Symptoms of a Sinus Infection
Sinus infections can be uncomfortable and irritating. Determining what symptoms you have, and diagnosing the underlying cause of the sinus infection is important to finding effective treatment and relief. Depending on the severity, it may be time to see a doctor. Understanding the causes of your sinus symptoms will help you find the appropriate solution, this guide should help assist you on the best next steps to a cure for your sinus infection.
What Are the Symptoms Associated with a Sinus Infection?
The symptoms associated with a sinus infection include:
- Nasal Congestion: Sinus congestion occurs when the mucus builds up in the sinuses leading to a slow down of the flow of mucous and the build up of sinus pressure and eventually sinus pain.
- Nasal Obstruction: This is a distinct sensation of airway obstruction within the nasal passage.
- Sinus Pain: Sinus pain is a dull, achy pressure that can be felt in the forehead, on the sides of the nose, upper jaw and teeth, and sometimes between the eyes.
- Rhinorrhea: a fancy word for runny nose.
- Post Nasal Drip: The nasal passage is a two way canal, while rhinorrhea is the symptom of mucous leaving the nasal passage in one direction, post nasal drip is the symptom of mucous leaving the nasal passage into the back of throat and down towards the esophagus (GI) and trachea (airway).
Do I Need to Treat a Sinus Infection, or Will It Go Away on Its Own?
The two common classes of sinus infections are those caused by viruses and those caused by bacteria. Bacterial sinus infections require antibiotics, whereas most viruses that cause sinus infections do not. The exception to this rule is the flu. Treating the flu will reduce your symptom duration from 1-3 days depending on the timing and severity of your symptoms.
So, the question requires us to distinguish between bacterial sinus infections, viral sinus infections, and the flu. While there is a definitive test for the flu, there is no test to help distinguish between a bacterial sinus infection and a viral sinus infection. Doctors rely almost entirely on the patient’s medical history in helping them to determine whether they will need antibiotics or not. The diagnosis is a three-step process:
Step 1: A patient is diagnosed with a sinus infection IF they have:
- Symptoms of nasal drainage for less than 4 weeks
AND
- Severe nasal obstruction OR facial pain OR facial pressure
Step 2: A patient’s sinus infection is diagnosed as Bacterial if any of these are true:
- Persistent symptoms lasting 10 or more days
OR
- The pattern of illness shows initial improvement before worsening again (“Double worsening”).
Step 3: Treat for the flu if the patient has the following symptoms:
- Fevers and chills
- Body aches
- “I feel like I’ve been run over by a bus”
The Severe but Rare Complications of bacterial Sinus Infections
Orbital Cellulitis:
This is an infection of the fat and muscle that surround the eye (this tissue’s primary function is to keep the eye within the eye socket). When this tissue is infected it causes the patient to have significant eye pain, swelling, and redness in this area surrounding the eye. This is a very serious infection and can result in permanent loss of vision and if left untreated can lead to death. It requires immediate hospitalization and administration of IV antibiotics. The important signs and symptoms that point to a diagnosis of orbital cellulitis is when there is pain with eye movements and when the eye “bugs” out giving a “surprised look on their face”.
Prespetal (periorbital cellulitis):
Preseptal cellulitis has similar appearance and presentation as orbital cellulitis but it doesn’t have the pain with eye movements nor do the eyes bug out. This infection is less serious and doesn’t have the associated risks for loss of vision and life that orbital cellulitis has.
Intracranial Abscess: Brain abscesses formed from sinus infections remain an important consideration as the bacteria of an untreated sinus infection can spread direction into the brain tissue given the close proximity of the sinuses to the brain. Symptoms typically include higher fever, severe headaches, and neurologic symptoms that mimic a stroke (such as 1 sided weakness, facial droop, slurring of the speech, confusion, etc). This is an urgent and life threatening condition. Patients should discuss their symptoms with their physician and/or go to the nearest hospital to be evaluated.
Meningitis:
This is the infection of the tissues that surround the brain and the spinal cord. This is another serious and life threatening infection that can result from untreated bacterial sinus infections. Patients typically present with high fevers, confusion, appear very ill, and classically have a stiffened neck with a headache.
The Fastest Way to Get Rid of a Sinus Infection
If you have a sinus infection, the quickest way to get rid of it requires drinking fluids, sleeping as much as possible, and taking a symptom targeted approach:
Use the following over-the-counter medications for the following symptoms:
Sinus Congestion or Obstruction:
- Saline irrigation (ie a Neti Pot) 2-3X/day
- 10 mins after saline irrigation use intranasal steroid (Flonase) in each nostril. Do this twice a day after your morning and evening irrigations.
- Oral Decongestants: Sudafed is one of the more common oral decongestants, however sudafed should be avoided in patients who have heart disease, hypertension, angle-closure glaucoma, or bladder neck obstruction.
- Tylenol will treat any fevers and sinus pain
Rhinorrhea (Runny Nose)
- Saline irrigation (ie a Neti Pot) 2-3X/day
- 10 mins after saline irrigation use intranasal steroid (Flonase) in each nostril. Do this twice a day after your morning and evening irrigations.
- Antihistamines are commonly used since it will reduce the production of mucous and improve the post nasal drip cough that is common for patients with sinus infections.
- Tylenol will treat any fevers and sinus pain
If, after following the diagnostic steps above, you’ve decided you have a bacterial sinus infection, then a course of antibiotics is warranted and will help to prevent or lower your risk of developing the above complications. The following antibiotics are most commonly prescribed and taken for 5-7 days.
- Amoxicillin or Augmentin (amoxicillin-clavulanate).
- If a Penicillin Allergic patient should take Doxycycline.
What Happens if, After Taking the Antibiotics, I Continue to Have Symptoms?
If, after the full course, your symptoms worsen again or if they never went away, then you need to speak with your doctor again to see if you should either repeat another course of antibiotics (albeit different antibiotics from the first course) OR to see if you need to receive CT imaging of the face to evaluate your sinuses and nasal passages for complications (mentioned above), anatomic obstructions that might require surgery.