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Sinusitis

How to know if that infection in your sinuses is caused by bacteria.

What is sinusitis?

Sinusitis is an infection of your nasal sinuses caused by bacteria. Your sinuses are hollow areas inside your skull and facial bones that connect to your nose.

When bacteria infect the lining of your sinuses, they can become irritated and inflamed. This leads to swelling, pain, congestion, and pus. When inflammation happens, it's called acute bacterial rhinosinusitis.

You can get a sinus infection from either bacteria or viruses. Most are viral, but a viral infection can turn into a bacterial infection.

Sinusitis usually lasts more than 7 days. It typically clears up within 4 weeks. Sometimes, the infection becomes chronic, which means that it comes back or lingers for more than 12 weeks.

How can you tell if you have a sinus infection?

Pro Tip

It is essential for your physician to know if you have diabetes (high blood sugar) or are immunocompromised in any way (such as HIV, recent chemotherapy, or some rheumatoid medications). This can predispose you to a more severe type of sinus infection that can be very dangerous. And if you have any type of visual changes, such as double vision or blurry vision, or any facial numbness, please let your doctor know promptly. —Dr. David Lee

You will have a lot of mucus in your nose. It’ll be thick and appear white, yellow, or green.

Also, your sinuses will get swollen in response to the infection. This creates a stuffy nose. As your sinuses fill with pus, you’ll feel pain, pressure, or fullness above and below the eyes and within the nose.

Bacterial sinusitis can also cause a fever, headache, tiredness, loss of smell, and ear pain or pressure.

These symptoms are usually mild when they start. They get worse over the course of a week. Sometimes, symptoms may seem to be going away and then become worse again. This is often a sign that a viral sinus infection, which was improving, gave way to a bacterial sinus infection.

Main symptoms

Next steps

If you have symptoms of bacterial sinusitis, go see your primary care doctor. Or visit an urgent care center. In most cases, it is not an emergency.

However, if you have any of the symptoms below, go to urgent care or the ER to be checked.

  • A high fever (102° F or above) that is not going away with tylenol, or that lasts longer than 3 days.
  • Changes in how you see, including double vision or blurry vision.
  • Swelling around your eyes.
  • Sudden and severe facial pain or headache.
  • Confusion.

What causes sinus problems?

Bacterial sinusitis comes from bacteria infecting the lining of the sinuses. Sinuses become vulnerable to an infection in many ways. This can come from the sinuses being irritated, either from the common cold, allergies, or a viral sinus infection, according to the U.S. National Library of Medicine. The infection causes sinuses to fill with pus, which inflames them more, and causes pressure in your face.

Dr. Rx

Many people hear the recommendation for sinus irrigations and think, “Oh, the sinus sprays will work just as well.” This is not the case. Sinus irrigations flush out the sinus cavity and can help the body clean out any trapped debris and mucus. Many patients truly love them once they get used to the feeling. —Dr. Lee

You are at higher risk of having sinusitis if you have:

  • Having a common cold or upper respiratory virus, which can cause inflammation in the sinuses.
  • Seasonal allergies or hay fever.
  • A nasal obstruction (something blocking the passage in your nose), like a polyp or a tumor.
  • A deviated nasal septum (when the thin wall between your nasal passages is over to one side).
  • A weakened immune system (such as from cancer, chemotherapy treatment, HIV/AIDS).
  • Any illness (like cystic fibrosis) that makes you more likely to get an infection.

Treatment

Pro Tip

As frustrating as “rest, hydration, and time” is to hear for patients in the early stage of a sinus infection—this is truly the best initial step. Multiple strong studies have shown that early treatment (i.e. with an antibiotic) for patients with an upper respiratory tract infection with sinus symptoms are not indicated—and may cause more harm than good. —Dr. Lee

If you’ve had symptoms for less than one week, you probably don’t need antibiotics. Viral sinus infections and many cases of bacterial sinus infections will get better on their own. Instead, you should treat your symptoms with natural remedies. And over-the-counter pain relievers.

If you’ve had symptoms for less than one week, you probably don’t need antibiotics. The infection will get better on its own. Instead, you should treat your symptoms with nasal rinses and over-the-counter pain relievers.

If you’ve had symptoms for more than 7 days, you probably need antibiotics. If the infection becomes chronic (meaning it comes back again and again), you might need surgery. Generally surgery is reserved for patients who have had chronic sinus infections lasting for 2-3 months, but each case should be discussed with your surgeon (an otolaryngologist, or ENT).

Nasal rinses

Flush your nose and sinuses with salt water (“nasal irrigation”). This is a simple and safe treatment. It can be done several times a day. It helps to flush out the bacteria and cells causing the infection. It also clears the way for new white blood cells to come in to fight the bacteria. Most pharmacies sell various types of nasal irrigation systems, such as a neti pot.

Medication

To help with symptoms, you can take:

  • Over-the-counter pain relievers like acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve). These can help with the pain and irritation.
  • Over-the-counter nasal steroid spray like fluticasone (Flonase). These can lower swelling and irritation.
  • Over-the-counter nasal decongestants like pseudoephedrine can help reduce congestion. Decongestant sprays like oxymetazoline can help with congestion but should only be used for 2 to 3 days. After 3 days, the sinus mucosa may become dependent on the spray decongestant, and can actually make your congestion worse.
  • Antibiotics. Your doctor will prescribe antibiotics if your symptoms do not get better after about a week.

Surgery

If your symptoms have lasted over 8 to 10 weeks, or you have had several sinus infections over a 2 to 3 month period, you might need surgery. Your doctor will send you to an ear, nose, and throat doctor (ENT, or otolaryngologist). The ENT might recommend surgery, though you need to discuss benefits and risks with your doctor.

Follow up

Bacterial sinusitis can take up to a month to completely go away. If you are treating your infection at home and it doesn’t get better after 7 to 10 days, follow up with your doctor. Or go to an urgent care center.

If your doctor gives you an antibiotic, take it exactly as prescribed.

If you have surgery, follow up with your surgeon. They will most likely suggest you keep doing nasal irrigations to avoid more bacterial sinus infections.

Preventative tips

To prevent sinusitis, do your best to avoid getting the common cold. It’s the most common trigger of a bacterial sinus infection.

  • Frequently wash your hands for 20 seconds with soap and water.
  • Don’t touch your face.
  • Stay away from people you know are sick.
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