Killer Sinus Infection? How to Tell If Yours Is Viral or Bacterial

Photo by Brittany Colette on Unsplash

You know the symptoms: nasal congestion, facial pressure, pain, fever, too much mucus. Ugh. It’s probably another sinus infection.

But is your infection caused by a virus or bacteria — and does it really matter?

It does matter. Doctors treat viral and bacterial sinus infections differently. Here is what you need to know about both kinds of infection and how to treat them.

Viral or bacterial?

Most sinus infections are viral, and most are caused by the virus that causes the common cold. How can you tell, based on symptoms, whether your infection is viral or bacterial?

Normally, you can't.

Symptoms like bad breath, yellow or green mucus, fever and headache are not reliable signs of a bacterial infection. They can be present with viral infections, too. Even your doctor can’t tell if your infection is viral or bacterial based solely on symptoms or an exam.

Instead, your doctor looks at symptom duration to determine the source of your infection. A viral sinus infection will usually start to improve after five to seven days. A bacterial sinus infection will often persist for seven to 10 days or longer, and may actually worsen after seven days.

4 steps you can take

Whether your sinus infection turns out to be viral or bacterial, you can help to ease your symptoms early on with supportive care:

1. Use saline spray two to three times per day in each nostril.

2. Use a nasal decongestant such as Afrin®, but not longer than three days. You may consider an oral decongestant, but these should be avoided if you have a history of hypertension.

3. Drink eight 8-ounce glasses of fluid per day.

4. Get plenty of rest.

5. If you have a history of allergies, consider a nasal steroid and antihistamines, such as zyrtec/claritn/benadryl.

If your symptoms aren’t improving after one week, then it may be time to see your doctor. If your doctor suspects a bacterial infection, you’ll probably need to take an antibiotic to clear up the infection and prevent further complications.

Note: Antibiotics won’t help a viral infection, and taking an antibiotic unnecessarily can do more harm than good. You risk possible side effects and increase your chances of developing antibiotic resistance, which can make future infections harder to treat. So it’s important to wait and see how long your symptoms last.

What to do for chronic sinusitis

If you’re suffering from chronic sinusitis (nasal congestion, drainage, facial pain/pressure, and a decreased sense of smell lasting 12 weeks or longer) you should see your doctor.

Your doctor will exam you and take a history. That will help to identify potential causes, including allergies and chronic post nasal drip. Sometimes, the doctor may swab your nose to collect mucus. Culturing it in a laboratory will reveal which type of bacteria is causing the infection so the right antibiotic can be prescribed.

Treat early sinus infection symptoms with rest, hydration and over-the-counter sprays and decongestants. But don’t look for an antibiotic unless your illness extends beyond a week, he says. Then check in with your doctor for a prescription and let him or her know if your condition worsens.

A more in depth explanation of Sinusitis

Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.

With acute sinusitis, it might be difficult to breathe through your nose. The area around your eyes and face might feel swollen, and you might have throbbing facial pain or a headache.

Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve within a week to 10 days.

In most cases, home remedies are all that's needed to treat acute sinusitis. However, persistent sinusitis can lead to serious infections and other complications. Sinusitis that lasts more than 12 weeks despite medical treatment is called chronic sinusitis.

Symptoms

• Acute sinusitis

symptoms often include:

• Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat (postnasal drainage). Studies have shown that yellow/green discharge does not have any correlation between whether the sinusitis is due to bacteria or a virus.

• Nasal obstruction or congestion, causing difficulty breathing through your nose

• Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead that worsens when bending over

Other signs and symptoms can include:

• Ear pressure

• Headache

• Aching in your upper jaw and teeth

• Reduced sense of smell and taste

• Cough, which might be worse at night

• Bad breath (halitosis)

• Fatigue

• Fever

When to see a doctor

Most people with acute sinusitis don't need to see a doctor.

Contact your doctor if you have any of the following:

• Symptoms that either don't improve within 5-7 days or worsen

• A persistent fever

• A history of recurrent or chronic sinusitis

Risk factors

You may be at increased risk of getting sinusitis if you have:

• Hay fever or another allergic condition that affects your sinuses

• A nasal passage abnormality, such as a deviated nasal septum, nasal polyps or tumors

• A medical condition such as cystic fibrosis or an immune system disorder such as HIV/AIDS

Complications

Acute sinusitis complications are uncommon. If they occur, they might include:

• Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis lasts longer than 12 weeks.

• Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord. This is rare

• Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis). This is also a rare complication

• Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.

• Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent. Again, this is not common.

Prevention

Take these steps to help reduce your risk of getting acute sinusitis:

• Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals.

• Manage your allergies. Work with your doctor to keep symptoms under control.

• Avoid cigarette smoke and polluted air. Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.

• Use a humidifier. If the air in your home is dry, such as it is if you have forced-air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning

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