Sinus Infections That Don’t Quit: When You Should Worry

Give it time, but keep your doctor in loop if it lingers

Sinus Headache

Most of us know the discomfort and annoyance of a sinus infection. Especially when they linger on. But few people realize that there are rare cases when untreated sinus infections can turn serious.

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Virus or bacteria?

The first thing to realize is that all sinus infections are not the same. A sinus infection, a.k.a. sinusitis, can be either a viral or bacterial infection. The term “sinusitis” simply means that there’s irritation in your sinuses, which make up the lining around the air spaces between bones that surround your nose. 

Ear, nose and throat specialist Raj Sindwani, MD, says the only way to know whether it’s a cold or a bacterial infection in the early stages is to swab inside the nose and grow a culture. “This is rarely necessary because sinusitis often goes away by itself,” Dr. Sindwani says. “But if it hangs on, you want to see your doctor.”

Symptoms of the different strains are so similar that doctors typically recommend patients wait seven to 10 days before seeking treatment. Viral infections — the common cold — usually work themselves out in that period of time with nothing more than liquids, rest and perhaps Tylenol, Dr. Sindwani says.

“If you don’t get better, we start thinking there’s a bacterial component,” he says. “That’s when we pull the trigger on an antibiotic.”

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When antibiotics are in order

The main reason to prescribe antibiotics is for patient comfort, Dr. Sindwani says. The medical field used to be more convinced than it is today than untreated sinusitis would inevitably become a chronic issue, he says.

“We don’t think that way as much,” he says. “We don’t know that an untreated acute sinusitis, if left untreated, will grumble along and cause people to have a chronic sinus infection.”

“Some people think that’s two separate things,” with chronic sinusitis more likely due to “underlying issues like allergies or immune problems.”

Rare cases can turn serious

Antibiotics also can help ward off rare but potentially dangerous complications that arise when a sinus infection spreads to the eyes or brain, Dr. Sindwani says.

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Complications around the eyes are the more common of the two. These complications can cause redness, swelling around the eyes and reduced vision, and even lead to blindness — in a severe form known as cavernous sinus thrombosis. Serious cases are immediately treated with IV antibiotics. Patients are usually admitted to the hospital for a CT scan to see if fluid needs to be drained, Dr. Sindwani says.

Also in rare cases, sinus infections in the rear center of one’s head can spread into the brain. This can lead to life-threatening conditions like meningitis or brain abscess, Dr. Sindwani says.

“Before antibiotics, people would die from sinusitis,” he says. But he emphasizes that such complications are unlikely. “In most cases, the bacterial infection goes away, especially if you don’t have underlying medical problems.”

It’s important to monitor your symptoms if you suspect a sinus infection. If the condition lingers or worsens, call your doctor.