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What to do if you think you have a sinus infection

Sinusitis, or sinus infection, is likely a familiar term. After all, about one in seven people has a sinus infection each year, for a total of more than 30 million cases. But you may not be familiar with all the different types or what to do if you start experiencing symptoms of a sinus infection.

Types of sinus infections and how to treat them

First, let’s talk about how a sinus infection happens. The sinuses are air-filled pockets in the bone around the nose, and they can become infected when you have a cold. This causes the spaces to become filled with pus and mucus and unable to drain, leading to a sinus infection.

Acute sinusitis

Acute (aka short-term) sinusitis is diagnosed when there is:

  • Colored nasal drainage
  • Facial pain or pressure
  • Nasal blockage lasting up to four weeks

Viral acute sinusitis

Most acute sinusitis is caused by a virus, which cannot be treated with antibiotics. Only 0.5 to 2 percent turn into bacterial infections, which can be treated with antibiotics. That means that 98 percent or more of acute sinus infections do not need antibiotics and can instead be treated with over-the-counter medications. We’ll get to those in a bit.

If you have sinusitis symptoms for fewer than 10 days and are not getting worse, you probably have viral acute sinusitis.

Bacterial acute sinusitis

Infections that fail to improve at all after 10 days or that get better, then worse again, are more likely to be from bacteria. Even acute bacterial sinus infections do not always need antibiotics. Most people with acute bacterial sinus infections feel better within seven days. By 15 days, about 90 percent are fully recovered or improved, even without antibiotics.

Chronic sinusitis

Chronic sinusitis occurs when the lining of the sinuses stays inflamed for many months or longer. Chronic sinusitis can result from different types of inflammation and can sometimes lead to nasal polyps, which are growths that that occur in your sinuses or nasal passages when inflamed.

Many people with chronic sinusitis can benefit from targeted treatments available from an ear, nose and throat (ENT) specialist. An ENT specialist can do a CT scan of the sinuses, which is one of the best ways to find out if chronic sinusitis is present. This is a helpful step because other diagnoses, like migraines, can have similar symptoms to sinus infections.

Do you really need antibiotics for a sinus infection?

Before rushing to get a prescription for antibiotics, try these four over-the-counter medications to treat your sinus infection:

  • Acetaminophen and ibuprofen can relieve pain and fever.
  • Steroid nasal sprays such as fluticasone can reduce symptoms a little after 15 days but can cause nosebleeds.
  • Saline irrigations or rinses can relieve symptoms and flush out thick mucus.
  • Decongestants, such as pseudoephedrine or oxymetazoline can help with congestion, although decongestant sprays should not be used more than three days in a row.

Unfortunately, many people mistakenly think that if they don’t get antibiotics for a sinus infection, they wasted their time at the doctor’s office. It’s important to keep in mind that unnecessary or prolonged antibiotic use can have serious side effects. And, most of the time, sinus infections can be treated without any antibiotic use. Taking time to wait is one of the toughest (but best) medications to take for a sinus infection.

Think you have a sinus infection? Make an appointment with your ENT today, or find one near you. You can also use virtual care options to get care conveniently from home.

About the author

Jacob S. Minor, MD, FACS
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What to do if you think you have a sinus infection