January 17, 2021/Ear, Nose & Throat

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

Some things you can do to ease symptoms

woman with sinus pain

Nasal congestion and swelling, facial pressure, pain, fever, too much mucus. Ugh. It’s probably another sinus infection. Or is it? And is your infection caused by a virus or bacteria — and does it really matter?

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It does, says otolaryngologist Raj Sindwani, MD. Doctors treat viral and bacterial sinus infections very differently. Here’s what you need to know about both kinds of infections and how to treat them.

Viral or bacterial?

Sinusitis happens when your sinuses — the normally air-filled pockets in your face — become inflamed and blocked. Most sinus infections are viral. How can you tell whether your infection is viral or bacterial based on your symptoms?

“You can’t,” says Dr. Sindwani.

“Symptoms like bad breath, yellow or green mucus, fever and headache are not reliable signs of a bacterial infection,” he says. “They can occur 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 largely 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.

Some 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 sinus 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.
  3. Drink eight 8-ounce glasses of fluid per day.
  4. Get plenty of rest.
  5. Take an over-the-counter anti-inflammatory, such as acetaminophen or ibuprofen to help relieve the swelling of your sinuses.

If your symptoms aren’t improving after one week, it’s important to see your doctor. If a bacterial infection is suspected, you’ll probably need to take an antibiotic to clear up the infection and prevent further complications.

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“If your infections occur more frequently, and your doctor really wants to establish if they are bacterial or viral, your Otolaryngologist or ear, nose and throat doctor can sample the snot from your nose when you’re infected and send it to a laboratory to know for sure.

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, says Dr. Sindwani. 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) or you are getting frequent sinus infections you should see your doctor, says Dr. Sindwani.

Your doctor will 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.

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