprays can reduce viral activity. This can lower the risk of future infections when used regularly, especially in people who are prone to recurrent sinus infections. While it’s not a cure, this approach may help reduce how often symptoms return.
For severe sinus infections that involve significant swelling that make it hard to breathe, your doctor may prescribe a steroid medication. Steroids help reduce inflammation in the sinus passages, easing congestion and improving airflow.
(Related: What's the Fastest Way to Get Sinus Pressure Relief?)
Listen to your sinuses
If your winter cold has overstayed its welcome, it's time to stop guessing and start getting relief. When symptoms last longer than expected, worsen after a week or interfere with sleep or daily life, talk with a doctor about how you can breathe easier — literally and figuratively.
